Emphysema

Emphysema Nursing Care Plans Diagnosis and Interventions

Emphysema NCLEX Review Care Plans

Nursing Study Guide on Emphysema

Emphysema is a medical condition wherein the alveoli are damaged, therefore limiting the lungs capability for proper oxygen – carbon dioxide exchange. It is one of the types of diseases under the umbrella term chronic obstructive pulmonary disease (COPD).

When exhaling, the damaged alveoli will not allow the oxygen to escape, therefore leaving old air to be trapped. This in turn will cause oxygen deprivation of the body, eventually resulting in hypoxemia.

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Prolonged hypoxemic states will negatively impact a patient’s health due to the lack of oxygen supply which is essential for the proper functioning of the body and maintenance of health.

Signs and Symptoms of Emphysema

Patients with emphysema usually do not immediately notice the clinical manifestations of the disease. This in turn connotes that the presenting signs and symptoms observed would often mean an already progressing condition.

The classic manifestations of emphysema include:

  • Shortness of breath – the pathognomonic sign of emphysema; usually starts gradually, then progresses as the disease worsen and more noticeable with physical activity
  • Shortness of breath at rest – usually occurs when the disease has not been managed well that it interferes with activities of daily living
  • Frequent coughing or wheezing
  • Productive cough – a cough that produces a lot of mucus
  • A whistling or squeaky sound when breathing
  • Chest tightness or discomfort

Causes and Risk Factors of Emphysema

The lungs are the main organs of respiration of the body. They are the primary organs responsible for the oxygen uptake, which in turn is transported through the circulatory system via the blood.

In the lungs, small sac-like structures, called alveoli, are the areas of the lungs where gas exchange happens. Emphysema is disease where the alveoli are destroyed, causing a significant problem in gas exchange.

The common causes of emphysema are as follows:

  • Tobacco smoking
  • Marijuana use
  • Air pollution
  • Chemical fumes and dust
  • Rarely, inherited deficiency in alpha-1-antitrypsin

The risk factors that increase the development of emphysema include:

  • Smoking – Smokers are more susceptible in developing emphysema due to the damaged brought to the lungs.
  • Age – Although lung damage from emphysema develops slowly, most patients with tobacco-induced conditions are observed between the ages 40 to 60 years old.
  • Exposure to secondhand smoke or passive smoking
  • Occupational exposure to fumes or dust – Inhalation of industrial-related pollution (e.g., working in the coal mines) predisposes its workers to emphysema.
  • Exposure to indoor and outdoor pollution – Fumes from factories, car exhausts, etc. can also contribute to emphysema.

Complications of Emphysema

If left untreated, emphysema may progress to the following conditions:

  1. Pneumothorax. A collapsed lung is life-threatening for people with severe cases of emphysema due to the lungs being already compromised.
  2. Heart problems. Cor pulmonale may develop for patients suffering from emphysema. This happens because of the increased pressure in the arteries connecting the heart and lungs, resulting in enlarged and weakened sections of the heart.
  3. Bullae. Bullae are large spaces in the lungs that develop in people with emphysema. Having this condition predisposes a patient to have pneumothorax.

Diagnosis of Emphysema

Diagnosing emphysema involves the following:

  • Physical Exam and History Taking– A physical exam focusing on the respiratory function and assessing for adventitious breath sounds is done to establish baseline data and identify signs and symptoms.
  • Imaging tests – Chest X-ray will be done as a primary imaging tool and as a method of ruling out other causes of shortness of breath. A CT-scan is oftentimes utilized as well to further assess and visualize the inherent lung structures which are often deviated for patients with lung issues, especially for sufferers of emphysema.
  • Laboratory tests – Arterial blood gases (ABGs) are done to monitor blood oxygenation levels and to assess for lung capability to transfer oxygen to the bloodstream.
  • Lung function tests – Oftentimes, incentive spirometry is the tool of choice for assessing for lung vital capacity. In this test, the patient is advised to inhale deeply then exhale through the device in order to measure the amount of air that is held and exchanged during respirations.

Treatment of Emphysema

Treatment management for emphysema includes the following:

Medications. The doctor may prescribe the following medications to treat, lessen or control the symptoms of emphysema and they are:

  • Bronchodilators – These are given for the relaxation of constricted airways as manifested by episodes of shortness of breath, coughing, and other breathing problems.
  • Inhaled steroids – Corticosteroids applied directly on the bronchial tree through inhalation will help in addressing inflammation that is also associated in emphysema.
  • Antibiotics – Infection may occur as a secondary condition due to the lungs inability to function properly.
  • Supportive medications – saline nebulization may be done to help alleviate symptoms of emphysema.

Pulmonary rehabilitation. Breathing exercises and techniques will be taught to aid in adjusting with the demands of having emphysema.

Nutrition therapy. People who are overweight would need to reduce their weight to lessen the effort in breathing. Likewise, patients who are underweight are advised for proper nutrition to support the body in adjusting with the condition.

Supplemental oxygen. Oxygen support will be given for patients with emphysema to address the inadequate supply given by the patient’s lungs. It is normal for most emphysema patients to have an oxygen level between 88 to 92% via pulse oximetry. Oxygen therapy may be required if the patient’s SpO2 drops to less than 88%.

Surgery. Surgical intervention may be required for severe emphysema. These may include:

  • Lung volume reduction surgery – This involves surgical reduction of the lungs that are already damaged by the condition. Utilizing this technique will allow for the remaining health lung tissue to expand and function properly.
  • Lung transplant – This is considered the last treatment option when the damage is to severe and irreversible.

Smoking cessation. Quitting smoking is one of the crucial steps to combat emphysema. This also includes avoiding second-hand smoking.

Nursing Care Plans for Emphysema

Nursing Care Plan 1

Ineffective Airway Clearance related to emphysema as evidenced by shortness of breath, wheeze, SpO2 level of 80%, productive cough, and difficulty to expectorate phlegm

Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, respiratory rates between 12 to 20 breaths per minutes, oxygen saturation between 88 to 92%, and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. Assess breath sounds via auscultation.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Wheezing breath sounds are important signs of emphysema.
Suction secretions.To help clear thick phlegm that the patient is unable to expectorate.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range of 88 to 92%.
Administer the prescribed emphysema medications (e.g., bronchodilators, steroids, or combination inhalers / nebulizers) and antibiotic medications.Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs. Antibiotics: To treat bacterial infection if present.
Elevate the head of the bed and assist the patient to assume semi-Fowler’s position.Head elevation and proper positioning help improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan 2

Nursing Diagnosis: Ineffective Breathing Pattern related to emphysema as evidenced by shortness of breath, respiratory rate of 25 breaths per minute, SpO2 level of 80%, productive cough, and fatigue

Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation between 88 to 92%, and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range of 88 to 92%.
Administer the prescribed emphysema medications (e.g., bronchodilators, steroids, or combination inhalers / nebulizers) and antibiotic medications.Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs. Antibiotics: To treat bacterial infection, as needed.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Perform chest physiotherapy such as percussion and vibration, if not contraindicated. Nebulization using sodium chloride (NaCl) may also be done, as ordered by the physician. Steam inhalation may also be performed.To facilitate clearance of thick airway secretions.
Assist the patient in the daily routine for effective pulmonary rehabilitation program.Breathing exercises and techniques will be taught to aid in adjusting with the demands of having emphysema.

Nursing Care Plan 3

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of emphysema as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of emphysema and its management.

InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g., denial of diagnosis or poor lifestyle habits).To address the patient’s cognition and mental status towards the new diagnosis of emphysema and to help the patient overcome blocks to learning.
Explain what emphysema is and its stages. Avoid using medical jargons and explain in layman’s terms.To provide information on emphysema and its pathophysiology in the simplest way possible.
Educate the patient about lifestyle changes that can help manage emphysema, particularly the cessation of smoking. Refer to smoking cessation team.Smoking cessation may stop or slow down the progression of emphysema. A smoking cessation team can provide further help and advice on how to stop smoking and can also monitor the patient’s progress when he/she is back in the community.
Inform the patient the details about the prescribed medications (e.g., drug class, use, benefits, side effects, and risks) to manage emphysema. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Educate the patient about pursed lip breathing and deep breathing exercises. Explain the importance of coughing up phlegm.To strengthen the respiratory muscles, reduce shortness of breath, and lower the risk for airway collapse.

Other possible nursing diagnoses:

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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