内科护理学课件英语考试资料Bronchiectasis.ppt

1、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 chan

2、ge that result in dilatation is destruction of the elastic 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

3、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

4、who has cystic fibrosis囊肿性纤维化, asthma哮喘, a-1 aitirypsin deficiency 抗胰蛋白酶不足, 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 bro

5、nchiectasis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

6、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

7、 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 obstructi

8、on.,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 lea

9、d 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,Th

10、e 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 Exertion

11、al 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 d

12、iseases 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 provid

13、e 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,Antibiotic

14、s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 indi

15、vidual 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 diffu

16、se 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 don

17、e 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 Be

18、d 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

19、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

20、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 sign

21、ificant 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 f

22、rom 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 shoul

23、d 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a

24、nd 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 effectivenes

25、s 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，选择任何合适的位置，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，

26、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。 烦躁不安者适当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

27、 dread表情恐怖, chest tightness胸闷, shortness of breath气促, cyanosis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 pati