EMPHYSEMA
INCLUDING THESE CONTENT
- INTRODUCTIONS
- DEFINITION OF
- EMPHYSEMA
- TYPES OF EMPHYSEMA
- CAUSES OF EMPHYSEMA
- RISK FACTORS OF EMPHYSEMA
- PATHOPHYSIOLOGY OF EMPHYSEMA
- SIGNS AND SYMPTOMS OF EMPHYSEMA
- DIAGNOSIS OF EMPHYSEMA
- MEDICAL TREATMENT OF EMPHYSEMA
- SURGICAL MANAGEMENT OF EMPHYSEMA
- NURSING MANAGEMENT OF EMPHYSEMA
- NURSING DIAGNOSIS ON EMPHYSEMA
- NURSING INTERVENTIONS OF EMPHYSEMA
Introduction
Emphysema is a chronic, progressive lung disease that is part of a group of conditions known as chronic obstructive pulmonary disease (COPD). This condition primarily affects the air sacs (alveoli) in the lungs, leading to their damage and destruction. Emphysema is characterized by breathlessness and a reduced capacity for physical activity due to impaired respiratory function.
Definition
Emphysema is defined as a pathological condition of the lungs marked by an abnormal increase in the size of the air spaces distal to the terminal bronchioles, with the destruction of their walls. This results in a decrease in the surface area available for gas exchange and the loss of elastic recoil, leading to difficulties in exhaling air.
Types
- Centrilobular (Centriacinar) Emphysema: This type primarily affects the upper lobes of the lungs and the central parts of the lobules. It is most commonly associated with long-term cigarette smoking and inhaled environmental pollutants.
- Panlobular (Panacinar) Emphysema: This form affects the entire acinus uniformly and is often seen in the lower lobes of the lungs. It is typically associated with alpha-1 antitrypsin deficiency, a genetic disorder.
- Paraseptal (Distal Acinar) Emphysema: This type involves the distal part of the acinus and is often located near the pleura or along the lobular septa. It can be associated with spontaneous pneumothorax in young adults.
Causes
- Smoking: The leading cause of emphysema is prolonged tobacco smoking, which contributes to the destruction of alveolar walls.
- Alpha-1 Antitrypsin Deficiency: A genetic condition that can cause emphysema even in non-smokers due to the lack of a protective enzyme in the lungs.
- Environmental Factors: Long-term exposure to airborne irritants such as industrial pollutants, chemical fumes, and dust.
- Chronic Respiratory Infections: Repeated lung infections can contribute to lung damage and emphysema development.
Risk Factors
- Smoking: The most significant risk factor for emphysema.
- Age: Emphysema is more common in people over the age of 40.
- Exposure to Secondhand Smoke: Inhalation of smoke from other people’s cigarettes.
- Occupational Exposures: Jobs that involve exposure to dust, chemicals, and fumes.
- Genetic Factors: Family history of emphysema and genetic disorders like alpha-1 antitrypsin deficiency.
- Air Pollution: Long-term exposure to polluted air.
Pathophysiology
Emphysema results from the destruction of alveolar walls due to an imbalance between proteases (which break down proteins) and antiproteases (which protect against such damage). In smokers, the inhalation of cigarette smoke stimulates the release of proteolytic enzymes from inflammatory cells, overwhelming the lung’s protective mechanisms. This leads to the loss of elastic fibers and structural support, causing the airways to collapse during exhalation and trapping air in the lungs. This air trapping results in hyperinflation and reduced gas exchange efficiency.
Step By Step
Due to etiological factor especially smoking
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Increase neutrophils and macrophages
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Deficiency of Alpha-1-antitrypsin
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Increased trypsin
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Imbalance between elastase and protease
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Breakdown of elastin and connective tissue in the lungs
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Destruction of alveolar septa, pulmonary capillaries and loss of plastic recoil of alveoli
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Collapse of the alveoli and septa
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Formation of bullae air pockets between alveolar space and within parenchyma of the lungs
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Airway obstruction and dyspnea
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Impaired gaseous exchange
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Emphysema
Signs and Symptoms
- Shortness of Breath (Dyspnea): Initially on exertion, later even at rest.
- Chronic Cough: Often accompanied by sputum production.
- Wheezing: Due to narrowed airways.
- Chest Tightness: A sensation of pressure in the chest.
- Fatigue: Due to reduced oxygenation.
- Weight Loss: Unintentional, due to the increased effort of breathing.
- Barrel Chest: An increased anteroposterior diameter of the chest.
Diagnosis
- Medical History and Physical Examination: Evaluation of symptoms, smoking history, and physical signs like wheezing and barrel chest.
- Pulmonary Function Tests (PFTs): Measurement of lung volumes and capacities, particularly the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC).
- Imaging: Chest X-rays and CT scans to visualize the extent of lung damage and hyperinflation.
- Blood Tests: To check for alpha-1 antitrypsin deficiency and assess blood oxygen and carbon dioxide levels.
- Arterial Blood Gas (ABG) Analysis: To evaluate gas exchange and acid-base balance.
Medical Treatment
1. Bronchodilators
Medications like beta-agonists and anticholinergics to relax the muscles around the airways.
2. Inhaled Corticosteroids
To reduce inflammation in the airways.
3. Phosphodiesterase-4 Inhibitors
To decrease inflammation and relax the airways.
4. Antibiotics
For bacterial infections that can exacerbate symptoms.
5. Oxygen Therapy
For patients with severe emphysema and low blood oxygen levels.
6. Smoking Cessation
Essential for slowing disease progression.
Surgical Management
- Lung Volume Reduction Surgery (LVRS): Removal of damaged lung tissue to improve lung function.
- Bullectomy: Removal of large air spaces (bullae) that compress healthy lung tissue.
- Lung Transplant: For severe, end-stage emphysema when other treatments are ineffective.
Nursing Management
- Assessment: Regular monitoring of respiratory status, oxygen saturation, and signs of infection.
- Education: Teaching patients about smoking cessation, medication adherence, and lifestyle modifications.
- Breathing Techniques: Instructing on techniques like pursed-lip breathing and diaphragmatic breathing.
- Nutritional Support: Ensuring adequate nutrition to maintain body weight and muscle mass.
- Physical Activity: Encouraging regular, moderate exercise to improve overall health and lung function.
- Psychosocial Support: Providing emotional support and counseling to cope with chronic illness.
Nursing Diagnosis According to NANDA
- Impaired Gas Exchange: Related to alveolar destruction and air trapping, evidenced by dyspnea and decreased oxygen saturation.
- Ineffective Breathing Pattern: Related to changes in lung structure and hyperinflation, evidenced by use of accessory muscles and tachypnea.
- Activity Intolerance: Related to dyspnea and fatigue, evidenced by reduced physical activity and increased rest periods.
- Anxiety: Related to difficulty breathing and chronic illness, evidenced by restlessness and verbalization of fear.
- Risk for Infection: Related to decreased airway clearance and immunosuppression, evidenced by a history of frequent respiratory infections.
Nursing Interventions for Nursing Diagnoses in Emphysema
1. Impaired Gas Exchange
Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply and demand as evidenced by decreased oxygen saturation and dyspnea.
Nursing Interventions:
- Monitor Respiratory Status: Regularly assess respiratory rate, depth, and effort. Check for signs of cyanosis and use of accessory muscles.
- Assess Oxygen Saturation: Use pulse oximetry to monitor SpO2 levels and adjust oxygen therapy as needed.
- Administer Supplemental Oxygen: As prescribed, ensuring the correct delivery method (nasal cannula, mask) and titrating to maintain target oxygen saturation levels.
- Positioning: Encourage a high Fowler’s position to facilitate lung expansion and improve breathing.
- Breathing Techniques: Teach and encourage pursed-lip and diaphragmatic breathing exercises to enhance ventilation and reduce air trapping.
- Medications: Administer bronchodilators, corticosteroids, and other prescribed medications to improve airway patency and reduce inflammation.
2. Ineffective Airway Clearance
Nursing Diagnosis: Ineffective Airway Clearance related to increased mucus production and airway obstruction as evidenced by wheezing, coughing, and difficulty clearing secretions.
Nursing Interventions:
- Hydration: Encourage fluid intake to help thin secretions and facilitate easier expectoration.
- Chest Physiotherapy: Perform or instruct on techniques such as percussion, vibration, and postural drainage to help mobilize secretions.
- Suctioning: Provide suctioning as needed to clear airways of excessive secretions.
- Humidification: Use humidified air or nebulizers to keep airways moist and reduce mucus viscosity.
- Medications: Administer expectorants, mucolytics, and bronchodilators as prescribed to enhance mucus clearance and airway patency.
- Incentive Spirometry: Encourage the use of incentive spirometers to promote deep breathing and effective coughing.
3. Activity Intolerance
Nursing Diagnosis: Activity Intolerance related to imbalance between oxygen supply and demand as evidenced by dyspnea, fatigue, and weakness during activity.
Nursing Interventions:
- Assess Activity Level: Monitor the patient’s response to activity, noting signs of dyspnea, fatigue, and changes in vital signs.
- Energy Conservation Techniques: Educate the patient on pacing activities, using assistive devices, and resting between tasks.
- Exercise Program: Develop a graded exercise program tailored to the patient’s tolerance, focusing on improving endurance and muscle strength.
- Oxygen Therapy: Ensure supplemental oxygen is available during activities if prescribed, to prevent desaturation.
- Environmental Modifications: Assist in modifying the home environment to reduce energy expenditure (e.g., using shower chairs, placing frequently used items within easy reach).
- Supportive Devices: Provide or recommend mobility aids like walkers or wheelchairs if necessary to enhance activity performance.
4. Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to increased energy expenditure and decreased intake as evidenced by weight loss and muscle wasting.
Nursing Interventions:
- Nutritional Assessment: Regularly assess dietary intake, weight, and nutritional status.
- High-Calorie Diet: Provide meals that are high in calories and protein to meet increased metabolic demands.
- Small, Frequent Meals: Encourage small, frequent meals to reduce the effort of eating and avoid early satiety.
- Nutritional Supplements: Offer oral nutritional supplements between meals if needed to increase caloric intake.
- Monitor Weight: Track weight regularly to assess for any significant changes.
- Consult Dietitian: Collaborate with a dietitian for personalized nutritional planning and management.
5. Risk for Infection
Nursing Diagnosis: Risk for Infection related to compromised respiratory function as evidenced by increased susceptibility to respiratory infections.
Nursing Interventions:
- Hand Hygiene: Emphasize the importance of regular handwashing for the patient and visitors to prevent infection.
- Vaccinations: Ensure the patient receives recommended vaccinations, such as the influenza and pneumococcal vaccines.
- Monitor for Signs of Infection: Regularly assess for symptoms of respiratory infections, including fever, increased sputum production, and changes in sputum color.
- Aseptic Techniques: Use aseptic techniques for procedures such as suctioning and the administration of medications.
- Educate on Infection Control: Teach the patient about avoiding contact with individuals who have respiratory infections and practicing good respiratory hygiene.
- Antibiotics: Administer prescribed antibiotics promptly if an infection is diagnosed.
6. Anxiety
Nursing Diagnosis: Anxiety related to breathlessness and fear of suffocation as evidenced by verbal expressions of concern, restlessness, and increased heart rate.
Nursing Interventions:
- Provide Information: Educate the patient about the disease process, treatment options, and what to expect to reduce fear of the unknown.
- Relaxation Techniques: Teach and encourage relaxation techniques such as deep breathing exercises, progressive muscle relaxation, and guided imagery.
- Supportive Environment: Create a calm and reassuring environment to help alleviate anxiety.
- Emotional Support: Offer emotional support, listen to the patient’s concerns, and provide reassurance.
- Therapeutic Communication: Use therapeutic communication techniques to help the patient express feelings and fears.
- Medications: Administer antianxiety medications as prescribed to help manage severe anxiety.
These nursing interventions aim to address the specific needs of patients with emphysema, focusing on improving their quality of life, reducing symptoms, and preventing complications.
Conclusion
Each of these sections provides a comprehensive understanding of emphysema, from its definition and causes to management and nursing care.
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