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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,Bronchiectasis,支气管扩张,Si Ting Wang,Faculty of Nursing,GuangXi Traditional Chinese Medical University,Pathophysiology,Bronchiectasis,支气管扩张,is a disorder characterized by permanent, abnormal dilatation,扩张,of one or more medium-sized and diameter greater than 2mm proximal bronchi,近端支气管,.,Pathophysiologic change that result in dilatation is destruction of the e,lastic tissue,弹性组织,and muscular structures of the bronchial wall,支气管壁,.,Etiology,病因,The disease process is often believed to start in childhood as an acquired disorder, beginning with respiratory complications secondary to influenza流行性感冒, measles麻疹, or whooping cough百日咳. Infant bronchial - lung infection婴幼儿期支气管-肺组织感染is the most common cause of bronchiectasis.,Recurring lower respiratory tract infections are another pattern of disease in childhood that may predispose an individual to bronchiectasis.,This pattern is typically seen in the individual who has cystic fibrosis囊肿性纤维化, asthma哮喘, a-1 aitirypsin deficiency 抗胰蛋白酶缺乏, or immunodeficiency diseases免疫缺陷疾病.,Pathologic types,病理类型,Saccular bronchiectasis,囊状支气管扩张,: occurs mainly in large bronchi and is characterized by cavity-like dilatations. The affected bronchi end in large sacs.,Cylindrical bronchiectasis,圆柱支气管扩张,:,involve in medium-sized bronchi that are mildly to moderately dilated.,Pathophysiology,病理生理,Almost all forms of bronchiectasis are associated with,bacterial infection,细菌感染,.,Infections cause the bronchial walls to be weaken, and pockets of infection begin to form.,When the walls of the bronchial system are injured, the mucocilliary mechanism,粘膜,-,纤毛防御机制,is damaged, allowing bacteria and mucus to accumulate within the pockets. The infection becomes worse and results in bronchiectasis.,Classification,分类,Localized,bronchiectasis,局部支气管扩张,:,results from focal airway obstruction, or from necrotizing,坏死性,or lobar pneumonia,大,叶性肺炎,whose,bronchiectatic,sequelae,后遗症,are limited to one area of the lung.,Obstructive processes of any kind can predispose an individual to,bronchiectasis,.,The obstruction causes the bronchi,支气管,and bronchioles,细支气管,to distend and balloon out below the level of obstruction,.,Classification,分类,2.,Generalized bronchiectasis,广泛性支气管扩张,:,is multifocal necrotizing,多灶性坏死性,bacterial infection, but other condition can predispose persons to the development of bronchiectasis, such as:,Congenital,先天性,factors,: altered bronchial structures such as cysts,支气管囊肿,and cul-de-sacs,盲囊, which lead to pooling of secretion.,A variety of immunodeficiency diseases,免疫缺陷疾病,are associated with recurrent bacterial pneumonia.,Some,inhalation exposures, particularly to irritant gases such as oxides of sulfur,硫氧化物,and nitrogen,氮, have been noticed as causes of bronchiectasis.,Clinical manifestation,临床表现,The primary manifestations of bronchiectasis vary,considerably, depending on the extent and location,of the disease process:,Chronic cough with production of mucopurulent sputum,黏液性脓性痰,; the cough is paroxysmal,阵发性,and is often stimulated with position changes.,*,Hemoptysis,咯血,Recurrent pneumonia,肺炎,Exertional dyspnea,运动性呼吸困难,Fatigue,疲劳,Weight loss,Anorexia,厌食症,Fetid,breath,恶臭呼吸,Diagnostic studies,辅助检查,An individual with a chronic productive cough with copious sputum (which may be blood streaked,血丝,should be suspected of having bronchiectasis. Characteristic findings in the health history such as childhood diseases complicated by respiratory infections or chronic bronchitis are significant.,Chest X-ray,may show streaky infiltrates.,Bronchoscope,支气管镜,may be useful in identifying the source of secretions or sites of hemoptysis in the individual with chronic productive cough.,Sputum collection,痰液收集,may provide with additional information regarding the severity of impairment and the presence of active infection.,Pulmonary function,肺功能测试,test,may be abnormal in advanced bronchiectasis.,A complete blood count,血细胞计数,may be normal or show evidence of anemia and leukocytosis.,Therapeutic management,治疗方案,Antibiotics,抗生素,are the major form of treatment and should be given on the basis of sputum culture,痰培养,result.,Maintaining good hydration is important to liquefy secretions. Encourage daily drinking water of not less than,1500 2000ml,.,Postural drainage,体位引流,is vital to facilitate expectoration of sputum,咳痰,.,The individual should reduce exposure to excessive air pollutants and irritants, avoid cigarette smoking and obtain pneumococcal,肺炎球菌,and influenza vaccinations,流感疫苗接种,.,Surgical resection of parts of the lungs may be done if conservative treatment is not effective; surgical in not available when there is diffuse or widespread involvement.,Nursing management,Acute and chronic intervention,An important nursing goal is to promote drainage,引流,and removal of bronchial mucus,支气管黏液,.,Some individuals require elevation of the foot of the bed by 4 to 6 itches to facilitate drainage. Postural drainage,体位引流,should be done on the affected parts of the lungs,患侧肺部,.,The patients should be taught effective deep-breathing exercises,深呼吸练习,and effective ways to cough.,Administration of the prescribed antibiotics,抗生素, bronchodilators,支气管扩张剂,or expectorants is important,祛痰剂,.,Nursing management,护理措施,Acute and chronic intervention,Bed rest may be indicated during the acute phase of the illness, chilling and excess fatigue should be avoided.,Good nutrition is important but may be difficult to maintain because the patient is often anorexic. Oral hygiene to cleanse the month and remove dried sputum crusts may improve the patients appetite.,Adequate hydration to help liquefy secretion, thus the patient should be instructed to drink at least 3L of fluid daily. However, generally the patient should be counseled to use low-sodium fluids to avoid systemic fluid retention.,Nursing management,护理措施,Acute and chronic intervention,The patient with,bronchiectasis,should avoid ultrasound nebulizers,超声雾化吸入,because they often induce,bronchospasm,支气管痉挛,. It is important that the patient medicate with an inhaled bronchodilator 10 to 15 minutes before to prevent,bronchoconstriction,.,The patient and family should be taught to recognize significant manifestation to be reported to the health care providers, these manifestation include increased sputum production, grossly bloody,血腥痰,sputum, increasing,dypsnea,呼吸困难, fever, chills,发烧, and chest pain.,Hemoptysis,Hemoptysis,is the expectoration (,coughing,up) of,blood,or of blood-stained,sputum,from the,bronchi,larynx,trachea, or,lungs.,500mlor 100500ml/time:,massive volume,。,Nursing management,护理措施,Hemoptysis care,咯血的护理,Promote personal and special environment to decrease anxiety from disease.,Keeping the patient at rest, position for maximal aeration of lung fields,the bleeding lung should be placed in the dependent position, so that blood is not aspirated into the unaffected lung.,When helping patient cough, use whatever position best ensures cooperation and minimizes energy expenditure.,Using suction as ordered, when its needed. with massive bleeding,endotracheal,intubation,气管内插管,and mechanical ventilation,机械通气,may be needed to control airway and maintain adequate gas exchange.,If there is massive bleeding which is prone to be suffocated, preparing for,endotracheal,intubation,气管内插管, as order.,Monitor and document vital sigh, bleeding characteristic to gauge therapys effectiveness and detect possible progression.,咯血的护理,促进个人和特殊的环境，减少焦虑。,保证病人休息和正确体位，能够最大限度促使肺野的通气。小量咯血应静卧休息，大量咯血者需绝对卧床休息。肺出血时应协助患者在患侧卧位，从而使血液不能被吸入健侧。,当帮助病人咳嗽时，选择任何适宜的位置，最好确保病人能够配合的同时最大限度地减少能量和体力的消耗。,及时为病人漱口，擦净血迹，保持口腔清洁，舒适，防止口腔异味刺激，再度引起咯血。,如果需要，遵医嘱使用吸引。当患者出现大出血，可能需要气管内插管和机械通气，以控制呼吸道和保持足够的气体交换。,如果有大量出血，患者很容易被窒息，因此，必须遵医嘱准备气管插管。,监测并记录生命体征，出血的情况，用于衡量治疗的效果和发现疾病可能的进展。,遵医嘱用止血药，抗生素，祛痰剂，支气管舒张药。,大咯血可使用垂体后叶素。,剧烈咳嗽者给予小剂量镇静剂。,烦躁不安者适中选用镇静剂如地西拌，禁用吗啡，派替啶以免抑制呼吸。,asphyxia,窒息,If the patient present,stressed,精神紧张,restless,坐卧不安,and dull,complexion,面色晦暗, poor in hemoptysis, it is often choking sign,窒息先兆,.,If the patient suddenly become,dread,表情恐怖,chest tightness,胸闷,shortness of breath,气促,c,yanosis,发绀,of mouth and lip,. sweating, or,loss of consciousness,意识丧失, etc., indicating that,asphyxia,窒息,has occurred, it should be urgently addressed.,Nursing,care for,asphyxia,First aid items are ready, closely monitor patients with aura suffocation.,When signs of asphyxia present, immediately place the patient on,Trendelenburg,position, with head to one side,purcuss,the back,quitely,in order to discharge blood clot. If necessary, tracheal intubation or,tracheostomy,should be well prepared.,Inform patients can not breath, so as not to induce,laryngospasm,.,Timely clear blood clots in mouth and nasal, or quickly connected with a suction catheter into nasal tracheal suction to remove blood clots within the respiratory tract.,If necessary, cooperating with doctor to perform,endotracheal,intubation or a bronchoscope under direct vision draw blood clots.,After blood clot removed, if the patient has not resumed spontaneous breathing, artificial respiration should be held to provide with high flow oxygen, or,uesing,respiratory stimulants.,Close observation of disease, monitoring blood gas analysis and coagulation mechanisms to guard against the possibility of choking again.,窒息的护理,备好急救物品，密切监测病人有无窒息先兆。,当窒息发生或有窒息征象时，立即采取头低脚高体位，头偏向一侧，轻扣背部，排出血块，必要时做好气管插管或气切的准备。,告知病人咯血时不能屏气，以免诱发喉头痉挛。,及时去除口，鼻腔内血凝块，或迅速用鼻导管接吸引器插入气管内抽吸，以去除呼吸道内的积血。,必要时配合医生行气管插管或气管镜直视下吸取血块。,血块去除后，假设病人自主呼吸尚未恢复，应行人工呼吸，给高流量吸氧或遵医嘱应用呼吸中枢兴奋剂。,密切观察病情，监测血气分析和凝血机制，警惕再次窒息的可能。,
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