Bronchiectasis

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CASE STUDY OF A PATIENT WITH BRONCHIECTASIS
INTRODUCTION
The respiratory system is divided into upper and lower respiratory system. The upper respiratory system refers to the nose, pharynx and associated structure while the lower respiratory system contains the larynx. Bronchiectasis is an uncommon type of chronic obstructive pulmonary lung disease. Bronchiectasis can be categorized as a chronic obstructive pulmonary lung disease manifested by airways that are inflamed and easily collapsible, resulting in air flow obstruction with shortness of breath, impaired clearance of secretions often with disabling cough, and occasionally hemoptysis. In this case study, a patient is suffering from bronchiectasis. Bronchiestasis is further defined and the pathophysiological action that take place are during this diease is also highlighted. The physical assessment is done to confirm this diagnosis, therefore, there is also a brief outline of the physical assessment being carried out with the results. Lastly, the drugs are outlined to treat bronchiectasis together with their pharmacokinetics and pharmacodynamics. Also, the effect of one of the drugs on two body system has been discussed. This assignment will help broaden our knowledge on the uncommon type of chronic obstructive pulmonary disorder.

HEALTH HISTORY
Name: John X.
Age: 42 years
Hospital: CWM
Date of admission: 12th November, 2010
Social History
Race: Fijian
Religion: Christianity
Marital Status: Married
He lives with his father, wife and four children.
He has been a non-smoker for two years but has been smoking since he was 2o years old. He at times drinks alcohol and Kava. Family History:
Paternal side: grandfather had hypertension and was positive for pulmonary tuberculosis. Medical History
Principal Diagnosis: Chronic bronchiectasis
Current Medical History
Mr. X was admitted to the hospital upon presenting signs and symptoms of chronic cough (more than 6 years), shortness of breath at rest and while moving about, and production of foul smelling, yellowish, thick sputum. On admission he was conscious, alert, oriented, and had clear speech. He can mobilize but prefers not to. He does not have any allergies and is neither diabetic nor asthmatic. He is currently on chloramphenicol and Ventolin for his treatment regime.

Past Medical History
He was previously admitted a number of times due to the same signs and symptoms and a suspect of being positive for tuberculosis. However, the test was negative. He was prescribed ventolin for shortness of breath.

PATHOPHYSIOLOGY
Bronchiestasis is the abnormal dilation of the bronchial wall muscle due to obstruction. According to Porth (2005), it is characterized by permanent dilation of the bronchi and the bronchioles caused by destruction of muscle and elastic supporting tissue resulting from a vicious cycle of infection and inflammation. This disease is secondary to chronic infection and obstruction of the bronchial passage. There are many changes that occur such as edema formation, scarring of the tissues in the bronchial wall, inflammation and ulceration.

Some of the common causes of bronchiectasis are cystic fibrosis, immune defects, and recurrent infections. All these causative factors impair the airway clearance system together with the host’s defense system and this leads to accumulation of the secretions in bronchi. The body has impaired ability to clear up secretions causes colonization and infection. Since the secretion harbors the microorganisms, it triggers the host’s body defense system to “respond through neutrophilic proteases, inflammatory cytokines, nitric oxide, and oxygen radicals” (www. emedicine.medscape.com) to counteract this reaction. These infections further damage the bronchi and the cycle of infection continues. These processes damage the muscular walls and the elasticity of the bronchial wall. This cause the bronchial walls to dilated and remain dilated since the elasticity is...
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