Emphysema Nursing Care Plan & Management

 Description

  1. Emphysema is the enlargement and destruction of the alveolar, bronchial, and bronchiolar tissue with resultant loss of recoil, air trapping, thoracic overdistention, sputum accumulation, and loss of diaphragmatic muscle tone.
  2. These changes cause a state of carbon dioxide retention,hypoxia, and respiratory acidosis.
Causes

The actual cause of emphysema is unknown. Risk factors for the development of emphysema include cigarette smoking, living or working in a highly polluted area, and a family history of pulmonary disease. Frequent childhood pulmonary infections have been identified as a cause of bronchiectasis.

Assessment
  1. Anorexia, fatigue, weight loss
  2. Feeling of breathlessness,cough, sputum production, flaring of the nostrils, use of accessory muscles of respiration, increased rate and depth of breathing, dyspnea.
  3. Decreased respiratory excursion,resonance to hyperresonance, decreased breath sounds with prolonged expiration, normal or decreased fremitus
Primary Nursing Diagnosis
  • Impaired gas exchange related to destruction of alveolar walls
Diagnostic Evaluation
  • Evaluation entails primarily chest x-rays, chest computed tomography (CT) scans, pulmonary function tests, pulse oximetry, blood gases, and complete blood count.
Medical Management

The major goals of medical management are to improve quality of life, slow progression of the disease, and treat obstructed airways to relieve hypoxia. Treatment is directed at improving ventilation, decreasing work of breathing and preventing infection.

  • Smoking cessation
  • Physical therapy to conserve and increase pulmonary ventilation
  • Maintenance of proper environmental conditions to facilitate breathing
  • Psychological support
  • Ongoing program of patient education and rehabilitation
  • Bronchodilators and metered-dose inhalers (aerosol therapy, dispensing particles in fine mist).
  • Treatment of infection (antimicrobial therapy at the first sign of respiratory infection)
  • Oxygenation in low concentrations for severe hypoxemia.
Pharmacologic Intervention
  • Bronchodilators: Anticholinergic agents such as atropine sulfate, ipratropium bromide are used in reversal of bronchoconstriction.
  • Bronchodilators: Beta2-adrenergic agents such as( inhaled beta2-adrenergic agonists by metered-dose inhaler (MDI) such as albuterol, metaproterenol, or terbutaline )are used in reversal of bronchoconstriction
  • Systemic corticosteroids such as methylprednisolone IV; prednisone PO is used to decrease inflammatory response and improve airflow in some patients for a few days during acute exacerbations
  • Other Drug Therapy: Bronchodilators, which are used for prevention and maintenance therapy, can be administered as aerosols or oral medications. Generally, inhaled anticholinergic agents are the first-line therapy for emphysema, with the addition of betaadrenergic agonists added in a stepwise fashion. Antibiotics are ordered if a secondary infection develops. As a preventive measure, influenza and pneumonia vaccines are administered.