Emphysema is a progressive lung disease characterized by alveoli (air sacs) damage, leading to decreased lung function and breathing difficulties. As a critical component of Chronic Obstructive Pulmonary Disease (COPD), emphysema requires comprehensive nursing care and detailed care planning.
Understanding Emphysema
Emphysema occurs when the alveoli in the lungs become damaged, leading to:
- Reduced lung elasticity
- Air trapping in the lungs
- Decreased oxygen exchange
- Progressive shortness of breath
- Chronic cough
- Reduced exercise tolerance
Key Clinical Manifestations
Common symptoms include:
- Dyspnea (shortness of breath)
- Chronic productive cough
- Barrel chest appearance
- Prolonged expiration
- Use of accessory muscles
- Pursed-lip breathing
- Decreased exercise tolerance
- Weight loss
- Anxiety
Nursing Assessment
Health History
Primary Assessment Focus:
- Smoking history and current status
- Occupational exposures
- Family history
- Current symptoms
- Impact on daily activities
Physical Assessment:
- Respiratory rate and pattern
- Use of accessory muscles
- Breath sounds
- Chest wall movement
- Oxygen saturation
- Presence of cyanosis
Diagnostic Findings
Key diagnostic tests include:
- Pulmonary Function Tests (PFTs)
- Arterial Blood Gases (ABGs)
- Chest X-ray
- CT scan
- Alpha-1 antitrypsin levels
Nursing Care Plans for Emphysema
Nursing Care Plan 1. Impaired Gas Exchange
Nursing Diagnosis Statement:
Impaired Gas Exchange related to alveolar-capillary membrane destruction as evidenced by dyspnea, abnormal arterial blood gases, and use of accessory muscles.
Related Factors/Causes:
- Alveolar damage
- Ventilation-perfusion mismatch
- Increased airway resistance
- Air trapping
Nursing Interventions and Rationales:
1. Monitor respiratory status hourly
- Rationale: Early detection of deterioration
2. Position the patient in semi-Fowler’s position
- Rationale: Optimizes lung expansion
3. Administer oxygen therapy as prescribed
- Rationale: Maintains adequate oxygenation
4. Teach pursed-lip breathing
- Rationale: Improves gas exchange
5. Monitor ABG results
- Rationale: Evaluates treatment effectiveness
Desired Outcomes:
- Patient maintains oxygen saturation >90%
- Demonstrates improved breathing pattern
- Reports decreased dyspnea
- Shows normal breath sounds
Nursing Care Plan 2. Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to imbalance between oxygen supply and demand as evidenced by dyspnea on exertion and fatigue.
Related Factors/Causes:
- Decreased oxygen supply
- Increased work of breathing
- Muscle fatigue
- Anxiety
Nursing Interventions and Rationales:
1. Assess activity tolerance
- Rationale: Establishes baseline and limitations
2. Plan activities with rest periods
- Rationale: Prevents exhaustion
3. Teach energy conservation techniques
- Rationale: Maximizes available energy
4. Implement a progressive activity program
- Rationale: Builds endurance safely
5. Monitor vital signs during activity
- Rationale: Ensures safe exercise levels
Desired Outcomes:
- Participates in daily activities without severe dyspnea
- Maintains stable vital signs during activity
- Uses energy conservation techniques effectively
- Reports improved exercise tolerance
Nursing Care Plan 3. Ineffective Breathing Pattern
Nursing Diagnosis Statement:
Ineffective Breathing Pattern related to hyperinflation of alveoli as evidenced by dyspnea, use of accessory muscles, and prolonged expiration phase.
Related Factors/Causes:
- Air trapping
- Decreased lung elasticity
- Anxiety
- Fatigue
Nursing Interventions and Rationales:
1. Assess breathing patterns hourly
- Rationale: Monitors respiratory status
2. Teach breathing exercises
- Rationale: Improves respiratory efficiency
3. Demonstrate relaxation techniques
- Rationale: Reduces anxiety and dyspnea
4. Position for optimal breathing
- Rationale: Facilitates respiratory function
5. Administer bronchodilators as prescribed
- Rationale: Reduces airway resistance
Desired Outcomes:
- Demonstrates effective breathing techniques
- Shows decreased use of accessory muscles
- Reports reduced dyspnea
- Maintains normal respiratory rate
Nursing Care Plan 4. Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to lack of exposure to information about emphysema management as evidenced by verbalization of questions and incorrect performance of techniques.
Related Factors/Causes:
- Lack of exposure to information
- Misinterpretation of information
- Cognitive limitations
- Language barriers
Nursing Interventions and Rationales:
1. Assess learning needs and barriers
- Rationale: Tailors education plan
2. Provide disease management education
- Rationale: Improves self-care ability
3. Demonstrate proper inhaler technique
- Rationale: Ensures medication effectiveness
4. Review smoking cessation strategies
- Rationale: Prevents disease progression
5. Teach exacerbation recognition
- Rationale: Promotes early intervention
Desired Outcomes:
- Demonstrates correct inhaler technique
- Verbalizes understanding of disease process
- Identifies exacerbation symptoms
- Follows the prescribed treatment plan
Nursing Care Plan 5. Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to compromised host defenses and retained secretions.
Related Factors/Causes:
- Decreased ciliary function
- Retained secretions
- Immunocompromise
- Poor nutrition
Nursing Interventions and Rationales:
1. Monitor temperature and sputum characteristics
- Rationale: Detects early infection
2. Encourage deep breathing and coughing
- Rationale: Promotes airway clearance
3. Promote adequate hydration
- Rationale: Thins secretions
4. Teach proper hand hygiene
- Rationale: Prevents infection spread
5. Administer vaccinations as prescribed
- Rationale: Provides immunization
Desired Outcomes:
- Maintains normal temperature
- Shows no signs of respiratory infection
- Demonstrates effective airway clearance
- Follows infection prevention measures
Prevention and Education
Essential education topics include:
- Smoking cessation
- Proper inhaler technique
- Energy conservation
- Exercise programs
- Infection prevention
- Diet and nutrition
- Stress management
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.
- Gredic M, Karnati S, Ruppert C, Guenther A, Avdeev SN, Kosanovic D. Combined Pulmonary Fibrosis and Emphysema: When Scylla and Charybdis Ally. Cells. 2023 Apr 28;12(9):1278. doi: 10.3390/cells12091278. PMID: 37174678; PMCID: PMC10177208.
- Shah PL, Herth FJ, van Geffen WH, Deslee G, Slebos DJ. Lung volume reduction for emphysema. Lancet Respir Med. 2017 Feb;5(2):147-156. doi: 10.1016/S2213-2600(16)30221-1. Epub 2016 Sep 29. Erratum in: Lancet Respir Med. 2016 Nov;4(11):e55. doi: 10.1016/S2213-2600(16)30331-9. PMID: 27693408.
- Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Yang, H., Yang, Y., Wang, F., Miao, C., Chen, Z., Zha, S., Li, X., Chen, J., Song, A., Chen, R., & Liang, Z. (2024). Clinical and Prognostic Differences in Mild to Moderate COPD With and Without Emphysema. CHEST. https://doi.org/10.1016/j.chest.2024.10.020
