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Case study bronchiectasis
Case study bronchiectasis
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Bronchiectasis is a chronic disease of the lungs where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection (Nhs.uk.2014). The extent of the disease can vary greatly- may be one section of an airway that is widened and abnormal or many airways- usually somewhere between these extremes. Widened parts of the airways are damaged and inflamed, which causes excess mucus to form which is less easily cleared. Furthermore, these parts of the airways are weaker and more liable to collapse inwards which may affect airflow through the affected airways- severity depends on how many of the airways are affected (Patient.co.uk. 2014). Patients with bronchiectasis have chronic cough and excess sputum production, and infections due to bacteria develop in them- this results in the loss of lung function (O’Donnell 2008).
About one in a thousand people in the UK have bronchiectasis (Patient.co.uk. 2014). Recent statistical analysis has shown that the mortality rate of Bronchiectasis in England and Wales is increasing at 3% per year and just under a thousand people die from it each year (Roberts and Hubbard, 2010). Where the number of deaths are increasing in older groups and decreasing in younger groups. Figure 1 (WHO Regional Office for Europe. 2013) illustrates the concern of Bronchiectasis in European countries, especially the UK.
Bronchiectasis is now being recognized with increasing frequency around the world. These mortality rates may underestimate the burden of disease as lack of knowledge about the disease may lead to underreporting. These data are mortality rates and not incidence data; hence Bronchiectasis remains a significant concern where ...
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...m. Respirology, 8 (2), pp. 181-5.
Shoemark, A., Ozerovitch, L. and Wilson, R.
Shoemark, A., Ozerovitch, L. and Wilson, R. 2007. Aetiology in adult patients with bronchiectasis. Epub, 101 (6), pp. 1163-70.
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Subotic, D. and Lardinois, D. 2013. Chapter 9. Surgical treatment of bronchiectasis. European Respiratory Society Monograph, 61 pp. 90-106.
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Textbookofbacteriology.net. 2013. Bacterial Resistance to Antibiotics. [online] Available at: http://textbookofbacteriology.net/themicrobialworld/bactresanti.html [Accessed: 31 Dec 2013].
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Additionally, some of the general diagnostic and pulmonary function tests are distinct in emphysema in comparison to chronic bronchitis. In the case of R.S. the arterial blood gas (ABG) values are the following: pH=7.32, PaCO2= 60mm Hg, PaO2= 50 mm Hg, HCO3- = 80mEq/L. R.S.’s laboratory findings are indicative of chronic bronchitis, where the pH and PaO2 are decreased, whereas PaCO2 and HCO3- are increased, when compare to normal indices. Based on the arterial blood gas evaluation, the physician can deduce that the increased carbon dioxide is due to the airway obstruction displayed by the hypoventilation. Furthermore the excessive mucus production in chronic bronchitis hinders proper oxygenation leading to the hypoxia. On the other hand, in emphysema the arterial blood gas values would include a low to normal PaCO2 and only a slight decrease in PaO2 which tend to occur in the later disease stages.
Chronic bronchitis differs from emphysema in that it affects the bronchioles. There are two forms of bronchitis: chronic and acute. We are going to focus on chronic bronchitis. In this disease, the bronchioles become thick and inflamed. The affected person might cough up thick mucus which can also block the bronchioles.
...spiratory infections. The patient must always be under continuous scrutiny since they can undergo aspiration or lack the ability to change from the passageway to their lungs versus their stomach and their spit travels to the lungs which, in turn, causes bronchopneumonia. The patient also does not have the facility to cough and so must undertake a treatment to shake up their body to eliminate the mucus from the lining of their lungs.
Healthy lung tissue is predominately soft, elastic connective tissue, designed to slide easily over the thorax with each breath. The lungs are covered with visceral pleura which glide fluidly over the parietal pleura of the thoracic cavity thanks to the serous secretion of pleural fluid (Marieb, 2006, p. 430). During inhalation, the lungs expand with air, similar to filling a balloon. The pliable latex of the balloon allows it to expand, just as the pliability of lungs and their components allows for expansion. During exhalation, the volume of air decrease causing a deflation, similar to letting air out of the balloon. However, unlike a balloon, the paired lungs are not filled with empty spaces; the bronchi enter the lungs and subdivide progressively smaller into bronchioles, a network of conducting passageways leading to the alveoli (Marieb, 2006, p. 433). Alveoli are small air sacs in the respiratory zone. The respiratory zone also consists of bronchioles and alveolar ducts, and is responsible for the exchange of oxygen and carbon dioxide (Marieb, 2006, p. 433).
Haas, D. F. (1990). The Chronic Bronchitis And EMPHYSEMA. New York,NY: John Wiley and Sons, Inc.
Although lung cancer is generally operable, by using either traditional open surgery, or one of the less intrusive and more sophisticated video-assisted thoracoscopic surgeries (VATS), often it may not be considered to be the best option for a patient. Where ill-health is a factor, or either the size and location of the tumor is deemed to be a consideration, other forms of treatment may well have to be considered.
later brings up green and yellow mucus. The cough may persist to 4 to 6
Person, A. & Mintz, M., (2006), Anatomy and Physiology of the Respiratory Tract, Disorders of the Respiratory Tract, pp. 11-17, New Jersey: Human Press Inc.
The clinical manifestation one may see in patients with chronic bronchitis are chronic cough, weight loss, excessive sputum, and dyspnea. Chronic cough is from the body trying to expel the excessive mucus build up to return breathing back to normal. Dyspnea is from the thickening of the bronchial walls causing constriction, thereby altering the breathing pattern. This causes the body to use other surrounding muscles to help with breathing which can be exhausting. These patients ca...
...llen S. “Dysphagia and Aspiration Pneumonia in Older Adults.” Journal of the American Academy of Nurse Practitioners 22 (2010) 17-22 *
Introduction: This paper will discuss a case study of Liam, a three-month-old boy who is transferred from the General Practitioner (GP) to a paediatric ward with bronchiolitis. Initially, Liam’s chief health issues will be identified, followed by a nursing assessment and diagnosis of the child’s needs. Focus will be made on the management of two major health problems: respiratory distress and dehydration, and summary and evaluation of the interventions with evidence of learning. Lastly, a conclusion of the author’s self-evaluation will be presented. Identification of specific key issues: Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days.
Hess Dean R., M. N. (2012). Respiratory Care: Principles and Practice 12th Edition. Sudbury, MA: Jones and Bartlett Learning.
Parker, Steve. "Chronic Pulmonary Diseases." The Human Body Book. New ed. New York: DK Pub., 2007.
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
Auscultation: Breath sounds vary in intensity, volume, and duration, depending on the site along the tracheobronchoalveolar system. In the upper part of the respiratory tree, over the trachea, breath sounds should be bronchial, Over the bronchi, the bronchovesicular sounds are of a medium intensity while the vesicular sounds over the peripheral lung tissue are, softer in volume with a shorter expiratory phase (Jo & Laurie 2014). In abnormal findings, there is increased breath sounds over peripheral lung regions indicate consolidation, usually seen with pneumonia. Decreased, or softer, peripheral breath sounds can also be heard as a when there is bronchial obstruction or pleural effusion. (Jo & Laurie 2014)