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What are the three forms of Bronchiectasis?
Cylindrical, Varicose, and Cystic.
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What kind of Bronchiectasis is Also called Tubular bronchiectasis � bronchi are dilated and rigid resembling a tube on X-ray
Cylindrical
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What kind of bronchiectasis is Also called Fusiform bronchiectasis � bronchi are dilated and constricted in an irregular pattern resulting in the bulbous shape on X-ray
Varicose
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What kind of bronchiectasis is Also called Saccular bronchiectasis � bronchi progressively increase in diameter until they end up as large sacs in the parenchyma
Cystic
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What are some anatomic alterations of the lungs that are seen with bronchiectasis?
Chronic dilation and distortion of bronchial airways from repeated infection, Excessive production of often foul-smelling sputum, Bronchospasm, Hyperinflation of alveoli (air-trapping), Atelectasis, and parenchymal fibrosis, Hemorrhage secondary to bronchial arterial erosion
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What are the two classifications of Bronchiectasis?
Aquired and cengenital
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What classification of brinchiectasis has Recurrent and prolonged pulmonary infections in lower respiratory tract, Bronchial obstruction caused by foreign body aspiration, mucous pluggin, tumors, or enlarged hilar lymph nodes, Inhalation and aspiration in patients exposed to large amounts of fumes or aspiration of gastric fluids
Acquired
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What are the two types of congenital bronchiectasis?
Kartagener's syndrome and Systemic disorders
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Recessive genetic disorder. Referred to as: dextrocardia-bronchiectasis-sinusitis syndrome, primary ciliary dyskinesia (PCD), Immotile ciliary syndrome. Consists of heart on the right side, bronchiectasis and sinusitis
Kartagener's syndrome
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Congenital bronchiectasis that Contains: Rheumatologic disorders, Inflammatory bowel disease, AIDS
Systemic disorders
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What are the clinical manifestations of bronchiectasis?
Excessive bronchial secretions, bronchospasm, and increased alveolar-capollary membrane thickness
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What kind of vital signs would you expect from bronchiectasis?
In creased: RR, CR, and BP
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During the physical examination what will you see with bronchiectasis?
Use of accessory muscles w/ insp.&Expir., pursed lips, Barrel chest, Cyanosis, diggital clubbing, Peripheral edema and venous distention, cough, sputum production, and hemoptysis.
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Chest Assessment Findings: Decreased tactile and vocal fremitus, Hyperresonant percussion note, Diminished breath sounds, Wheezing, Rhonchi
Primarily obstructive in nature
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Chest Assessment Findings: Increased tactile and vocal fremitus, Bronchial breath sounds, Crackles, Whispered pectoriloquy, Dull percussion note
Primarily restrictive in nature
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What lung vols./capacities will increase or be N when obstructive?
VT, RV, FRC, TLC, RV/TLC
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What lng vols./capac. will decrease of be N when obstructive?
IRV, ERV, VC, IC
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What Forced Expiratory flow rate finding will you expect to be different w/ a restrictive nature of bronchiectasis?
FEV1%
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What type of blood gas will you see with Mild to mod. stages of bronchietasis?
pH up, PaCO2 dow, HCO3 dow. slight, PaO2 dow. (Acute alveolar hyperventilation w/ hypoxemia
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What kind of ABG will you see with severe stage of bronchiectasis?
pH N, PaCO2 inc, HCO3 inc. Signif., PaO2 low. (chronic bent. failure w/ hypoxia)
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Because acute ventilatory changes are frequently seen in patients with chronic ventilatory failure, the respiratory care practitioner must be familiar with and alert for the following:
Acute alveolar hyperventilation superimposed on chronic ventilatory failure. Acute ventilatory failure (acute hypoventilation) superimposed on chronic ventialtory failure.
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What O2 indices are increase?
Qs/QT and O2ER
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What O2 indices are normal?
VO2 and C(a-v)O2
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What O2 indices are lower?
DO2 and SvO2
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What kind of Hemodynamic indices will be Normal?
PCWP, CO, SV, SVI, CI, LVSWI, and SVR
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what kind of hemodynamic indices will be increased?
CVP, RAP, PA, RVSWI, and PVR
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What are some abnormal Lab tests seen?
Increase hematocrit, hemoglobin, and WBC if infection present
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What kind of X-ray findings would you expect when When the bronchiectasis is primarily obstructive in nature
Translucent (dark) lung fields, Depressed or flattened diaphragms, Long and narrow heart (pulled down by diaphragms), Areas of consolidation and/or atelectasis may or may not be seen.
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In a CT scan how may the bhronchial walls appear?
Thick, Dilated, Characterized by ring lines or clusters, Signet ring-shaped, Flamed-shaped
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What is the general management of bronchiectasis?
Controlling pulmonary infections, Controlling airway secretions, Preventing complications, Oxygen Therapy Protocol, Bronchopulmonary Hygiene Therapy Protocol, Lung Expansion Therapy Protocol, Aerosolized Medication Therapy Protocol, Mechanical ventilation protocol, Expectorants, Antibiotics
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