bronchiectasis /brong′kē·ek″təsis/ [Gk, bronchos + ektasis, stretching] , an abnormal condition of the bronchial tree characterized by irreversible dilation and destruction of the bronchial walls. The condition is sometimes congenital but is more often a result of bronchial infection or of obstruction by a tumor or an aspirated foreign body. Symptoms include a constant cough producing copious purulent sputum; hemoptysis; chronic sinusitis; clubbing of fingers; and persistent moist, coarse crackles. Some of the complications of bronchiectasis are pneumonia, lung abscess, empyema, brain abscess, and amyloidosis. Treatment includes frequent postural drainage, expectorants, antibiotics, and, rarely, surgical resection of the affected part of the lungs. ▪ OBSERVATIONS: The individual is often asymptomatic early in the disease. A chronic cough with sputum production is the most common presenting sign. Hemoptysis, recurrent pneumonia, dyspnea, wheezing, and fatigue are also frequently seen. Fever, night sweats, weight loss, fetid breath, and hemoptysis may also be present. Moist crackles in lung bases may be heard on auscultation. Sputum appears purulent and foamy with sediment and has a large number of WBCs. Sputum cultures and Gram’s stain are used to identify microorganisms. Chest x-rays reveal increased markings, honeycombing, and tram tracking. Pulmonary function studies show a decrease in vital capacity and expiratory flow. CT scans are used to detect cystic lesions and rule out neoplastic obstruction. Bronchography may be used when surgery is contemplated to visualize bronchiectatic areas. Clubbed fingers, pulmonary hypertension, right ventricular failure, and cor pulmonale are complications associated with long-standing disease. ▪ INTERVENTIONS: Acute treatment includes medications, such as mucolytics to clear secretions; antibiotics to treat bacterial infection; and bronchodilators to reduce dyspnea. Chest physiotherapy, with postural drainage, is used to clear secretions. Adequate hydration and a vaporizer help liquefy secretions. Supplemental oxygen is administered for hypoxemia. Bronchial resection is used to treat confined disease, which is unresponsive to conservative therapy. ▪ PATIENT CARE CONSIDERATIONS: The focus of nursing, medical, and respiratory therapy care during acute episodes is to promote airway clearance and effective breathing patterns through respiratory monitoring, cough enhancement, anxiety reduction, and rest. Preventive and chronic care focuses on avoidance of air pollution and contact with individuals with respiratory infections; prompt identification and treatment of respiratory infection; maintenance of adequate nutrition and hydration; smoking cessation as applicable; and use of influenza and pneumonia vaccines for prophylaxis.
