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Cadiopulmonary Medicine > Test 3 Ch.16 Bronchiectasis > Flashcards

Test 3 Ch.16 Bronchiectasis Flashcards

1
Q

Bronchiectasis is an acquired disorder of the major bronchi and bronchioles characterized by chronic dilation and distortion of one or both bronchi, usually as a result of extensive inflammation and destruction of the

A
  • bronchial wall cartilage
  • blood vessels
  • elastic tissue
  • smooth muscle components
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2
Q

One or ______ lungs may be involved

A

both

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3
Q

Commonly limited to one lobe or segment, and is frequently found in the

A

lower lobes

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4
Q

The smaller __________ are predominantly affected

A

bronchi

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5
Q

B/c of _____________ wall destruction, normal mucociliary clearance is impaired which results in copious amounts of ____________ secretions

A

bronchial;
bronchial secretions

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6
Q

Blood that becomes foul-smelling b/c of

A

secondary colonization w/ anaerobic organisms

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7
Q

Infection and irritation may lead to

A

secondary bronchial smooth muscle constriction and fibrosis

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8
Q

The small bronchi and bronchioles distal to the affected areas become partially or totally obstructed w/ secretions, which leads to (2)

A
  1. Hyperinflation of the distal alveoli as a result of expiratory check valve obstruction
  2. Atelectasis, consolidation, and fibrosis as a result of complete bronchial obstruction
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9
Q

Based on gross anatomic appearance, the long- accepted Reid classification subdivides bronchiectasis in 3 pattern:

A
  • Varicose (fusiform)
  • Cylindrical (tubular)
  • Cystic (saccular)
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10
Q

The bronchi are dilated and constricted in an irregular fashion similar to varicose veins, ultimately resulting in a distorted, bulbous shape. What type of bronchiectasis is this?

A

Varicose Bronchiectasis (Fusiform Bronchiectasis)

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11
Q

The bronchi are dilated and rigid and have regular outlines similar to a tube. What type of bronchiectasis is this?

A

Cylindrical Bronchiectasis (Tubular Bronchiectasis)

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12
Q

The bronchi progressively increases in diameter until they end in a large, cyst like sacs in the lung parenchyma. What type of bronchiectasis is this?

A

Cystic Bronchiectasis (Saccular Bronchiectasis)

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13
Q

This form of Bronchiectasis causes the greatest damage to the TB tree.

A

Cystic Bronchiectasis

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14
Q

Major pathological or structural changes associated w/ Bronchiectasis (7)

A
  • Chronic dilation and distortion of bronchial airways
  • Excessive production of often foul- smelling sputum
  • Bronchospasm
  • Hyperinflation of the alveoli
  • Atelectasis
  • Parenchymal consolidation and fibrosis
  • Hemoptysis secondary to bronchial arterial erosion
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15
Q

Most causes of Bronchiectasis include a combination of…..

A

bronchial obstruction and infection

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16
Q

What is the most common cause of Bronchiectasis in children?

A

Cystic Fibrosis

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17
Q

The prevalence of non cystic fibrosis Bronchiectasis (NCFB) is

A

relatively low

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18
Q

In the U.S the incidence of NCFB is about

A

4.2 per 100,000 young adults

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19
Q

In other population, such as Polynesia, Alaska, Australia, and New Zeland the occurrence of NCFB is as high as

A

15 per 1000 children

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20
Q

The most common cause of NCFB is _______________ infection

A

pulmonary

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21
Q

The causes of Bronchiectasis are commonly classified into the following categories: (5)

A
  • Acquired bronchial obstruction
  • Congenital anatomic disorder
  • Immunodeficiency states
  • Abnormal secretion clearance
  • Miscellaneous disorders (alpha1- antitryspin deficiency)
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22
Q

A routine chest radiography may reveal: (5)

A
  • Overinflated lungs
  • Marked volume loss
  • Increased opacities
  • Dilated fluid- filled airways
  • Crowding of the bronchi atelectasis
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23
Q

This scan has virtually replaced bronchography. as the best tool for diagnosing NCFB _____-___________ _____________

A

High- resolution tomogram (HR-CT)

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24
Q

___________ testing can be used to determine if the Bronchiectasis demonstrates an…..

A

Spirometry;
obstructive or restrictive lung path-physiology

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25
Q

ABG measurements can confirm if the pt has

A

mild , moderate or sever gas exchange compromise

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26
Q

The following clinical manifestation result from the pathophysiologic mechanism caused (or activated) by: (5)

A
  • Excessive bronchial secretions
  • Bronchospasm
  • Atelectasis
  • Consolidation
  • Increased alveolar- capillary membrane thickness
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27
Q

Depending on the amount of bronchial secretions and the degree of bronchial destruction and fibrosis/ atelectasis associated w/ Bronchiectasis, the disease may create what?

A

Obstructive or a restrictive lung disorder or a combination of both

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28
Q

Clinical manifestation: Vital signs

A
  • Increased RR (Tachypnea)
    1. Stimulation of peripheral chemoreceptors (hypoxemia)
    2. Decreased lung compliance and increased ventilatory rate relationship
    3. Anxiety
  • Increased HR (pulse) and BP
29
Q

More physical examination for Bronchiectasis

A
  • Use of Accessory muscles during Inspiration and Expiration
  • Pursed-Lip Breathing (when obstructive)
  • Increased Anteroposterior Chest Diameter (Barrel Chest) (When obstructive)
  • Cyanosis
  • Digital Clubbing
30
Q

Peripheral Edema and Venous Distention. B/c polycythemia and cor pulmonale are associated w/ severe Bronchiectasis this may be seen:

A
  • Distended neck veins
  • Pitting edema
  • Enlarged and tender liver
31
Q

Cough, Sputum Production and Hemoptysis

A
  • Chronic cough w/ production of large quantities of foul- smelling is a hallmark of Bronchiectasis
  • A 24- hr collection of sputum is usually voluminous and tends to settle into several different layers
  • Streaks of blood are seen frequently in the sputum, presumable from necrosis of hemoptysis
  • Haemophilus influzae, Strepococcus, Pseudomans aeruginosa are commonly cultured from the sputum of a pt w/ Bronchiectasis
32
Q

Chest Assessment findings: When Bronchiectasis factors are primarily obstructive:(5) (think of air)

A
  • Decreased tactile and vocal fremitus
  • Hyperresonant percussion note
  • Diminished breath sounds
  • Wheezing
  • Crackles
33
Q

Chest Assessment findings: When Bronchiectasis factors are restrictive (over areas of atelectasis and consolidation):(5)

A
  • Increased tactile and vocal fremitus
  • Bronchial breath sounds
  • Crackles
  • Whispered pectoriloquy
  • Dull percussion note
34
Q

Abnormal Lab Test and Procedures: Hematology

A
  • Increased hematocrit and hg
  • Elevated WBC if pt is acutely infected
35
Q

Sputum Culture Results and Sensitivity (4)

A
  • Streptococcus pneumoniae
  • Haemophilius influnzae
  • Pseudomonas aeruginosa
  • Anaerobic organism
36
Q

Radiologic Findings: Chest Radiographs: When Bronchiectasis is primarily obstructive (6)

A
  • Translucent (dark) lung fields
  • Depressed or flattened diaphragms
  • Long and narrow heart (pulled down by diaphragms)
  • Enlarged heart (when heart failure is present)
  • Tram tracks
  • Lungs may be hyperinflated, leading to an increased functional residual capacity and depressed diaphragms
37
Q

Chest Radiographs: When Bronchiectasis is primarily restrictive (3)

A
  • Atelectasis and consolidation
  • Infiltrates (suggesting PNA)
  • Increased opacity
38
Q

For most cases of Bronchiectasis the treatment of the underlying disease

A

is not possible

39
Q

The general management and treatment plan is aimed at: (4)

A
  • Controlling pulmonary infections
  • Airway secretions
  • Airway obstruction
  • Preventing complications
40
Q

What is often prescribed during periods of exacerbation?

A

Antibiotics, bronchodilators, and expectorants

41
Q

What are the protocols to treat Bronchiectasis

A
  • Oxygen Therapy
  • Airway Clearance Therapy
  • Lung Expansion Therapy
  • Aerosolized Medication Therapy
  • Mechanical Ventilation
42
Q

This protocol is used to treat hypoxemia, decreased WOB, and decrease myocardial work

A

O2 Therapy

43
Q

Used to mobilize secretions

A

Airway Clearance Therapy

44
Q

Attempts to keep the distal lung units inflated to prevent atelectasis. What protocol is this?

A

Lung Expansion Therapy

45
Q

Use of Bronchodilators and use corticosteroids is discouraged. What protocol

A

Aerosolized Medication Therapy

46
Q

This protocol may be necessary to provide and temporarily help alveolar ventilation and eventually return pts to their baseline condition/ or spontaneous breathing

A

Mechanical Ventilation

47
Q

These are sometimes ordered when oral liquids and aerosol therapy alone are not sufficient to facilitate expectoration

A

Expectorants

48
Q

Used to treat associated respiratory tract infections

A

Antibiotics

49
Q

Questions from the back
In which forms of Bronchiectasis are bronchi dilated and constructed in an irregular fashion?

A
  • Fusiform
  • Varicose
50
Q

Which are common causes of acquired Bronchiectasis?

A

Pulmonary tuberculosis

51
Q

In the primarily obstructive form of Bronchiectasis, the pt commonly demonstrates

A

Decreased PEFR

52
Q

Which of the following radiologic findings are associated w/ Bronchiectasis that is primarily obstructive?

A
  • Depressed or flattened diaphragms
  • Long and narrow heart
  • Translucent lung fields
53
Q

Which is considered a hallmark of Bronchiectasis

A

Chronic cough and large quantities of foul- smelling sputum

54
Q

Which of following are commonly cultured in sputum of pts w/ Bronchiectasis

A
  • Streptococcus pneumoniae
  • Pseudomonas aeruginosa
  • Haemophilus influenzae
55
Q

When the pathophysiology of Bronchiectasis is primarily obstructive, the pt demonstrates, which of the following clinical manifestations?

A
  • Decreased tactile and vocal fremitus
  • Rhonchi and wheezing
56
Q

Which of the following diagnostic procedures are used to positively diagnose Bronchiectasis?

A
  • Bronchography
  • Computed tomography
57
Q

Which of the following causes are related to abnormal secretion clearance

A

Cystic Fibrosis

58
Q

Which of the following hemodynamic indices are associated w/ Bronchiectasis

A
  • Increased mean Pulmonary artery pressure
  • Increased right atrial pressure
59
Q

Which of the following protocols may be of importance in the outpatient care of pts w/ Bronchiectasis

A
  • Oxygen Therapy
  • Airway Clearance Therapy
  • Lung Expansion Therapy
  • Aerosolized Medication Therapy
60
Q

Another name for Varicose

A

fusiform

61
Q

Another name for Cylindrical

A

tubular

62
Q

Another name for Cystic

A

saccular

63
Q

Yellow pages Increased RR (Tachypnea) (3)

A
  1. Stimulation of peripheral chemoreceptors (hypoxemia)
    1. Decreased lung compliance and increased ventilatory rate relationship
    2. Anxiety
64
Q

Example of Acquired Bronchiectasis

A
  • Foreign body aspiration- peanut, chicken bone, teeth
  • Hilar adenopathy- TB, sarcoidosis
  • COPD- chronic bronchitis
65
Q

Example of Congenital Anatomic Defects

A
  • Vascular abnormalities- pulmonary artery aneurysm
  • Lymphatic abnormalities- slow growing yellow syndrome
66
Q

Example of Immunodeficiency States

A
  • IgG deficiency
  • IgA deficiency
67
Q

Example of Abnormal secretion clearance

A
  • CF mucoviscidosis
  • cilary defects of airway mucosa
  • young syndrome
68
Q

Examples of Miscellaneous disorders

A
  • A1AT
  • viral infections (influenza)
  • chronic organ rejection after transplant (lung and heart transplant)
  • other infections (M.TB)

Cadiopulmonary Medicine (24 decks)

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