BRONCHIECTASIS

Presentor :
Noor Fadillah Ahmad
Nur Lyana Mohamad Omor
LEARNING OBJECTIVES
1. Describe about anatomy and physiology lower respiratory
airway
2. Define bronchiectasis
3. Explain pathophysiology and sign symptom of bronchiectasis
4. State the treatment and education for patient with
bronchiectasis
5. Identify the complication from bronchiectasis
6. Integrate nursing care plan related to care of bronchiectasis in
children
 ANATOMY OF RESPIRATORY SYSTEM
❖ The respiratory system, also called the pulmonary system, comprise of
several organs that responsible as a whole to oxygenate the body through
the process of respiratory or breathing.

❖ This process involves inhaling air and conducting it to the lungs where
gas exchange occurs, in which oxygen is extracted from the air, and
carbon dioxide expelled from the body.

❖ The respiratory tract divided into two which is upper respiratory tract
and lower respiratory tract.
 LOWER RESPIRATORY TRACT
❖ The major structures of the lower respiratory tract include the windpipe
(trachea) and within the lungs, the bronchi, bronchioles, and alveoli.

❖ Deep in the lungs, each bronchus divides into secondary and tertiary
bronchi, which continue to branch to smaller airways called the
bronchioles.

❖ The bronchioles end in air sacs called the alveoli. Alveoli are bunched
together into clusters to form alveolar sacs.
 DEFINITION OF BRONCHIECTASIS

■ BRONCHI – refer to the bronchi and bronchioles way to lower

lungs
■ ECTASIS – means of dilatation or expansion
■ Bronchiectasis is a condition of persistent abnormal dilation of
the bronchi where is the bronchi get damaged and widened due
to chronic inflammation
■ It is one of obstructive lung disease
 EPIDEMIOLOGY
 Bronchiectasis affects children from low, middle, and high-
income countries
 Reported incidence of bronchiectasis in children aged 0 to 14
years old is 3.7 per 100,000 child-years in New Zealand
 In the UK, the estimated prevalence of non-CF bronchiectasis
is 172/million children aged <15 years.
 Most pediatric bronchiectasis in New Zealand is idiopathic
with predominant chronic Haemophilus influenzae infection
which in turn associates with reduced lung function
 Considering the Pacific region; a high incidence is observed in
children under 15 years of age in New Zealand
 Bronchiectasis in children is also associated with high rates of
hospital admission particularly in Australian aboriginal
children. This latter group have one of the highest reported
prevalence rates of bronchiectasis (14.7 per 1000) worldwide
(Ravishankar Chandrasekaran, 2018)
 ETIOLOGY
Airway obstruction

• Endobronchial tumor, broncholitiasis, right middle lobe

syndrome

Pulmonary infection

• Klebsiella species, staphylococcus aureus, myobacterium

tuberculosis, mycoplasma pneumoniae, measles virus,
pertussis virus, influenza virus, herpes simplex virus, certain
type adenovirus
Genetic disorder

• Cystic fibrosis, congenital anatomic defects, alpha1-

antitrypsindeficiency

Idiopathic causes

• Idiopathic inflammatory disorders

Autoimmune diseases
PATOPHYSIOLOGY
INFLAMMATION

IMPAIREMENT DISTENSION

SYMPTOMS COLLAPSE

SCARRING
1. The inflammatory process associated with pulmonary infection
damages the bronchial wall, causing a loss of its supporting
structure and resulting in thick sputum that ultimately obstructs the
bronchi
2. The walls become permanently distended and distorted, impairing
mucociliary clearance
3. The retention of secretions and subsequent obstruction ultimately
cause the alveoli distal to the obstruction collapse
4. Inflammatory scarring or fibrosis replaces functioning lung tissue
5. In time, the patient develops respiratory insufficiency with reduced
vital capacity, decreased ventilation, and an increased ratio of
residual volume to total lung capacity usually patient frequent
cough and having difficulties of breathing
6. There is impairment in the match of ventilation to perfusion and
hypoxemia
 CLINICAL MANIFESTATIONS

Chronic Cough Purulent Sputum Hemoptysis

Recurrent
Clubbing Finger
Infection
 DIAGNOSTIC INVESTIGATION
♠ A compatible history of chronic respiratory symptoms (eg,
daily cough and purulent sputum production)
♠ Sputum analysis may strengthen clinical suspicion
♠ Chest radiography is occasionally sufficient for confirming the
diagnosis
♠ CT scan ( HRCT )
 MANAGEMENT OF
BRONCHIECTASIS

Antimicrobial Therapy Bronchodilator

MEDICAL

Postural drainage Chest physiotherapy

 MANAGEMENT OF
BRONCHIECTASIS

Segmental resection Lobectomy

SURGICAL
Lung transplantation in related
Pneumonectomy bronchiectasis with cystic
fibrous
Health Education for Bronchiectasis Survivor

1. Avoiding tobacco smoke and exposure to second hand smoker

2. Quitting smoking
3. Avoiding people who are sick with cold or flu.
4. Avoiding cold or damp locations or area with lot of air
pollution
5. Avoid crowded place
6. Keeping active and staying physically fit can help
bronchiectasis from progressing
7. Ask respiratory therapies to help design a program to pace
all physical activities including exercise to strengthen airway
8. Keep continue treatment to progressing of bronchiectasis
9.Taking medications regularly can help make it easier to
breath and slow down the damage to the lung.
 COMPLICATIONS

Emphysema Pneumonia

Atelactasis
NURSING CARE PLAN
Subjective data:
Patient complaint of dyspnea, inability to remove secretion and
have ineffective cough.
Goal
Patient will be able to maintain clear, open airway ,as evidence of
normal breath sound, normal rate and depth of respiration, and
ability to effective cough up secretion after treatment given.
Nursing Diagnosis
Ineffective airway clearance related to increase mucus production
Supportive Data
Objective data :
• Spo2 < 95%
• Temperature febrile 38
• Respiratory rate increasing >40/ min
• Heart rate show tachycardia > 130bpm
4. Monitor vital sign heart rate, blood pressure, spo2,
respiration rate, temperature 4 hourly
Rationale: Increased work of breathing can lead to tachycardia
and hypertension. Retained secretions may be a sign of an
existing infection or inflammatory process manifested by a fever
or increased temperature
5. Teach the patient the proper ways of coughing and
breathing by take a deep breath, hold for 2 seconds, and
cough two or three times in succession
Rationale: The most convenient way to remove most secretions is
coughing. So it is necessary to assist the patient during this
activity. Deep breathing, on the other hand, promotes oxygenation
before controlled coughing
Nursing Interventions
1. Assess airway patency by asking patient to cough either chesty or not
Rationale: Maintaining patent airway is always the first priority
2. Assess respirations. Note quality, rate, pattern, depth, flaring of
nostrils, dyspnea on exertion, use of accessory muscles, and position for
breathing
Rationale: A change in the usual respiration may mean respiratory
compromise. An increase in respiratory rate and rhythm may be a
compensatory response to airway obstruction
3. Auscultate lungs for presence of normal or adventitious breath sounds
Rationale: Abnormal breath sounds can be heard as fluid and mucus
accumulate. This may indicate ineffective airway clearance
6. Position the patient upright if tolerated. Regularly check
the patient’s position to prevent sliding down in bed
Rationale: Upright position limits abdominal contents from
pushing upward and inhibiting lung expansion. This position
promotes better lung expansion and improved air exchange
7. Perform nasotracheal suctioning as necessary, especially if
cough is ineffective
Rationale: Suctioning is needed when patients are unable to
cough out secretions properly due to weakness, thick mucus
plugs, or excessive or tenacious mucus production
8. Encourage patient to increase fluid intake to 3 liters per day if
no contraindication within the limits of cardiac reserve and renal
function
Rationale: Fluids help minimize mucosal drying and maximize ciliary
action to move secretions
9. Administer nebulizer salbutamol ½ vial QID as prescribed by
doctor
Rationale: Promote clearance of airway secretions and may reduce
airway resistance
10. Coordinate with a respiratory therapist for chest physiotherapy
Rationale: Chest physiotherapy includes the techniques of postural
drainage and chest percussion to mobilize secretions from smaller
airways that cannot be eliminated by means of coughing or suctioning
11. Inform doctor immediately for any worsening condition
Rationale: For further management and treatment
Evaluation:
Patient maintain clear, open airway ,as evidence of normal breath
sound, normal rate and depth of respiration, and ability to effective
cough up secretion after treatment.
Objective Data:
Spo2 98%
Temperature in normal 37.3
Respiratory rate 28/min
Heart rate show normal 120bpm
Subjective Data : Patient told to nurse he more easy to breath and relax.
Able to cough up the secretion effectively with productive cough.
Nursing Diagnosis
Activity intolerance related to hypoxemia and ineffective
breathing patterns
Supportive Data
Objective Data:
■Spo2 92-93%
■Temperature febrile 38
■Respiratory rate increasing 40-45 per min
■Heart rate show tachycardia 130 bpm
Subjective Data:
Patient complaint of dyspnoea, lethargy, unable to do activity
daily living in long interval time
Goal
Patient will be able to do activity daily living and improve
breathing pattern after nursing intervention given
Nursing Intervention:
1. Assess the physical activity level and mobility of the
patient
Rationale: To provides baseline information for formulating
nursing goals and determine limitation of activity from patient
2. Assess the patient’s nutritional status from intake and
output chart to see calorie intake per day for patient
Rationale: Adequate energy reserves are needed during activity
3. Investigate the patient’s perception of causes of activity
intolerance
Rationale: Causative factors may be temporary or permanent as
well as physical or psychological
4. Assess the need for additional help at home and
involvement of family member
Rationale: Coordinated efforts are more meaningful and effective
in assisting the patient in conserving energy
5. Establish guidelines and goals of activity with the patient
Rationale: Motivation and cooperation are enhanced if the patient
participates in goal setting
6. Encourage the patient perform the activity more slowly, in
a longer time with more rest or pauses, or with assistance if
necessary
Rationale: Helps in increasing the tolerance for the activity
7. Gradually increase activity with active range-of-motion
exercises in bed, increasing to sitting and then standing
Rationale: Gradual progression of the activity prevents
overexertion
8. Assist with ADLs while avoiding patient dependency like
walking, eating and perform bathing
Rationale: Assisting the patient with ADLs allows conservation of
energy. Carefully balance provision of assistance; facilitating
progressive endurance will ultimately enhance the patient’s
activity tolerance and self-esteem
9. Encourage physical activity consistent with the patient’s
energy levels
Rationale: Helps promote a sense of autonomy while being
realistic about capabilities
10. Encourage active ROM exercises. Encourage the patient
to participate in planning activities that gradually build
endurance
Rationale: Exercise maintains muscle strength, joint ROM, and
exercise tolerance. Physical inactive patients need to improve
functional capacity through repetitive exercises over a long
period of time. Strength training is valuable in enhancing
endurance of many ADLs
11. Provide bedside commode as indicated
Rationale: Use of commode requires less energy expenditure than
using a bedpan or ambulating to the bathroom
12. Inform doctor if worsening condition persists
Rationale: For further management and treatment
Evaluation:
Patient able to improve in activity daily living gradually with
patient’s energy level and improve in breathing pattern after nursing
intervention given
Objective Data:
•Spo2 95%-97%
•Temperature in normal 37.5
•Respiratory rate 25/min
•Heart rate show normal 120bpm
Subjective Data :
Patient told to nurse he able to do simple activities daily living with
minimal assisting as improved in breathing.
 REFERENCES
▪ BOOKS
Hill, A. T., Barker, A. F., Bolser, D. C., Davenport, P., Ireland, B., Chang, A. B., … &
McGarvey, L. (2018). Treating cough due to non-CF and CF bronchiectasis with
nonpharmacological airway clearance: CHEST expert panel report. Chest, 153(4), 986-993.
Shekleton, M. E., & Nield, M. (1987). Ineffective airway clearance related to artificial
airway. The Nursing Clinics of North America, 22(1), 167-178.
Ravishankar Chandrasekaran, M. M. (2018). Geographic Variation in the Aetiology,
Epidemiology and Microbiology in Bronchiectasis. BMC Pulmonary Medicine,
▪ WEBSITE
Marianne Belleza, R. N. (2021, February 20). Bronchiectasis Nursing Care and
management: Study Guide. Nurseslabs. Retrieved September 20, 2022, from
https://nurseslabs.com/bronchiectasis/#pathophysiology