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Course: Medical Surgical Nursing

Topic: Bronchiectasis

The Nurses International Community

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Module Goals

Learners will be able to

Describe the clinical manifestation of bronchiectasis.
Discuss the assessment and diagnostic findings of bronchiectasis.
Discuss the complications of bronchiectasis.
Describe the medical management of bronchiectasis.
Discuss the nursing management of bronchiectasis.

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Bronchiectasis

Long-term respiratory condition characterized by an abnormal widening of one or more airways.
Widened airways leads to excessive mucus build-up.
Excessive mucus makes the lungs more vulnerable to infection.

WHO, 2019

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Bronchiectasis

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Bronchiectasis: Symptoms

Common:

Persistent cough accompanied by a large amount of phlegm.

Others:

Shortness of breath
Wheezing
Bloodstained phlegm
Chest pain
Joint pain
Clubbing
Fatigue
Low grade fever
Weight loss
Halitosis

WHO, 2019

NHS, 2021

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Bronchiectasis: Causes

Lung infections:

tuberculosis (TB)
whooping cough

pneumonia

measles

Immunodeficiency:

HIV)

Allergic bronchopulmonary aspergillosis (ABPA)

WHO, 2019

NHS, 2021

Congenital factors
Aspirations:
foreign body

food
Cystic fibrosis

Cilia abnormalities:

Young's Syndrome
Primary Ciliary Dyskinesia

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People with ABPA have an allergy to a type of fungi known as Aspergillus. If a person with ABPA inhales fungal spores, it can trigger an allergic reaction and persistent inflammation, which can progress to bronchiectasis.
Cystic fibrosis is a genetic disorder where the lungs become clogged with mucus.

Cilia abnormalities

Cilia are the tiny hair-like structures that line the airways in the lungs. They're designed to protect the airways and help move away any excess mucus.

Bronchiectasis can develop if there's a problem with the cilia, which means they're unable to effectively clear mucus from the airways.

Conditions that can cause problems with the cilia include:

Young's syndrome – a rare condition only affecting males thought to be caused by exposure to mercury in childhood
primary ciliary dyskinesia – a rare condition caused by inherited faulty genes

Bacterial Infections

Mycobacterium: Tuberculosis and atypical
Haemophilus influenzae
Pseudomonas aeruginosa
Staphylococcus aureus
Mycoplasma and HIV

Viral Infections

Respiratory syncytial virus and measles

Fungal Infections

Bronchial obstruction

Foreign body
Mucus plug
Tumors
Hilar lymphadenopathy (right middle lobe syndrome: extrinsic compression from postinfectious adenopathy)

Post Inflammatory pneumonitis

Chronic aspiration/gastroesophageal reflux disorder
Chronic sinusitis
Inhalational injury

Congenital/Genetic

Cystic fibrosis
Young syndrome
PCD: primary ciliary dyskinesia (Kartenger Syndrome)
immunodeficiency (hypogammaglobulinemia)
Alpha1-antitrypsin deficiency (AAT)
Mounier-Kuhn syndrome

Inflammatory diseases

Ulcerative colitis
Rheumatoid arthritis
Sjögren syndrome

Pulmonary Diseases

Asthma
Bronchomalacia
Cronic-obstructive pulmonary disease (COPD) (reported in up to 50% of patients with moderate-to-severe COPD)
Diffuse panbronchiolitis
Idiopathic pulmonary fibrosis (traction bronchiectasis)

Altered immune response

Allergic Bronchopulmonary Aspergillosis
Hypersensitivity pneumonitis

(Bird, 2022)

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Critical Thinking Question

The nurse is conducting the physical assessment on a client diagnosed with bronchiectasis.

Which of the following clinical manifestations would the nurse expect to find? (Select all that apply)

Bloodstained phlegm
Bradycardia
Chest pain
Joint pain
Persistent cough

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Bronchiectasis: Diagnosis

History and physical examination
Diagnostic examination:

Chest X-ray
Chest CT scan
Blood tests
Sputum culture (bacteria that cause tuberculosis)

WHO, 2019

NHS, 2021

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Bronchiectasis: Diagnosis (Continued)

Sweat test (Diagnostic of cystic fibrosis)

Bronchoscopy

WHO, 2019

NHS, 2021

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Bronchiectasis: Diagnosis (Continued)

Lung function test (spirometry)

During spirometry, a client is instructed to take a deep breath and blow into a small tube (spirometer).

WHO, 2019

NHS, 2021

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Critical Thinking Question

A 48-yr-old client who has been smoking for 20 years is suspected of having bronchiectasis.

The provider ordered a spirometry to confirm the diagnosis.

Which of the following instructions should the nurse give the client in preparation for the test?

Avoid caffeine for 12 hours before the test
Avoid smoking for 24 hours before the test
Do not eat or drink after midnight
Do not take you antihypertensive medication before the test

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Bronchiectasis: Complications

Massive hemoptysis accompanied by:

Expectorating (coughing up) more than 100ml of blood in a 24-hour period
Breathing difficulties
Lightheadedness
Dizziness
Cold, clammy skin

NHS, 2021

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Bronchiectasis: Complications (Continued)

Respiratory failure
Atelectasis
Heart failure
Cor pulmonale
Recurrent pneumonia

National Heart, Lung and Blood Institute, 2022

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Bronchiectasis: Treatment Goals

Treat any underlying conditions and lung infections.
Remove mucus from lungs.
Prevent complications.

National Heart, Lung and Blood Institute, 2022

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Bronchiectasis: Treatment

Medications:

Antibiotics
Expectorants
Bronchodilators
Inhaled corticosteroids

Hydration (drinking plenty of water)
Chest physical therapy
Oxygen Therapy
Surgery (lobectomy)

National Heart, Lung and Blood Institute, 2022

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Bronchiectasis: Management

Stop smoking
Vaccination:

flu vaccine every year
pneumococcal vaccine

Exercise regularly
Adequate hydration
Consume a balanced diet
Avoid toxic fumes (gases)

NHS, 2021

National Heart, Lung and Blood Institute, 2022

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Critical Thinking Question

The nurse educator prepares a lesson on bronchiectasis. Which of the following statements best reflects the complications of this respiratory condition?

Heart failure, hypertension, and leg ulcers
Hypertension, Atelectasis, and diabetes mellitus
Respiratory failure, atelectasis, and heart failure
Pneumonia, cor pulmonale, and diabetes mellitus

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Bronchiectasis: Nursing Management

Assess respiration characteristics and vital signs.
Assess pain level, characteristics, and location.
Observe nonverbal cues and pain behaviors.
Auscultate lung sounds.
Assess and monitor oxygen saturation.
Elevate the client’s head of bed.
Administer medications as prescribed.
Administer oxygen therapy as prescribed.
Provide nonpharmacologic methods of pain relief.
Provide rest and simplify ADLs.
Provide education and support.

Wagner, 2022

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Bronchiectasis: Nursing Management (Continued)

Education and support

Deep breathing exercises
Stop smoking
Exercise regularly
Stay well hydrated
Eat a balanced diet
Avoid toxic fumes (gases)

NHS, 2021

National Heart, Lung and Blood Institute, 2022

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Critical Thinking Question

A newly diagnosed bronchiectasis client with a history of cigarette smoking for more than 20 years is being discharged.

Which lifestyle modification should the nurse encourage in this client?

Drink fluids before and after meals
Notify the doctor if symptoms get worse
Quit smoking
Take medications as prescribed

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Red Flags

May develop at any age.
Over time, clients have more serious symptoms.
Early diagnosis and treatment may help prevent further lung damage.

National Heart, Lung and Blood Institute, 2022

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References

Agency for Healthcare Research. (2020). Health Literacy Universal Precautions Toolkit, 2nd Edition. https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html

Bird, K. (2022). Bronchiectasis. https://www.statpearls.com/ArticleLibrary/viewarticle/18639

National Heart, lung, Blood Institute. (2022). Bronchiectasis: Treatment. https://www.nhlbi.nih.gov/health/bronchiectasis/treatment

NHS.(2021). Symptoms: Bronchiectasis. https://www.nhs.uk/conditions/bronchiectasis/symptoms/

NHS.(2021). Causes: Bronchiectasis. https://www.nhs.uk/conditions/bronchiectasis/causes/

WHO. (2019). Chronic respiratory diseases: Bronchiectasis. https://www.who.int/news-room/questions-and-answers/item/chronic-respiratory-diseases-bronchiectasis

Wagner, M.(2022). Pleural Effusion Nursing Diagnosis & Care Plan. https://www.nursetogether.com/pleural-effusion-nursing-diagnosis-care-plan/

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