EMPHYSEMA

DEFINITION:

- Is a chronic lung disease caused by damage to the alveoli, the tiny air sacs in the lung where
the exchange of oxygen and carbon dioxide takes place.

ANATOMY AND PHYSIOLOGY:

- The nostrils: Nostrils are involved in air intake, i.e. they bring air into the nose, where air is warmed
and humidified. The tiny hairs called cilia filters out dust and other particles present in the air and
protects the nasal passage and other regions of the respiratory tract.
- Trachea: The trachea is also known as windpipe. The trachea filters the air we inhale and branches into
the bronchi.
- Bronchi: The bronchi are the two air tubes that branch off of from the trachea and carry atmospheric
air directly into the lungs.
- Lungs: The main organ of the respiratory system is lungs. Lungs are the site in body where oxygen is
taken into and carbon dioxide is expelled out. The red blood cells present in the blood picks up the
oxygen in the lungs and carry and distribute the oxygen to all body cells that need it. The red blood
cells donate the oxygen to the cells and picks up the carbon dioxide produced by the cells.
- Alveolus: Alveolus is the tiny sac like structure present in the lungs which the gaseous exchange takes
place.
- Diaphragm: Breathing begins with a dome-shaped muscle located at the bottom of the lungs which is
known as diaphragm. When we breathe in the diaphragm contracts and flatten out and pull downward.
Due to this movement the space in the lungs increases and pulls air into the lungs. When we breathe
out, the diaphragm expands and reduces the amount of space for the lungs and forces air out.

ETIOLOGY:

The main cause of emphysema is long-term exposure to airborne irritants, including:

- Tobacco smoke
- Marijuana smoke
- Air pollution
- Chemical fumes and dust
Rarely, emphysema is caused by an inherited deficiency of a protein that protects the elastic structures in the
lungs. It's called alpha-1-antitrypsin deficiency emphysema.
SYMPTOMATOLOGY:

- Shortness of Breath = Most Common Symptom

- Cough
- Wheezing
- Chest Pain
- Cyanosis
- Exercise Intolerance
- Barrel Chest

GENERAL PATHOPHYSIOLOGY:
 MEDICAL MANAGEMENT

LABORATORY TEST:

(1) “CHEST X-RAY”

- Help support a diagnosis of advanced emphysema and rule out other causes of shortness of breath. But
the chest X-ray can also show normal findings if you have emphysema. The X-ray also may show the
presence of an infection or a mass in the lung (such as a tumor) that could explain your symptoms.
(2) “COMPUTERIZED TOMOGRAPHY (CT) SCANS”
- Combine X-ray images taken from many different directions to create cross-sectional views of internal
organs. CT scans can be useful for detecting and diagnosing emphysema. You may also have a CT scan if
you're a candidate for lung surgery.
(3) “LAB TESTS”
- Blood taken from an artery in your wrist can be tested to determine how well your lungs transfer
oxygen into, and remove carbon dioxide from, your bloodstream.
(4) “LUNG FUNCTION TESTS”
- Noninvasive tests that measure how much air your lungs can hold and how well the air flows in and out
of your lungs. They can also measure how well your lungs deliver oxygen to your bloodstream. One of
the most common tests uses a simple instrument called a spirometer, which you blow into.

MEDICATIONS:

(1) “BRONCHODILATORS”
- These drugs can help relieve coughing, shortness of breath and breathing problems by relaxing
constricted airways.
(2) “INHALED STEROIDS”
- Corticosteroid drugs inhaled as aerosol sprays reduce inflammation and may help relieve shortness of
breath.
(3) “ANTIBIOTICS”
- If you have a bacterial infection, like acute bronchitis or pneumonia, antibiotics are appropriate.

TREATMENT AND/OR SURGERY:

(1) “LUNG VOLUME REDUCTION SURGERY”

- In this procedure, surgeons remove small wedges of damaged lung tissue. Removing the diseased
tissue helps the remaining lung tissue expand and work more efficiently and helps improve breathing.
(2) “LUNG TRANSPLANTATION”
- Lung transplantation is an option if you have severe lung damage and other options have failed.

NURSING MANAGEMENT:

1) Auscultate lung sounds.

2) Monitor vital signs, O2 saturation and ABG.
3) Maintaining a patent airway is a priority. Use a humidifier at night to help the patient mobilize
secretions in the morning.
4) Encourage the patient to use controlled coughing to clear secretions that might have collected in the
lungs during sleep.
5) Instruct the patient to sit at the bedside or in a comfortable chair, hug a pillow, bend the head
downward a little, take several deep breaths, and cough strongly.
 6) Place patients who are experiencing dyspnea in a high Fowler position to improve lung expansion.
Placing pillows on the overhead table and having the patient lean over in the orthopneic position may
also be helpful. Teach the patient pursed-lip and diaphragmatic breathing.
7) To avoid infection, screen visitors for contagious diseases and instruct the patient to avoid crowds.
8) Conserve the patient’s energy in every possible way. Plan activities to allow for rest periods, eliminating
nonessential procedures until the patient is stronger. It may be necessary to assist with the activities of
daily living and to anticipate the patient’s needs by having supplies within easy reach.
9) Refer the patient to a pulmonary rehabilitation program if one is available in the community.
10) Patient education is vital to long-term management. Teach the patient about the disease and its
implications for lifestyle changes, such as avoidance of cigarette smoke and other irritants, activity
alterations, and any necessary occupational changes. Provide information to the patient and family
about medications and equipment.

POSSIBLE PRIORITY NURSING DIAGNOSIS:

(1) Impaired Gas Exchange r/t alveolar-capillary membrane changes and destruction.
(2) Ineffective Airway Clearance r/t increased production or retained tenacious secretions, decreased
energy level and muscle wasting.
(3) Activity Intolerance r/t imbalance between O2 supply and demand.
(4) Imbalanced Nutrition: Less than Body Requirements r/t inability to ingest food (shortness of breath,
anorexia, generalized weakness, medication side effects).
(5) Risk for Infection r/t risk factors of inadequate primary defenses (stasis of body fluids, decreased
ciliary action), chronic disease process and malnutrition.

PROGNOSIS:

- Depending on the severity of the condition and whether or not the patient continues to smoke.
Although the disease is progressive and irreversible, patients who stop smoking and receive oxygen
therapy generally have a longer life expectancy.