Health reminder: the treatment principle of bronchiectasis is to eliminate the pathogen, promote sputum excretion, control infection and other conservative medical treatment, if necessary, surgical operation. Bronchiectasis is preventable. Early treatment of respiratory tract infection in infants and young children should be actively carried out, and vaccination against pertussis, measles and other infectious diseases should be carried out to reduce bronchiectasis.
(1) General nursing: Patients with severe bronchiectasis infection and systemic reactions such as high fever and hemoptysis should stay in bed, keep the ward environment clean, quiet and fresh air, change bedding at any time, and keep the bed unit clean and tidy. When high fever, according to the nursing of patients with high fever, sweating patients, should pay attention to supplement liquid, prevent dehydration. Timely clean up the secretion in the mouth, do oral care, keep the mouth clean, and prevent the occurrence of stomatitis. Encourage patients to eat as much as possible, and the choice of diet should meet the physiological and energy needs of patients. We should give high protein, high calorie, multi vitamin, easy to digest diet, supplement body consumption, improve the ability of disease resistance.
(2) Remove the cause of disease: many bronchiectasis patients with chronic sinusitis, gingivitis, alveolar effusion, chronic tonsillitis, often have purulent secretion into the bronchus, so that repeated infection of the bronchus, therefore, we must first remove these diseases, to avoid inducing factors.
(3) The amount, smell, color and stratification of sputum were observed closely, and sputum samples were sent to laboratory in time.
(4) Active anti infection, keep respiratory tract unobstructed
① The sensitive antibiotics were selected according to the bacterial culture and drug sensitivity test of sputum. It can be used for systemic and topical use. When the patient has cough and sputum is thick and sticky, antibiotics and chymotrypsin can be inhaled into ultrasonic atomization to achieve the purpose of eliminating phlegm, moistening respiratory tract and diluting sputum.
② Keeping the breath unobstructed, eliminating the secretion in the trachea, reducing the accumulation of sputum in the airway and pulmonary bronchus, and removing the places where bacteria grow and propagate are the main links to control the infection.
(5) Nursing of bronchial drainage: first of all, expectorants should be given to make sputum thinner and easier to cough up, so as to reduce bronchial infection and systemic toxicity. Guide the patient to make the side of the patient up and the mouth down according to the location of the lesion, deep breathing and coughing, and assisting to pat the back to make the secretion vibrate in the trachea, and discharge the secretion out of the body with the help of gravity. If necessary, atomization inhalation can be carried out, and the effect is better. Position drainage should be performed on an empty stomach, 2-4 times a day, 15-20 minutes each time. During drainage, the patient's respiration, pulse and other changes should be observed. In case of dyspnea, palpitation, cold sweat and other symptoms, the drainage should be stopped and oxygen inhalation should be given in the semi recumbent or supine position. After drainage, patients should be assisted to clean oral secretions.
(6) Bronchography nursing: in order to determine the scope and location of bronchiectasis, bronchography is often used to determine. Before angiography, the purpose and precautions should be explained clearly to the patients, and the concerns and tensions should be relieved in order to obtain cooperation. Four hours before the operation, fasting and water deprivation should be conducted. After the operation, the patient should take food after the recovery of throat reflex to avoid choking and aspiration. Deep breathing and coughing should be done to facilitate the discharge of contrast medium.
(7) Hemoptysis nursing:
① Close observation of the disease changes. When a small amount of hemoptysis, ask patients to rest quietly, do a good job in mental care, relieve the tension of psychological state, can add a small amount of sedatives.
② Rescue nursing of massive hemoptysis. When massive hemoptysis, we should comfort patients, keep calm, cooperate with medical staff to actively treat and prevent asphyxia. First of all, we should prepare rescue items and drugs, such as aspirator, thick sputum suction tube, oxygen, tracheotomy treatment package, hemostatic agent, etc. Take the affected side lying head, head to one side, as far as possible to play out blood, keep airway unobstructed, if necessary, use suction tube suction. The rapid establishment of venous access and intravenous infusion of pituitrin can make the systemic arterioles contract, reduce the blood flow of the heart and lung circulation, and stop the bleeding of the lung. Intravenous pituitrin should adjust the input speed and observe the change of blood pressure. If the speed is too fast, nausea, vomiting, blood pressure rise and heart rate increase are easy to occur, so it is forbidden for patients with hypertension and coronary heart disease. If the massive hemoptysis stops suddenly, and the patient's face turns blue and his mind is dull, the possibility of asphyxia should be considered. The patient must be placed in a high position of head and feet immediately, and the blood clot in the trachea is sucked out with a thick suction tube. If necessary, endotracheal intubation or tracheotomy suction should be performed to relieve the obstruction. At the same time, blood transfusion, fluid infusion and other anti shock treatment were given.
(8) Nursing of selective bronchial artery embolization: for patients with repeated hemoptysis and ineffective medical treatment, we should also adopt the method of blood vessel embolism at bleeding site, which can save the critical patients with massive hemoptysis. Under X-ray, catheter was inserted through femoral artery, abdominal aorta and aorta to bronchial artery, and contrast agent was injected to determine the bleeding site. Then the cut gelatin sponge was filled above the bleeding site along the catheter to stop bleeding. The effect of this method is very good, postoperative patients need to rest in bed, give anti infection treatment, strengthen nutrition, continue to observe whether there is hemoptysis.
(9) Surgical treatment: if the patient has repeated massive hemoptysis, the lesion is limited, the medical treatment can not relieve the symptoms, the general condition and cardiopulmonary function are better, lobectomy and other surgical treatment can achieve better treatment effect, postoperative nursing should be done according to the requirements of thoracic surgery.
5. Prevention
Bronchiectasis is preventable. First of all, the respiratory tract infection of infants and young children should be actively treated and vaccinated against pertussis, measles and other infectious diseases, so as to reduce the incidence of bronchiectasis induced diseases.