內(nèi)科護(hù)理學(xué)英語考試資料第1頁/共22頁Bronchiectasis

支氣管擴(kuò)張第2頁/共22頁P(yáng)athophysiology

Bronchiectasis支氣管擴(kuò)張

isadisordercharacterizedbypermanent,abnormaldilatation擴(kuò)張ofoneormoremedium-sizedanddiametergreaterthan2mmproximalbronchi近端支氣管.Pathophysiologicchangethatresultindilatationisdestructionoftheelastictissue彈性組織andmuscularstructuresofthebronchialwall支氣管壁.第3頁/共22頁Etiology病因Thediseaseprocessisoftenbelievedtostartinchildhoodasanacquireddisorder,beginningwithrespiratorycomplicationssecondarytoinfluenza流行性感冒,measles麻疹,orwhoopingcough百日咳.Infantbronchial-lunginfection嬰幼兒期支氣管-肺組織感染isthemostcommoncauseofbronchiectasis.Recurringlowerrespiratorytractinfectionsareanotherpatternofdiseaseinchildhoodthatmaypredisposeanindividualtobronchiectasis.Thispatternistypicallyseenintheindividualwhohascysticfibrosis囊腫性纖維化,asthma哮喘,a-1aitirypsindeficiency抗胰蛋白酶不足,orimmunodeficiencydiseases免疫缺陷疾病.第4頁/共22頁P(yáng)athologictypes病理類型

Saccularbronchiectasis囊狀支氣管擴(kuò)張:occursmainlyinlargebronchiandischaracterizedbycavity-likedilatations.Theaffectedbronchiendinlargesacs.Cylindricalbronchiectasis圓柱支氣管擴(kuò)張:involveinmedium-sizedbronchithataremildlytomoderatelydilated.第5頁/共22頁P(yáng)athophysiology病理生理Almostallformsofbronchiectasisareassociatedwithbacterialinfection細(xì)菌感染.Infectionscausethebronchialwallstobeweaken,andpocketsofinfectionbegintoform.Whenthewallsofthebronchialsystemareinjured,themucocilliarymechanism粘膜-纖毛防御機(jī)制

isdamaged,allowingbacteriaandmucustoaccumulatewithinthepockets.Theinfectionbecomesworseandresultsinbronchiectasis.第6頁/共22頁Classification分類

Localizedbronchiectasis局部支氣管擴(kuò)張:resultsfromfocalairwayobstruction,orfromnecrotizing壞死性orlobarpneumonia大葉性肺炎whosebronchiectaticsequelae后遺癥arelimitedtooneareaofthelung.Obstructiveprocessesofanykindcanpredisposeanindividualtobronchiectasis.Theobstructioncausesthebronchi支氣管andbronchioles細(xì)支氣管todistendandballoonoutbelowthelevelofobstruction.第7頁/共22頁Classification分類

2. Generalizedbronchiectasis廣泛性支氣管擴(kuò)張:ismultifocalnecrotizing

多灶性壞死性bacterialinfection,butotherconditioncanpredisposepersonstothedevelopmentofbronchiectasis,suchas:Congenital先天性factors:alteredbronchialstructuressuchascysts支氣管囊腫andcul-de-sacs盲囊,whichleadtopoolingofsecretion.Avarietyofimmunodeficiencydiseases免疫缺陷疾病areassociatedwithrecurrentbacterialpneumonia.Someinhalationexposures,particularlytoirritantgasessuchasoxidesofsulfur硫氧化物andnitrogen氮,havebeennoticedascausesofbronchiectasis.第8頁/共22頁Clinicalmanifestation臨床表現(xiàn)

Theprimarymanifestationsofbronchiectasisvaryconsiderably,dependingontheextentandlocationofthediseaseprocess:Chroniccoughwithproductionofmucopurulentsputum黏液性膿性痰;thecoughisparoxysmal陣發(fā)性andisoftenstimulatedwithpositionchanges.*Hemoptysis咯血Recurrentpneumonia肺炎Exertionaldyspnea運(yùn)動(dòng)性呼吸困難Fatigue

疲勞WeightlossAnorexia厭食癥Fetidbreath惡臭呼吸第9頁/共22頁Diagnosticstudies輔助檢查Anindividualwithachronicproductivecoughwithcopioussputum(whichmaybebloodstreaked血絲shouldbesuspectedofhavingbronchiectasis.Characteristicfindingsinthehealthhistorysuchaschildhooddiseasescomplicatedbyrespiratoryinfectionsorchronicbronchitisaresignificant.ChestX-raymayshowstreakyinfiltrates.Bronchoscope支氣管鏡maybeusefulinidentifyingthesourceofsecretionsorsitesofhemoptysisintheindividualwithchronicproductivecough.Sputumcollection痰液收集mayprovidewithadditionalinformationregardingtheseverityofimpairmentandthepresenceofactiveinfection.Pulmonaryfunction肺功能測試testmaybeabnormalinadvancedbronchiectasis.Acompletebloodcount血細(xì)胞計(jì)數(shù)maybenormalorshowevidenceofanemiaandleukocytosis.第10頁/共22頁Therapeuticmanagement治療方案Antibiotics抗生素arethemajorformoftreatmentandshouldbegivenonthebasisofsputumculture痰培養(yǎng)result.Maintaininggoodhydrationisimportanttoliquefysecretions.Encouragedailydrinkingwaterofnotlessthan1500~2000ml.Posturaldrainage體位引流isvitaltofacilitateexpectorationofsputum咳痰.Theindividualshouldreduceexposuretoexcessiveairpollutantsandirritants,avoidcigarettesmokingandobtainpneumococcal肺炎球菌andinfluenzavaccinations流感疫苗接種.Surgicalresectionofpartsofthelungsmaybedoneifconservativetreatmentisnoteffective;surgicalinnotavailablewhenthereisdiffuseorwidespreadinvolvement.第11頁/共22頁第12頁/共22頁第13頁/共22頁NursingmanagementAcuteandchronicinterventionAnimportantnursinggoalistopromotedrainage引流andremovalofbronchialmucus支氣管黏液.Someindividualsrequireelevationofthefootofthebedby4to6itchestofacilitatedrainage.Posturaldrainage體位引流shouldbedoneontheaffectedpartsofthelungs患側(cè)肺部.Thepatientsshouldbetaughteffectivedeep-breathingexercises深呼吸練習(xí)andeffectivewaystocough.Administrationoftheprescribedantibiotics抗生素,bronchodilators支氣管擴(kuò)張劑orexpectorantsisimportant祛痰劑.第14頁/共22頁Nursingmanagement護(hù)理措施AcuteandchronicinterventionBedrestmaybeindicatedduringtheacutephaseoftheillness,chillingandexcessfatigueshouldbeavoided.Goodnutritionisimportantbutmaybedifficulttomaintainbecausethepatientisoftenanorexic.Oralhygienetocleansethemonthandremovedriedsputumcrustsmayimprovethepatient’sappetite.Adequatehydrationtohelpliquefysecretion,thusthepatientshouldbeinstructedtodrinkatleast3Loffluiddaily.However,generallythepatientshouldbecounseledtouselow-sodiumfluidstoavoidsystemicfluidretention.第15頁/共22頁Nursingmanagement護(hù)理措施AcuteandchronicinterventionThepatientwithbronchiectasisshouldavoidultrasoundnebulizers超聲霧化吸入becausetheyofteninducebronchospasm支氣管痙攣.Itisimportantthatthepatientmedicatewithaninhaledbronchodilator10to15minutesbeforetopreventbronchoconstriction.Thepatientandfamilyshouldbetaughttorecognizesignificantmanifestationtobereportedtothehealthcareproviders,thesemanifestationincludeincreasedsputumproduction,grosslybloody血腥痰sputum,increasingdypsnea呼吸困難,fever,chills發(fā)燒,andchestpain.第16頁/共22頁HemoptysisHemoptysisistheexpectoration(coughingup)ofbloodorofblood-stainedsputumfromthebronchi,larynx,trachea,orlungs.<100ml：smallvolume；=100~500ml:moderatevolume；>500mlor>100~500ml/time:massivevolume。第17頁/共22頁Nursingmanagement護(hù)理措施Hemoptysiscare咯血的護(hù)理Promotepersonalandspecialenvironmenttodecreaseanxietyfromdisease.Keepingthepatientatrest,positionformaximalaerationoflungfields,thebleedinglungshouldbeplacedinthedependentposition,sothatbloodisnotaspiratedintotheunaffectedlung.Whenhelpingpatientcough,usewhateverpositionbestensurescooperationandminimizesenergyexpenditure.Usingsuctionasordered,whenit’sneeded.withmassivebleeding,endotrachealintubation氣管內(nèi)插管andmechanicalventilation機(jī)械通氣maybeneededtocontrolairwayandmaintainadequategasexchange.Ifthereismassivebleedingwhichispronetobesuffocated,preparingforendotrachealintubation氣管內(nèi)插管,asorder.Monitoranddocumentvitalsigh,bleedingcharacteristictogaugetherapy’seffectivenessanddetectpossibleprogression.第18頁/共22頁咯血的護(hù)理促進(jìn)個(gè)人和特殊的環(huán)境，減少焦慮。保證病人休息和正確體位，能夠最大限度促使肺野的通氣。小量咯血應(yīng)靜臥休息，大量咯血者需絕對臥床休息。肺出血時(shí)應(yīng)協(xié)助患者在患側(cè)臥位，從而使血液不能被吸入健側(cè)。當(dāng)幫助病人咳嗽時(shí)，選擇任何合適的位置，最好確保病人能夠配合的同時(shí)最大限度地減少能量和體力的消耗。及時(shí)為病人漱口，擦凈血跡，保持口腔清潔，舒適，防止口腔異味刺激，再度引起咯血。如果需要，遵醫(yī)囑使用吸引。當(dāng)患者出現(xiàn)大出血，可能需要?dú)夤軆?nèi)插管和機(jī)械通氣，以控制呼吸道和保持足夠的氣體交換。如果有大量出血，患者很容易被窒息，因此，必須遵醫(yī)囑準(zhǔn)備氣管插管。監(jiān)測并記錄生命體征，出血的情況，用于衡量治療的效果和發(fā)現(xiàn)疾病可能的進(jìn)展。遵醫(yī)囑用止血藥，抗生素，祛痰劑，支氣管舒張藥。大咯血可使用垂體后葉素。劇烈咳嗽者給予小劑量鎮(zhèn)靜劑。煩躁不安者適當(dāng)選用鎮(zhèn)靜劑如地西拌，禁用嗎啡，派替啶以免抑制呼吸。第19頁/共22頁asphyxia窒息Ifthepatientpresentstressed精神緊張,restless坐臥不安anddullcomplexion面色晦暗,poorinhemoptysis,itisoftenchokingsign窒息先兆.Ifthepatientsuddenlybecomedread表情恐怖,chesttightness胸悶,shortnessofbreath氣促,cyanosis發(fā)紺ofmouthandlip

.sweating,orlossofconsciousness意識(shí)喪失,etc.,indicatingthatasphyxia窒息hasoccurred,itshouldbeurgentlyaddressed.第20頁/共22頁NursingcareforasphyxiaFirstaiditemsareready,closelymonitorpatientswithaurasuffocation.Whensignsofa