Emphysema

is a disease from chronic obstructive pulmonary diseases

1. Emphysema Prepared by : akeel abd muslem

2. Content Definition causes Types Pathophysiology Clinical manifestation (S&S) Complication Medical management Nursing management

3. emphysema In emphysema: Damage and abnormal distention of airspaces beyond the terminal bronchioles and obstruction of walls of alveoli. there’s impaired carbon dioxide and oxygen exchange , result from obstruction of walls of over _ distended Alveoli ( enlargement of airspaces } alveoli { . Destroyed by recurrent infection .

4. When wall of alveoli destroy ( the process will lead to recurrent infection )

5. Causes Cigarrete smoking –or second hand smoking Damaged bronchi tubes or lungs , or it maybe inherited . Breathing in a-air pollution or b- toxic air

6. types 1- centrilobular emphysema 2- panlobular emphysema 3- distal acinar (paraseptal ) emphysema 4-Irregular emphysema

7. pathophysiology Emphysema is abnormal permanent enlargement of airspaces distal to terminal bronchioles , we discuss pathophysiology according to types of disease . 1- centriacinar emphysema (centrilobular ) : The central parts of acini are affected while distal alveoli are spared . *Acini : formed by respiratory bronchioles . *this emphysema is consequences of cigarette smoking in people who don’t have congenital deficiency of Alfa-one antitrypsin

8. 2- panlobular emphysema Acini are uniformly enlarged from the level of respiratory bronchioles to the terminal blind alveoli . *Occur commonly in lower lung zone . * And occur in people with alfa- one antitrypsin deficiency .

9. 3- distal acinar (paraseptal ) emphysema Distal parts of acinus is involved ( while proximal portion is normal ) It’s more striking adjacent to pleura , along lobular connective tissue septa , and at margins of lobules. The characteristic findings are the presence of multiple , continues enlargement of airspaces ( range in daimeter from less than 0.5 mm to more than 2 cm , sometimes form a cyst like structure called bullae .

10. 4-Irregular emphysema Mixed and unclassified . The acini irregularly involved . Asymptomatic Usually as a complication from TB ( Tuberculosis ) or other various chronic inflammatory disease .

11. Healthy lung tissue produce substance called ( alfa antitrypsin ) 1-in response to infection : neutrophils and macrophages release proteases enzymes (destructive enzymes ) 2- smoking reduce activity of alfa antitrypsin and increase activity of proteases enzymes . * Proteases destroy elastic fibers that act for elastic recoli , that needed in exhalation . * As a result alveoli are over inflated as air becomes trapped in lung , and increase air volume pushes diaphragm down ward and disrupting chest shape and make breathing difficulty . * And finally , result in reduces lung tissue available to external respiration , (and put patient at risk for hypoxemia and hypoxia )

12. Pathogenesis of emphysema

13. Clinical manifestation 1-S.O.B (dyspnea) 2-cough 3-difficulty breathing while exertion 4-underweight 5-barrel chest 6-wheezing 7-morning headache 8-difficulty sleeping 9-difficulty concentration 10 sputum production

14. complication Respiratory insufficiency or failure Pneumonia Pneumothorax Chronic atelectasis Pulmonary arterial hypertension ( cor-pulmonale ) that lead to RIGHT SIDED HEART FAIULURE

15. Medical management Cessation of smoking Use of bronchodilators ( to relive spasm ) Metered dose inhaler Oxygen therapy Surgical : 1 -Bullectomy , 2 -lung transplantation , 3 -lung voulme reduction surgery

16. Nursing management Adminster low flow oxygen as needed Check vital signs Ascultate lung sounds Give medication as ordered Provide fowler position Assess skin color and temperature Assess respiratory condition And assess pulse oximetry Pulse oximetry :  is a test used to measure the oxygen level (oxygen saturation) of the blo

17. Reference Brunner book medical surgical nursing Slideshare.com www.google .com