NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT

Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.

It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.

1. Prepared by:- Prof. BLESSY THOMAS, MSc NURSING VICE PRINCIPAL, FNCON,SPN

2. DEFINITION Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and wi thout obvious fibrosis. Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli .

3. It is a type of chronic obstructive pulmonary disease. It is a progressive disease of lungs.

4. INCIDENCE All age groups are equally affected. More common in men than women. More common in smoking people Occurs uses after 60‘s.

5. RISK FACTORS /CAUSES Smoking cigarettes / passive smokers Inhaling toxins or other irritants. Genetic factors. Exposure to pollution. Due to frequent lowe r respiratory infections. HIV infection. Alteration in normal defence mechanism. Infection. Ageing after 50‘s or 60 ‘s .

6. TYPES OF EMPHYSEMA Centriacianar Emphysema Pan a cinar Emphysema Para septal Emphysema Irregular Emphysema

7. Centri lobular/ Centriacinar / Proximal acinar Dilatation of respiratory Bronchiole. Occurs in chain smokers/Coa/mine workers. Upper lobes are severely involves . Can Co-exist with chronic bronchitis. Begins in the respiratory bronchioles and spreads mainly in the upper half of the lungs. This is the most common type of emphysema.

8. Panacinar emphysema (Pan lobular) Can occurs in smokers. Commonly resides in the lower half of the lungs and destroys the tissue of the air sacs, causing a distinctive, uniform enlargement of air spaces. It is associated with a genetic disease.

9. Para septal Emphysema (Distal acinar) Involves the distal airway structures alveolar ducts & alveolar sacs. It can leads to pneumothorax. Giant Bullae’s can be seen. Tends to localize around the septa or pleura. It’s often associated with inflammatory processes, such as prior lung infections.

10. Irregular Can be seen anywhere in the respiratory tubules and alveolar sacs or ducts

11. PATHOPHYSIOLOGY Healthy lungs. Healthy alveoli & others structures. Harm particular trappe d in alveoli. Inflammatory response triggered. Inflammatory chemicals dissolve alveolar septum. Formation of large air cavity lined with carbon deposits. Increased ventilatory dead space. Leads to clinical manifestation.

12. CLINICAL MANIFESTATIONS Cough in the morning Cough with clear sputum Wheezing. Shortness of Breath. Deceased exercise tolerance. Rapid breathing. Clubbing of fingers. Fat intolerance. Blush lips. Cyanosis.

13. Fatigue. Barrel chest Edema in ankles and legs. Loss of appetite. Weight loss. Breathing through pursed lips. Desire to lean forward to improve breathing. Cardiomegaly ( right chamber ). Heart failure

14. Lean forward position

15. DIAGNOSTIC EVALUATION History Collection Physical examination Chest X ray (abnormally large lungs) ABG Arterial Blood cell court. Pulse oximetry Sputum examination ECG

16. Management Pharmacological Management Beta-agonists – for relaxation of clearances smooth muscles mucociliary Anti cholinergic – for relaxation of bronchial smooth musk . Bronchodilators – A lbuterol Formoterol Salmeterol Corticosteroid – aerosol spray. Oxygen Therapy To improve oxygen delivery to lungs.

17. Pulmonary Rehabilitation – Supportive measures for smoking cessation. Breathing exercises Spiro metric exercises Nutritional Therapy Balanced diet Postural drainage – helps to remove the section

18. Surgical Management Lung volume reduction surgery – In this surgery the diseased part of the lungs (30%) will be removed so that the remaining healthy lung tissue can perform better. Types Median sternotomy Video assisted thoracoscopy Bronchoscope surgery.

19. Median sternotomy In this procedure parts of diseased lungs is removed and tissue reattached using a sapling device. Video assisted thoracoscopy Can be performed unilaterally or bilaterally.

20. Bullectomy In case of presence of large Bulla. It is performed through bronchoscopy. Lung Transplantation It is the procedure in which the diseased lungs totally removed and door lung will be transplanted.

21. Nursing Management Breathing Retraining Pulsed – lip breathing Diaphragmatic breathing Effective coughing Chest physiotherapy Postural drainage Nebulization therapy

22. Nursing Diagnosis Impaired gas exchange related to impaired ventilation. Ineffective airway clearance due to ineffective coughing and large amount of secretions. Impaired nutrition due to less in take with diseased appetite due to medication and anxiety. Anxiety due to breathing problem and fear of suffocation. Activity intolerance related to dyspnoea. Sleep Disturbance related to breathing difficulty.