A permanent, abnormal enlargement of gas-

exchange airways, with destruction of alveolar

walls, without fibrosis (2).




SYDONIE STOCK
RESOURCES

(1) Chronic obstructive pulmonary disease among
adults - United States, 2011. (2012). MMWR:
Morbidity & Mortality Weekly Report, 61938-943.
(2) Huether, Sue & McCance, Kathryn. (2012).
Understanding Pathophysiology (5
th
ed) p.693-4.
St. Louis, MO: Elsevier Mosby Inc.
(3) Ladwig, Gail & Ackley, Betty. (2011). Mosbys
guide to nursing diagnosis (3
rd
ed). Maryland
Heights, MO: Mosby Inc.
(4) Lynn, Pamela. (2011). Clinical nursing skills: A
nursing process approach (3
rd
ed). Philadelphia,
PA: Lippincott, Williams & Wilkins.
(5) Mitzner, W. (2011). Emphysema--a disease of
small airways or lung parenchyma? New England
Journal of Medicine, 365(17), 1637-1639.
(6)Tabloski, Patricia. (1995). NCLEX Review
Questions. Gerontological Nursing. Chapter 16.
Pearson.
All pictures were found in Google Images. Emphysema
patient.
What is Emphysema?
The accepted definition of emphysema is a
permanent, abnormal enlargement of acini with
destruction of alveolar walls without fibrosis (2).
Etiology There could be two different ways
emphysema forms. One way is the commonly
accepted explanation: inflammation of the alveoli
leads to the destruction of the alveolar walls and
the elastic fibers that connect the acini to the
terminal bronchiole, which causes airway
enlargement and narrowing of the small airway at
the bronchiole opening. The other explanation
could be that the small airway is narrowed and
obstructed by inflammation. The resulting
increased pressure in the acini would cause folding
and breaking of the alveolar walls and destruction
of the elastic fibers (5).
Incidence COPD, the category of pulmonary
disorders that emphysema falls under, became the
third leading cause of death in 2008. According to
a randomized national telephone survey, whose
participation average was 74.2%, approximately 15
million people have been diagnosed with COPD by
their physician. More than 11.6% of this population
was 65 years or older (1).
Risk Factors There are two categories of
emphysema: primary and secondary. Primary
emphysema is associated with an inherited
deficiency of the enzyme 1-antitrypsin [which]
inhibits the action of many proteolytic enzymes.
Without this enzyme, there is a greater chance the
patient will develop emphysema due to proteolysis
in the lung tissue (2). Secondary emphysema is
caused by inhalation of cigarette smoke. Other
contributing factors are air pollution, occupational
exposure, and childhood respiratory tract
infections (2).
Pathophysiology With the inhalation of tobacco
smoke or chemicals, antiproteases are inhibited
while inflammation and protease activity are
stimulated. This stimulation promotes alveolar
destruction by cellular apoptosis and senescence.
The alveolar destruction produces bullae, large air
spaces in the lung parenchyma, and blebs, air
spaces by the pleurae. The bullae and blebs do not
promote gas exchange and the result is an
alteration to the ventilation-perfusion ratio, leading
to hypoxemia. The barrel chest appearance is
caused by air trapped within the lung, resulting in
hyperexpansion of the chest. This stretches the
muscles used during respiration and more effort is
required during breathing (2).
NCLEX Questions (6)

All of the following nursing diagnoses are
important for a client with chronic pulmonary
emphysema (COPD). Which would receive
priority when planning nursing interventions?
A. Self-care deficit
B. Activity intolerance
C. Ineffective airway clearance
D. Impaired gas exchange
Answer: D

Which of the following interventions would be a
priority in the plan of care for the person with
pulmonary emphysema?
A. Intravenous ampicillin therapy
B. Maintaining hydration status
C. Low-flow oxygen via face mask
D. Intravenous aminophylline
Answer: C












EMPHYSEMA


Lifespan and Cultural Considerations

Emphysema typically affects the older generation. In
the survey mentioned previously, 3.2% of those
diagnosed with COPD were between the ages of 18
and 44 while more than 11.6% were 65 years or
more. The subjects could have been diagnosed with
COPD, emphysema, or chronic bronchitis (1). If the
younger generation was in fact diagnosed with
emphysema, it was most likely primary emphysema
(2).
Culturally, those diagnosed with emphysema would
have a history of inhaled tobacco use, additionally
they could have had exposure to inhaled chemicals
either in their place of employment or simply have
lived in a highly polluted area (2).
CLINICAL MANIFESTATIONS

The classic sign of emphysema is the barrel
chest and a prolonged expiration is always
present. The common manifestations are
dyspnea and wheezing. Most likely, the patient
has a history of smoking. Late in the course of
the disease, the patient may present with chronic
hypoventilation, polycythemia, or cor pulmonale.
If there is an infection with the emphysema, the
patient could have a productive cough as well (2).
PINK PUFFER
BULLAE
WHAT IS EMPHYSEMA?
DIFFERENCES SHOWN
CAUSE & EFFECT
Impaired gas exchange related to ventilation-
perfusion inequality (3).
The client will verbalize understanding of
oxygen supplementation and other
therapeutic interventions by day two (3).
Noncompliance related to reluctance to accept
responsibility for changing detrimental health
practices (3).
The client will review emphysema literature
and verbally admit responsibility for the
current health state by day five.
Imbalanced nutrition: less than body
requirements related to decreased intake
because of dyspnea (3).
The client will consume adequate
nourishment during at least five meals in one
week (3).



COMPLICATIONS
Complications that could be associated with
emphysema are related to the increased effort it
takes to breathe and to chronic inflammation of
the airways. Because there is greater resistance
against the respiratory muscles, respiratory
fatigue could develop after a while. This fatigue
may lead to hypoventilation and hypercapnia.
Inflammation could result in bronchi
hyperreactivity and bronchioconstriction, making
breathing even more difficult. Chronic
inflammation could also have systemic affects.
Weight loss, muscle weakness, and increased
susceptibility to comorbidities, such as infection
could all be caused by chronic inflammation of
the airways (2).
NURSING DIAGNOSES
SIGNIFICANCE TO NURSING
Emphysema has a significant impact on nursing
and respiratory therapists. When treating an
emphysema patient, the nurse needs to
remember the fragile state the patients lungs are
in. With any COPD patient, the nurse has to take
care not to force too much oxygen into the lungs
because this could rupture the already damaged
alveoli. The highest level should be no greater
than 3 L/min (4). Also, with the advancing age of
the baby boomer generation, there could be an
increase in patients diagnosed with emphysema.
I know a 79 year old male who was diagnosed
with emphysema within the last year.