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.
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:
- Pneumothorax. A collapsed lung is life-threatening for people with severe cases of emphysema due to the lungs being already compromised.
- 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.
- 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.
Emphysema Nursing Diagnosis
Nursing Care Plan for Emphysema 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.
| Emphysema Nursing Interventions | Rationales |
| 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 for Emphysema 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.
| Emphysema Nursing Interventions | Rationales |
| 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 for Emphysema 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.
| Emphysema Nursing Interventions | Rationales |
| 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. |
Nursing Care Plan for Emphysema 4
Impaired Gas Exchange
Nursing Diagnosis: Impaired Gas Exchange related to alveolar-capillary membrane changes secondary to emphysema as evidenced by abnormal breathing, abnormal ABG values , and changes in vital signs.
Desired Outcomes:
- The patient will be able to demonstrate improved ventilation and adequate oxygenation by ABG results within the normal limits and be free of clinical manifestations of respiratory distress.
- The patient will be able to participate in the treatment rendered within the tolerance level of the patient in his current condition.
| Emphysema Nursing Interventions | Rationale |
| Evaluate and record the characteristics of the patient’s breathing, including the rate, depth, use of accessory muscles of breathing, presence of pursed-lip breathing, and difficulty or inability to speak. | The respiratory status of the patient can be best evaluated through various characteristics such as the rate and depth. Some additional characteristics such as the use of accessory muscles will assist the healthcare team to assess the degree of respiratory distress present in the patient. |
| Evaluate the patient’s skin, including its color and the body’s mucus membrane color. | Cyanosis is described as a bluish discoloration of either the skin or mucus membranes indicating the depletion of oxygen-rich blood in the tissues. Cyanosis can either be noted in the peripheral (e.g., nail beds) or central (e.g., around the lips). Marked duskiness and central cyanosis would usually indicate worsening hypoxemia. |
| Observe and take note of the patient’s mental status and level of consciousness. | Agitation and restlessness are some common clinical manifestations of hypoxia. This, with corresponding worsening arterial blood gas values and confusion, is indicative of cerebral hypoperfusion due to depressed oxygen levels in the blood. |
| Assess and auscultate the patient’s breath sounds, focusing on areas with decreased airflow and adventitious sounds. | Patients suffering from emphysema would have areas with faint breath sound due to the decreased airflow or presence of lung tissue consolidation. Wheezes observed on the patient may indicate for the presence of bronchospasm or retained secretions. The diffused crackling sound would usually indicate interstitial fluid or cardiac decompensation. |
| Observe and take note of the patient’s oxygen saturation. Ensure to maintain oxygen saturation between 88% to 92%. | Pulse oximetry results of 87% and below may indicate oxygen supplementation while readings of 92% or higher may need titration of oxygen supplementation. |
| Teach the patient how to do proper expectoration of the sputum and encourage to do it regularly. Render suctioning as needed. | The presence of sticky, thick, and extensive secretions are the primary source of impaired gas exchange in the alveoli. Rendering deep suctioning may be indicated, especially when coughing is inefficient in removing secretions in the airways. |
| Adjust the patient’s head of the bed at least 30 degrees or as high as the patient can tolerate. Help the patient to be placed in his desired position to facilitate better breathing. Ensure to include time periods for the prone position as tolerated by the patient. Allow the patient to perform slow, deep breaths or pursed-lip breathing as needed and tolerated. | Breathing exercises and upright positioning may help in improving the patient’s oxygenation by reducing airway collapse, dyspnea, and effort in breathing. The use of the prone position is useful in increasing the partial pressure of oxygen (i.e., PaO2). |
| Assess the patient’s activity tolerance level. Ensure to maintain calm and quiet environment that is conducive for resting. Limit patient’s activity in relation to acute phases of dyspnea. Encourage the patient to gradually resume and increase actions as tolerated. | During episodes of respiratory distress, the patient is severely limited to the amount of activity that he/she can effectively perform, including basic functions such as self-care activities due to the presence of hypoxemia and dyspnea. Scheduling rest periods in between activities is considered a crucial part of the therapeutic regimen. Planning for an exercise program is aimed at increasing the patient’s tolerance to activities and respiratory strength without inducing severe dyspnea, hence improving the patient’s well-being. |
| Render humidified oxygen supplementation as indicated by the physician. | Humidified oxygen supplementation suppresses the drying of the airways, reducing moisture losses and enhancing compliance of the body to oxygen demands. |
| Anticipate utilizing noninvasive positive pressure ventilation (NIPPV) as ordered by the physician. | The advantage of using NIPPV has been established by decreasing the PaCO2 (i.e., partial pressure of carbon dioxide in arterial blood), increasing blood pH levels, and reducing manifestations of severe dyspnea within the first 4 hours of initiating treatment. |
Nursing Care Plan for Emphysema 5
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to dyspnea and sputum production secondary to emphysema as evidenced by weight loss and poor muscle tone.
Desired Outcomes:
- The patient will be able to display improving weight gain towards the applicable target in relation to the current condition and ideal BMI.
- The patient will be able to display behavioral changes to recover or maintain the appropriate weight needed for proper biological processes.
| Emphysema Nursing Interventions | Rationale |
| Confirm patient comprehension of his nutritional needs. | Knowing the level of understanding is crucial in determining the knowledge needs of both the patient and significant others in order to bring out areas of improvement for better therapeutic outcomes. |
| Evaluate the patient’s dietary characteristics, including habits and recent intake. Take note of patient challenges when eating. Assess the current weight and body mass of the patient. | Respiratory distress can be a major factor for the patient to be anorexic due to the challenges in breathing, the presence of copious secretions, and the effects of medications. Furthermore, the habitually poor food intake has been associated with many COPD (Chronic obstructive pulmonary disease) patients despite being in respiratory insufficiency that should otherwise elevate caloric needs. Consequently, patients with emphysema are emaciated and would present with thin and wasted body structure. |
| Assess the patient’s bowel sounds. | Hypoactive bowel sounds are reflective of depleted gastric motility, thus resulting to constipation (a common complication) that is correlated with little fluid intake, poor nutritional choices, reduced activity, and hypoxemia. |
| Record and monitor the patient’s weight daily as necessary. | This is crucial in deciding caloric needs, determining applicable weight goals and gauging the effectiveness of the nutritional and general therapeutic plan for the patient. |
| Render frequent oral care to the patient, ensuring prompt removal of secretions. Ensure for the availability of designated containers for discarding secretions and tissues. | Presence of offensive taste, smell, and sights are primary reasons that may worsen the patient’s appetite, thus inhibiting them from eating better. It can also produce undue nausea and vomiting that may further compound respiratory efforts. |
| Educate the patient on the importance of eating high-caloric foods in smaller portions. | COPD patients spend immense energy levels just on breathing alone. Maintaining a good intake of high caloric meals will help address hypermetabolic needs in order to maintain or improve body weight and muscle mass. |
| Allow the patient to take ample rest periods of at least 1 hour before and after eating. | Fatigue reduction is crucial in patients with emphysema. As in the case of these types of patients, where breathing takes tremendous effort and energy, rest periods provide increased chances in improving food intake. |
| Remove gas-producing foods and drinks in the patient’s diet. | Gas-producing foods and beverages can result in abdominal distention that will greatly affect the patient’s abdominal breathing. In addition, the movement of the diaphragm, which is also crucial in breathing, is compromised and would complicate an already dyspneic patient. |
| Refrain from giving the patient extremely hot or col foods. | Very hot or cold foods can induce the patient’s coughing which would further complicate respiratory effort and patient satiety. |
| Advise the patient to improve fluid intake to 2.5 liters per day or more, or as indicated and tolerated. | Increasing fluid intake assists in liquefying tenacious secretions in the body, especially those in the patient’s airways. This is very much helpful for long sufferers of sputum exacerbations secondary to lung disease. |
| Coordinate with other members of the healthcare team (i.e., dietician) as indicated for the patient. | The expert advice of the dietician s crucial in providing accurate nutritional assessment and counseling tailor-fitted for patients with COPD. In addition, they may also seek ways on improving nutritional intake by suggesting enteral supplementation for the intubated or oral feeding intolerant patent. |
| Give supplemental oxygen while the patient eats as indicated. | Supplemental oxygen assists by reducing patient dyspnea. Furthermore, it supplements the patient’s energy levels that will improve satiety and food intake. |
Nursing Care Plan for Emphysema 6
Activity Intolerance
Nursing Diagnosis: Activity Intolerance related to an imbalance between oxygen supply and demand due to breathing inefficiency secondary to emphysema as evidenced by exertional dyspnea and shortness of breath.
Desired Outcomes:
- The patient will be able to demonstrate decreased episodes of dyspnea while doing activities of daily living.
- The patient will give exertion efforts of 3 or less on a scale of 0-10 to reflect tolerance levels.
| Emphysema Nursing Interventions | Rationale |
| Evaluate the patient’s respirations in relation to activity. This includes assessing for respiratory rate and depth, oxygen saturation, and utilization of the accessory muscles of breathing. | Sufferers of COPD experience hypoxia while doing elevated activity levels, thereby requiring supplemental oxygenation, to evade hypoxemia risks that could worsen the patient’s condition and bring untoward complications. |
| Consider evaluating the patient’s nutritional condition. | The nutritional status of the patient is crucial in determining the energy reserves of the patient that may otherwise improve or inhibit the completion of activities of daily living. |
| Ensure to maintain the tolerated and activities of the patient. | Maintaining tolerated levels assists in developing tolerance and reducing dyspneic episodes of the patient in order to handle the daily demands of patient efforts. |
| Allocate at least 90 minutes of complete rest periods in between patient activities. | Allotting of rest periods assists the patient in reducing oxygen demands of the body. Furthermore, undisturbed rest promotes physiologic recovery, which is markedly needed by patients with emphysema. |
| Educate the patient in doing active ROM (range of motion) exercises. Ensure that the patient is assisted all throughout these activities. | Active ROM’s helps in recovering and building the patient’s stamina, thus improving performance in doing activities of daily living. In addition, it reduces complications brought about by limited patient mobility. |
| Teach the patient with energy conservation methods such as Position usually used items within easy access by the patient.Assume the sitting position when doing tasks. Employ constant position changes. Do activities with an even pacing. | Employing these methods aids in decreasing the oxygen consumption of the body. Decreased oxygen consumption would equate to better energy reserves that would help the patient perform better in doing prolonged activities. |
| Instruct the patient on exercises that improve breathing range. Examples of these methods include diaphragmatic and pursed-lip breathing. | Employing these techniques assist by elongating the exhalation effort of the patient. Prolonging the patient’s exhalation can assist in reducing carbon dioxide retention that would otherwise complicate the patient’s breathing and result in added activity intolerance. |
| Support the patient for appropriate referral to a respiratory rehabilitation program. | Rehabilitation programs are effective and helpful in addressing the needs of an emphysemic patient. Activities surrounding this program include improving the knowledge base of the patient regarding nutrition and medication, breathing and relaxation methods, removing the risk of developing complications, and other improvement techniques in living with COPD. |
| Consider and take note of the patient’s sleep patterns, including the quality and amount of sleep achieved within the past days. | Lack of sleep and issues while sleeping can gravely affect the activity levels of the patient. Any deprivations or deviations can greatly reduce therapeutic outcomes and should be addressed promptly before worthy activity progression can even be attained. |
| Ascertain the patient’s routine in relation to the other medications of the patient. | Fatigue can negatively affect the patient’s performance levels in doing activities of daily living. Likewise, certain medications have been attributed in causing fatigue. Examples of these drugs are beta-blockers, calcium channel blockers, antihistamines, tranquilizers, alcohol, sedatives, and relaxants. |
| Educate the patient to schedule activities at times when they have peak energy levels. | Planning activities ahead of time in congruent with peak energy levels are crucial in maintaining normalcy and completion of daily tasks. Adjust therapeutic goals as necessary, especially if goals are too low. |
More Emphysema Nursing Diagnosis
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. (2022). 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. (2020). 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
