Bronsiectazii

Represents an irreversible dilation of one or more bronchi aa medium caliber (usually sub-segmented proximal ) due to destruction of muscle fibers and elastic bronchial walls .
Bronchiectasis can be:
– Wet the affected airways are inflamed , edematous and contain sputăpurulentă , smelly
– Dried – the affected airway mucosal erosions and ulcers that can develop abscesses and sputum production is very low
1 . Data collection – interview
a.Circumstanţe of occurrence – etiology
The history may reveal :
– History of repeated lung infections – infections with Staphylococcus aureus , Klebsiella , H. influenzae , adenovirus infections, fungal infections micplasme
– bronchial obstruction – foreign bodies , neoplasms , hilar lymphadenopathy , COPD ,
– Congenital anatomical defects
– Immunodeficiency – lack of IgG , IgA
– A family history of hereditary defects – the respiratory mucous cilia , cystic fibrosis , deficiency
alpha -1 – antitrypsin
– Other cases , aspiration pneumonia , inhalation of irritants after cardiopulmonary transplantation
Factors favoring the deepening
– cold, wet
– Exposure to dust and irritants
dependence b.Manifestări
– Paroxysmal cough sometimes dry, then with sputum – sputum purulent – pronounced morning awakening. Sometimes d sputum quantity exceeds 600ml / 24 . Breathing can be smelly
– Hemoptysis occurs in 50 % of cases
– Anorexia , weight loss is associated with exacerbations during
– Fever, increased sputum , increased cough and breathlessness
– Physical exam may reveal : Hippocratic fingers , cyanosis , nasal polyps , chronic pulmonary heart signs .
– To auscultation : reduced vesicular mumurului , prolonged expiration , rales and crepitation ronflante bullous
laboratory findings :
– RG may be normal chest 70 % of the
– Bronhografia I considered the best way to highlight today is utilizeează bronchiectasis becoming rarer because of severe bronchospasm reaction may occur
– Is contraindicated in patients with active disease , as indicated when it is assumed that bronchiectasis are located in a particular territory and can be addressed surgically
– Computed tomography – in most cases replaced today bronhografia
– Fibrobronchoscopy depistrea used in bronchial obstruction , the source of hemoptysis or bronchial secretions discharge also can be obtained from bronchial mucosa biopsies to confirm ciliary dyskinesia
– Rg sinuses may help to identify patients with sinusitis associating bronchiectasis
– Respiratory function tests : patients with extensive bronchiectasis may present evidence repiratorii changes similar to those of chronic bronchitis or respiratory emfizem.Disfuncţia can occur depends on: anatomical form of bronchiectasis ( cylindrical bronchial dilatation ” varicose ” or saccular ) , the extension disease
– Sputum – cultures can often highlight : H influenzae , Streptococcus pneumonia, sterptococus piogenis , Pseudomonas aeruginosa , Staphylococcus aureus , Aspergillus
– Ex Blood : leukocytosis , changes in blood gases ,
– Nasal or bronchial mucosa biopsy of the suspected immobile cilia syndrome

2 . patient problems

– Airway obstruction – dyspnea
– Reduction in gas exchange – cyanosis, hypoxia
– Fever , cough
– Fatigue , anorexia
– Potential complications
3 . Objectives

– Reduce symptoms : breathlessness , fever, cough, hemoptysis
– Fight against infection
– Hygienic-dietary regime : hydration and balanced diet , rest
– Prevention of complications
– Influenza vaccination , pneumococcal
– Patient education regarding living arrangements for the prevention of exacerbations
4 . Speeches

– Provide bed rest and fluid administration 2-3 l / day to thin secretions
– Postural drainage , tapotament : penru indicated mobilization of bronchial purulent secretions – paceintul will be placed in the prone position on a slight incline with your head and upper torso lower than the rest of the body and is easily tapotat the posterior thorax
– Anti -administration of hemostatic hemoptysis , cough – cough , fever – Antithermal , breathlessness , bronchodilators , oxygen
– Administration of antibiotic treatment according to the antibiogram indicated : ampicillin , amoxicillin , cephalosporins
– Education paceintului in terms of deepening avoiding predisposing factors , sanitation ENT infection outbreaks , treating sinusitis , teaching the patient to cough only in covered and disinfected with chloramine to prevent infection transmission
– Stopping smoking
– Influenza vaccination

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