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1、Bronchiectasis支气管扩张,Si Ting WangFaculty of Nursing GuangXi Traditional Chinese Medical University,翌魁驾揖换暂锦镣否山极几惯古汕搞靛娜屿屡疙植茫执弥俊辫歧漠娃刻梭内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,Pathophysiology,Bronchiectasis支气管扩张 is a disorder characterized by permanent,abnormal dilatation扩张of one or mor
2、e medium-sized and diameter greater than 2mm proximal bronchi近端支气管.Pathophysiologic change 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.,渤馁俊桥拦聪冬蔚踏驭按四惰枣搽租旦醇穆型帧情失瞧恳致欺荫默淋瘩节内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,E
3、tiology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 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 res
4、piratory tract infections are another pattern of disease in childhood that may predispose an individual to bronchiectasis.This pattern is typically seen in the individual 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.,呼锣御微剿刑诧耙题蹬渡改饵炎栽液华系民讳
5、驼漏甄帐壹匣蛤鳖帅镊床措内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,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 bronchiectasis圆柱支气管扩张:involve in medium-sized b
6、ronchi that are mildly to moderately dilated.,郝晶巴塘故尝撒桐堆疽演沸构闻员粳数募桃况汹传硼冠缆仑撵馅恶焰叹力内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,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
7、 infection begin to form.When the walls of 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.,颤桔可枯词潭抹茁隘子涕闰铬答宿感阀闭嫩更诸娄丛唱犹驮今窘疚佬家痔内科护理学课件 英语 考试资料Bronchiec
8、tasis内科护理学课件 英语 考试资料Bronchiectasis,Classification分类,Localized bronchiectasis局部支气管扩张:results from focal airway obstruction,or from 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
9、 bronchiectasis.The obstruction causes the bronchi支气管and bronchioles细支气管to distend and balloon out below the level of obstruction.,钩彼比移闸求徽无希值辙犊替福蜂适尧絮妮蔡抢染和办惕袒奇抛变徒葛范内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,Classification分类,2.Generalized bronchiectasis广泛性支气管扩张:is multifocal necrotizin
10、g 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 lead to pooling of secretion.A variety of immunodeficiency diseases免疫缺陷疾病are associated wit
11、h 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.,警凹婉蛋中韶柴卜推忌懊蝇路译隅规的肢落柴仍讥殆疟市琼盆庚后行桌旱内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,Clinical manifestation临床表现,The
12、 primary manifestations of bronchiectasis varyconsiderably,depending on the extent and locationof 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Exertional dyspne
13、a运动性呼吸困难Fatigue 疲劳Weight lossAnorexia厌食症Fetid breath恶臭呼吸,窃幅彪别廊授肢燎逼腾呜睬阐湃韭仍锣钠掐咖胡异干抑嫂鱼孪饼藐莹黑莽内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,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 bron
14、chiectasis.Characteristic findings in the health history such as childhood diseases 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
15、 individual with chronic productive cough.Sputum collection痰液收集may provide 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 evi
16、dence of anemia and leukocytosis.,蝎都趣靴拜眷透奋袋瞎脉锄梢噪纯休码砖褐仲桂祟捣狗歉旨蟹酋贝失处蔗内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,Therapeutic management治疗方案,Antibiotics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
17、 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 individual should reduce exposure to excessive air pollutants and irritants,avoid cigarette smoking and obtain pneumococcal肺炎球菌and influenza vacci
18、nations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 diffuse or widespread involvement.,唁靳邯居安佰腹衅秽格揭械藩拨贼貌寓灼咏姿邮惠更岁扛纤学骄蝇伟本全内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,者南狠秸枚要吕祟尊弗脉硕璃男裤卸供蓟哉噎恐襄勇醋
19、懊莉愧亭缀泊搭冯内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,儡夷逼允宝术碟涧争谩基写竟悔眠爸魁脊苗袍聋蚜撅预筑罕奖猛修伴唇置内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,Nursing management,Acute and chronic interventionAn important nursing goal is to promote drainage引流and removal of bronchial mucus支气管黏液.Some in
20、dividuals require elevation of the foot of the bed by 4 to 6 itches to facilitate drainage.Postural drainage体位引流should be done 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 anti
21、biotics抗生素,bronchodilators支气管扩张剂or expectorants is important祛痰剂.,填坛号狞隋遵贡暗篮蔬矗斤肃砰祁林斜张合摹皖潍成充匆侮生班敏馁溢莉内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,Nursing management 护理措施,Acute and chronic interventionBed rest may be indicated during the acute phase of the illness,chilling and excess fatigu
22、e 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 appetite.Adequate hydration to help liquefy secretion,thus the patient should be instructed
23、 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.,既肠冠主无栈憾头琼桑厕泽豆悦主叠栗朽劲醚骑剥板拦祷抓磁限么狱藤震内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,Nursing management护理措施,Acute and chronic interventionThe patie
24、nt 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 significant
25、 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.,涅用困幼江露渗沂臆羔冤英疮樊迪宣颖篓绚舀咳厅照爸绞揣扛匀豺汗隅溜内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,Hemoptysis,Hemop
26、tysisis the expectoration(coughing up)of blood or of blood-stained sputum from the bronchi,larynx,trachea,or lungs.500mlor 100500ml/time:massive volume。,暴漠扫浅矿瓶刺乙竟饰里勾蔑令烷漠巴脊艰矿捆纤缺韭形鲤商执医熟设论内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,Nursing management护理措施,Hemoptysis care咯血的护理Promote perso
27、nal and special environment to decrease anxiety from disease.Keeping the patient at rest,position for maximal aeration of lung fields,the bleeding lung should be placed in the dependent position,so that blood is not aspirated into the unaffected lung.When helping patient cough,use whatever position
28、best ensures cooperation and minimizes energy expenditure.Using suction as ordered,when its needed.with massive bleeding,endotracheal intubation气管内插管and 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 suff
29、ocated,preparing for endotracheal intubation气管内插管,as order.Monitor and document vital sigh,bleeding characteristic to gauge therapys effectiveness and detect possible progression.,畜梗桨搬郑暂玻荡溃屡氨观赏难邯废民疵蔓运干语掀嗡鸽药藻污哨框市硫内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,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
30、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，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
31、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。,救架顿纲译擦碴蔷漏备距脑末溃簇惯钳吵益反豁竹扣锭死接痛横蚤揣凡没内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,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 su
32、ddenly become 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.,徘王似洛灶终剔鄂樟缄广张郧哗痊蔼结箭腋拷亿肾光赘榷答毅憋寐坠茨撮内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,Nu
33、rsing 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
34、tracheostomy should be well prepared.Inform patients can not breath,so as not to induce laryngospasm.Timely clear blood clots in mouth and nasal,or quickly connected with a suction catheter into nasal tracheal suction to remove blood clots within the respiratory tract.If necessary,cooperating with d
35、octor to perform endotracheal intubation or a bronchoscope under direct vision draw blood clots.After blood clot removed,if the patient has not resumed spontaneous breathing,artificial respiration should be held to provide with high flow oxygen,or uesing respiratory stimulants.Close observation of d
36、isease,monitoring blood gas analysis and coagulation mechanisms to guard against the possibility of choking again.,讶档躁吞储分磺懈胎纪躬情澄婉钎镶阿茁乖派逼拄糯级檄钝耕孺涯凳濒缨内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,窒息的护理,备好急救物品，密切监测病人有无窒息先兆。当窒息发生或有窒息征象时，立即采取头低脚高体位，头偏向一侧，轻扣背部，排出血块，必要时做好气管插管或气切的准备。告知病人咯血时不能屏气，以免诱发喉头痉挛。及时清除口，鼻腔内血凝块，或迅速用鼻导管接吸引器插入气管内抽吸，以清除呼吸道内的积血。必要时配合医生行气管插管或气管镜直视下吸取血块。血块清除后，若病人自主呼吸尚未恢复，应行人工呼吸，给高流量吸氧或遵医嘱应用呼吸中枢兴奋剂。密切观察病情，监测血气分析和凝血机制，警惕再次窒息的可能。,刮苹朗庄捏琉滇贵缎菜盈氓扛膨扩刊孽圣嗓辛谍纯砰犬蹈挥焉法孜盈袁腿内科护理学课件 英语 考试资料Bronchiectasis内科护理学课件 英语 考试资料Bronchiectasis,
