Nursing Care of Emphysema patient .pptx

The Emphysema PPT will be helpful for the Adult health nursing students

1. By Mr. Anandh Sam Perera . S, M.Sc (N) Professor Emphysema

2. Definition Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis.

3. Emphysema is a long term progressive disease of the lungs that primarily causes shortness of breath due to over inflation of the alveoli. It affects the walls of the millions of tiny air sacs in the lungs, which become inflamed and loose elasticity, causing the bronchioles to collapse. As a result, air becomes trapped in the air sacs, which become overstretched and may rupture, greatly affecting a persons ability to breathe normally. Emphysema frequently occurs together with chronic bronchitis.

4. Causes Smoking cigars Inhaling toxins / other irritants Alpha 1 – antitrypsin deficiency – a genetic defect which can cause emphysema at an early stage in non smokers.

5. Risk factors: Smoking cigars Family members with emphysema Exposure to pollutants at work Exposure to indoor and outdoor pollution Frequent lower respiratory infections History of frequent childhood lung infections Age 50 or older Connective tissue disorder ( Marfan Syndrome) HIV infection.

6. Types Centriacinar : It begins in the respiratory bronchioles and spreads peripherally. This form is associated with long standing cigarette smoking and predominantly involves destruction of bronchioles in the upper half of the lungs but the alveolar sac remain intact.

7. Panacinar There is destruction of the respiratory bronchioles, alveolar duct and alveoli in the lower half of the lungs. It is generally observed in patients with homozygous alpha 1 antitrypsin deficiency. In people who smoke, focal panlobular emphysema at the lung bases may accompany centrilobular emphysema

8. Paraseptal Also known as distal acinar emphysema, involves the distal airway structures, alveolar ducts and alveolar sacs. The process is localized around the septae of the lungs or pleura. Although airflow frequently is preserved, the apical bullae may lead to spontaneous pneumothorax . Giant bullae occasionally cause severe compression of adjacent lung tissue.

9. Pathophysiology Due to etiological factors Loss of elastic recoil of airway from breakdown of elastin by the enzyme elastage Lungs become damaged because of reactions to irritants entering the airways and alveoli Collapse of respiratory bronchioles causing airway obstruction Walls of alveoli are destroyed, reduces the lung surface area available for gas exchange.

10. This prevents the alveoli from deflating completely and the person has difficulty exhaling The trapped ‘old’ air takes up space, so the alveoli are unable to fill with enough fresh air to supply the body with needed oxygen Impaired oxygen diffusion Hypoxemia

11. Clinical manifestations Emphysema usually develops slowly. Emphysema symptoms are mild to begin with but steadily get worse as the disease progresses. Early symptoms: Coughing in the morning Coughing up clear sputum Wheezing Shortness of breath with activity Decreased exercise tolerance

12. As the disease progresses, pt may experience Increased shortness of breath Rapid breathing Chocking sensation when lying flat. Cyanosis Fatique Barrel chest Hemoptysis Swelling in ankles and legs. Loss of appetite Breathing through pursed lips Desire to lean forward to improve breathing Rt ventricular hypertrophy Heart failure.

13. Diagnostic evaluation H.C P.E Chest x-ray ABG Analysis Complete blood count PFT, Spirometry Sputum examination Test for AAT deficiency Pulmonary ventilation/ perfusion scan.

14. Medical Management Smoking cessation is very important Only quitting smoking can stop the progression of lung damage once it has started. O2 therapy Bronchodilators eg . Theophylline Steroida inhaled as aerosol spray Antibiotics eg . Amoxicillin Breathing techniques – coughing, deep breathing, diaphragmatic breathing and pursed lip breathing Postural drainage after inhalation Chest percussion

15. Surgical management Lung reduction surgery: removal of small wedges of damaged lung tissue Bullectomy : removal of one/more of the large air spaces ( bullae ) that form when the small air sacs are destroyed Lung Transplantation

16. Pulmonary Rehabilitation Education Nutrition counselling Learning special breathing techniques Help with quitting smoking Starting an exercise regimen