Emphysema

Group 2 Members
Bachiller, Lianne Jane
Barra, Andrea
Bolina, Gia
Ermita, Joy Fatima
Francia, Cherybie Raine
Mendoza, Chelsea Faith M.
Peñaranda, Jessa
Pregonero, Kathleen Ann
Vega, Christine Joy
Slide 1 Copyright © 2006 by Mosby, Inc.
 Figure 12–2. Centrilobular emphysema. Abnormal weakening and enlargement
of the respiratory bronchioles in the proximal portion of the acinus.
Slide 2 Copyright © 2006 by Mosby, Inc.
 Anatomic Alterations of the Lungs
 Permanent enlargement and deterioration of
the air spaces distal to the terminal
bronchioles
 Destruction of pulmonary capillaries
 Weakening of the distal airways, primarily the
respiratory bronchioles
 Bronchospasm (with concomitant bronchitis)
 Hyperinflation of alveoli (air-trapping)

Slide 3 Copyright © 2006 by Mosby, Inc.

 Etiology
 Cigarette smoking
 Genetic predisposition
 Alpha1 protease inhibitor
 Occupational exposure to chemical irritants
 Exposure to atmospheric pollutants

Slide 4 Copyright © 2006 by Mosby, Inc.

 Overview of the Cardiopulmonary
Clinical Manifestations Associated
with EMPHYSEMA
The following result from the pathophysiologic
mechanisms caused by Distal Airway and
Alveolar Weakening ( Figure 9-12)—the major
anatomic alterations of the lungs associated
with emphysema (see Figures 12-1 and 12-2).

Slide 5 Copyright © 2006 by Mosby, Inc.

 Figure 9-12. Distal airway and alveolar weakening clinical scenario.
Slide 6 Copyright © 2006 by Mosby, Inc.
 Clinical Manifestations
Vital signs
 Increased respiratory rate
 Increased heart rate, cardiac output,
blood pressure

Slide 7 Copyright © 2006 by Mosby, Inc.

 Clinical Manifestations
 Use of accessory muscles of inspiration
 Use of accessory muscles of expiration
 Pursed-lip breathing
 Increased anteroposterior chest diameter
(barrel chest)
 Cyanosis
 Digital clubbing

Slide 8 Copyright © 2006 by Mosby, Inc.

 Clinical Manifestations
Peripheral edema and venous distention
 Distended neck veins
 Pitting edema
 Enlarged and tender liver

Slide 9 Copyright © 2006 by Mosby, Inc.

 Distended
Neck Veins

Figure 2-48. Distended neck veins (arrows).

Slide 10 Copyright © 2006 by Mosby, Inc.
 Clinical Manifestations
 Cough, sputum production, hemoptysis
 Chest assessment findings
 Hyperresonant percussion notes
 Wheezing
 Diminished breath sounds
 Diminished heart sounds
 Decreased tactile and vocal fremitus
 Crackles/rhonchi (when accompanied by bronchitis)

Slide 11 Copyright © 2006 by Mosby, Inc.

 Figure 2-12. Percussion becomes more hyperresonant with alveolar hyperinflation.

Slide 12 Copyright © 2006 by Mosby, Inc.

 Figure 2-17. As air trapping and alveolar hyperinflation develop in obstructive
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lung diseases, breath sounds progressively diminish. Copyright © 2006 by Mosby, Inc.
 Laboratory Tests and Special
Procedures

Slide 14 Copyright © 2006 by Mosby, Inc.

 Arterial Blood Gases
Mild to Moderate Emphysema
 Acute alveolar hyperventilation with
hypoxemia

pH PaCO2 HCO3- PaO2

   (Slightly) 

Slide 15 Copyright © 2006 by Mosby, Inc.

 Arterial Blood Gases
Severe Emphysema
 Chronic ventilatory failure with hypoxemia

pH PaCO2 HCO3- PaO2

Normal  (Significantly) 

Slide 16 Copyright © 2006 by Mosby, Inc.

 Acute Ventilatory Changes Superimposed
on Chronic Ventilatory Failure
 Acute alveolar hyperventilation on chronic
ventilatory failure

 Acute ventilatory failure on chronic ventilatory

failure

Slide 17 Copyright © 2006 by Mosby, Inc.

 Abnormal Laboratory Tests
and Procedures
Hematology
 Increased hematocrit and hemoglobin
Electrolytes
 Hypochloremia (chronic ventilatory failure)
Sputum examination
 Streptococcus pneumoniae
 Haemophilus influenzae

Slide 18 Copyright © 2006 by Mosby, Inc.

 Radiologic Findings
Chest radiograph
 Translucent (dark) lung fields
 Depressed or flattened diaphragms
 Long and narrow heart
 Enlarged heart
 Increased retrosternal air space
(lateral radiograph)

Slide 19 Copyright © 2006 by Mosby, Inc.

 Figure 12-3. Chest X-ray of a patient with emphysema. The heart often appears long
and narrow as a result of being drawn downward by the descending diaphragm.
Slide 20 Copyright © 2006 by Mosby, Inc.
 Figure 12–4. Emphysema. Lateral chest radiograph demonstrates a characteristically large
retrosternal radiolucency with increased separation of the aorta and sternum measuring 4.6 cm, 3 cm
below the angle of Louis and extending down to within 3 cm of the diaphragm anteriorly. Both
costophrenic angles are obtuse, and both hemidiaphragms are flat. (From Armstrong P et al, editors:
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Imaging of diseases of the chest, ed 2, St. Louis, 1995, Mosby.) Copyright © 2006 by Mosby, Inc.
Slide 22 Copyright © 2006 by Mosby, Inc.
 General Management of
Emphysema
 Patient and family education
 Behavioral management
 Avoidance of smoking and inhaled irritants
 Avoidance of infections
 Proper nutrition instruction

Slide 23 Copyright © 2006 by Mosby, Inc.

 GOLD Standards

Global Initiative for Chronic

Obstructive
Lung
Disease

Slide 24 Copyright © 2006 by Mosby, Inc.

 Figure 11-4. From GUIDELINES Pocketcard: Managing chronic obstructive pulmonary
disease, Baltimore, 2004, Version 4.0, International Guidelines Center. (From
GUIDELINES Pocketcard: Managing Chronic Obstructive Pulmonary Disease.
Slide 25 Copyright © 2006 by Mosby, Inc.
Baltimore, 2004, Version 4.0, International Guidelines Center.)
 Figure 11-4. (Close-ups). (From GUIDELINES Pocketcard: Managing Chronic
Obstructive Pulmonary Disease. Baltimore, 2004, Version 4.0, International
Guidelines Center.)
Slide 26 Copyright © 2006 by Mosby, Inc.
 Figure 11-4. (Close-ups). (From GUIDELINES Pocketcard: Managing Chronic
Obstructive Pulmonary Disease. Baltimore, 2004, Version 4.0, International
Guidelines Center.)
Slide 27 Copyright © 2006 by Mosby, Inc.
 Figure 11-4. (Close-ups). (From GUIDELINES Pocketcard: Managing Chronic
Obstructive Pulmonary Disease. Baltimore, 2004, Version 4.0, International
Guidelines Center.)
Slide 28 Copyright © 2006 by Mosby, Inc.
 Figure 11-4. (Close-ups). (From GUIDELINES Pocketcard: Managing Chronic
Obstructive Pulmonary Disease. Baltimore, 2004, Version 4.0, International
Guidelines Center.)
Slide 29 Copyright © 2006 by Mosby, Inc.
 General Management of
Emphysema
Respiratory care treatment protocols
 Oxygen therapy protocol
 Bronchopulmonary hygiene therapy protocol
 Aerosolized medication protocol
 Mechanical ventilation protocol

Slide 30 Copyright © 2006 by Mosby, Inc.

 Additional Treatment Considerations
for Emphysema
 Antibiotics
 Inoculations against influenza and pneumonia
 Alpha1 antitrypsin therapy
 Lung volume reduction surgery
 Lung transplantation

Slide 31 Copyright © 2006 by Mosby, Inc.

 Nursing Interventions
• Maintaining a patent airway is a priority. Use a humidifier at night
to help the patient mobilize secretions in the morning.
• Encourage the patient to use controlled coughing to clear secretions
that might have collected in the lungs during sleep.
• Instruct the patient to sit at the bedside or in a comfortable chair, hug
a pillow, bend the head downward a little, take several deep breaths,
and cough strongly.
• Place patients who are experiencing dyspnea in a high Fowler
position to improve lung expansion. Placing pillows on the overhead
table and having the patient lean over in the orthopneic position may
also be helpful. Teach the patient pursed-lip and diaphragmatic
breathing.

Slide 32 Copyright © 2006 by Mosby, Inc.

  To avoid infection, screen visitors for contagious diseases and instruct the
patient to avoid crowds.
 Conserve the patient’s energy in every possible way. Plan activities to
allow for rest periods, eliminating nonessential procedures until the
patient is stronger. It may be necessary to assist with the activities of daily
living and to anticipate the patient’s needs by having supplies within easy
reach.
 Refer the patient to a pulmonary rehabilitation program if one is available
in the community.
 Patient education is vital to long-term management. Teach the patient
about the disease and its implications for lifestyle changes, such as
avoidance of cigarette smoke and other irritants, activity alterations, and
any necessary occupational changes. Provide information to the patient
and family about medications and equipment.

Slide 33 Copyright © 2006 by Mosby, Inc.

 Pharmacologic interventions
 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.

Slide 34 Copyright © 2006 by Mosby, Inc.