Emphysema is a lung disease that gradually damages the air sacs (alveoli). Over time, the sacs weaken and rupture, resulting in a reduction of the surface area of the lungs and the amount of oxygen reaching the bloodstream, which results in dyspnea.
Gradually, damage to the alveoli causes the lungs to overfill, making breathing increasingly difficult. The alveoli won’t work properly when exhaling, which causes air to become trapped, reducing the ability to inhale. Emphysema may occur with chronic bronchitis, which is inflammation of the bronchioles. Both conditions occur under the umbrella term of chronic obstructive pulmonary disease (COPD).
Smoking is considered the number one cause of emphysema. Therefore, it is a preventable respiratory illness. Other factors that may cause emphysema include:
- Air pollutants
- Occupational exposure to chemical fumes
- Marijuana use
- A rare genetic condition called alpha-1 antitrypsin deficiency
Symptoms of emphysema are:
- Chronic cough
- Shortness of breath, especially with exertion
- Increased mucus production
- Barrel-chest appearance
- Anxiety
- Weight loss
Chest X-rays or CT scans can confirm emphysema while ruling out other lung conditions.
Complications related to emphysema may include pneumothorax, cor pulmonale, and large holes (bullae) in the lungs.
There is no cure for emphysema, but the symptoms can be managed through medications, pulmonary rehabilitation, surgery, and smoking cessation.
Nursing Process
Because emphysema is a progressive disease, the nursing role is crucial in long-term support. Nurses can deliver interventions that aim at reducing symptoms and preventing complications. Educating the patient about the disease process and how to slow progression will aid in improved quality of life.
Nursing Care Plans Related to Emphysema
Ineffective Airway Clearance
The damaged air sacs cause shortness of breath and reduce airway clearance.
Nursing Diagnosis: Ineffective Airway Clearance
Related to:
- Damaged alveoli
- Excess sputum production
- Smoking
- Inflammation
As evidenced by:
- Dyspnea
- Wheezing, crackles
- Excessive secretions
- Usage of accessory muscles
- Coughing
Expected outcomes:
- Patient will maintain clear breath sounds and unlabored respirations.
- Patient will demonstrate effective expectoration of excess sputum.
- Patient will develop techniques for maintaining an effective airway.
- Patient will maintain an oxygen saturation over 92%.
Assessment:
1. Frequently assess the patient’s lung sounds and respirations.
Adventitious lung sounds are expected with emphysema. Monitor for rhonchi or crackles that signal an infection, such as pneumonia. Monitor for changes in respiratory patterns for impending respiratory distress.
2. Assess oxygen saturation.
Patients with chronic lung diseases often present with a lower baseline oxygen saturation, sometimes between 88-90%.
Interventions:
1. Encourage expectoration of secretions. Suction if necessary.
If the patient cannot clear secretions on their own, suctioning will aid in clearing thick mucus that they cannot expectorate.
2. Provide supplemental oxygen as prescribed.
Supplemental oxygen will help in increasing SpO2 levels to an acceptable level. Do not over-oxygenate the patient.
3. Assist the patient in assuming a semi-Fowler’s position.
Elevating the patient’s upper body will help improve expansion, allowing the patient to breathe more easily.
4. Instruct on breathing techniques.
Pursed-lip breathing slows the pace of breathing, allows trapped air to be released, and keeps the airways open longer to decrease the work of breathing.
5. Prepare for surgery.
Lung volume reduction surgery removes damaged lung tissue so the remaining lung tissue can expand and work efficiently. Severe cases may require a lung transplant.
Activity Intolerance
Chronic dyspnea, especially with exertion, is a common feature of emphysema and can ultimately lead to reduced physical ability.
Nursing Diagnosis: Activity Intolerance
Related to:
- Inefficient breathing pattern
- Oxygen supply and demand imbalance
- Gas exchange limitations
- Peripheral muscle fatigue
As evidenced by:
- Reports of fatigue
- Physical inactivity
- Dyspnea on exertion
- Dyspnea at rest
- Orthopnea
Expected outcomes:
- Patient will display reduced dyspnea during regular physical activities.
- Patient will display respiratory and pulse rates within normal limits during activity.
- Patient will participate in pulmonary rehabilitation.
Assessment:
1. Assess the patient’s physiological response to activity.
Assess vital signs and respiratory patterns with movement, self-care, and exercise to assess the degree of severity and limitations.
2. Determine wants versus needs with activity.
Is the patient limited to activities in the home? Can they climb stairs? Is exercise limited to 10 minutes or none at all? Can they partake in self-care, such as bathing? Patients may need to decrease expectations or may require additional resources.
Interventions:
1. Encourage exercise as tolerable.
In the later stages of emphysema, exercise may not be possible. Exercise should be undertaken as long as possible as it increases lung capacity.
2. Stop smoking.
This is the most important intervention to prevent worsening emphysema. Smoking irritates the airways and makes it harder to breathe. Continuing to smoke will significantly limit the patient’s tolerance for activity.
3. Educate the patient on energy conservation techniques.
Instruct on working at an even pace, placing frequently used items within reach, resting between tasks, and taking naps to reduce oxygen consumption and fatigue.
4. Encourage pulmonary rehab.
Pulmonary rehabilitation will instruct the patient with a lung disease on achieving exercise with less dyspnea.
5. Instruct on inhaler use.
Patients with emphysema use steroid inhalers and bronchodilators. Educate that bronchodilators are used first to open the airways, and steroid inhalers are used next to allow the medication to enter the airways.
Deficient Knowledge
Patients with emphysema need health-related education to support them in managing their illness and preventing further complications.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Unfamiliarity with information
- Information misinterpretation
- Cognitive limitation
As evidenced by:
- Statements displaying misconceptions
- Progression of preventable symptoms
- Inaccurate understanding and demonstration of instructions
- Request for information
Expected outcomes:
- Patient will show increased interest and willingly participate in the learning process.
- Patient will initiate necessary lifestyle changes and adhere to the treatment regimen.
Assessment:
1. Assess the patient’s readiness to learn and their individual learning needs.
Assessing how willing a patient is to learn about their condition and specific needs will help determine how much is needed to be taught and which teaching strategies will be effective.
2. Identify support persons or significant others requiring information.
Involving the patient’s family or significant others will ensure better adherence to care.
3. Assess for any individual risk factors that may aggravate the condition.
The number one leading cause of emphysema is smoking. It is important to determine any habits the patient has that may contribute to worsening their condition so that they can be addressed.
Interventions:
1. Educate the patient on the importance of regular follow-up consultations.
It is essential to monitor the disease process so that necessary changes in the treatment plan can be done to match their changing needs. This includes follow-up with a pulmonologist, pulmonary function tests, and imaging as needed.
2. Encourage vaccinations.
Patients with chronic lung diseases should receive pneumococcal and influenza vaccinations to prevent worsening lung health.
3. Prevent infections.
Instruct on preventing infections through handwashing, proper nutrition, and avoiding sick people or large crowds. A patient with emphysema is at a higher risk of developing pneumonia.
4. Encourage the patient and their significant others to control risk factors.
Second-hand smoke is also a contributor to emphysema. Areas of high air pollutants or workplaces that use fumes are additional risk factors. Instruct patients to wear masks or respirators in these settings.
References
- Emphysema. American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/emphysema. Accessed on Dec. 11, 2022
- Emphysema. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9370-emphysema. Accessed on Dec. 11, 2022
- Emphysema. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/emphysema/symptoms-causes/syc-20355555. Accessed on Dec. 11, 2022
- Expanding nurse practice in COPD: is it key to providing high quality, effective and safe patient care?. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442791/. Accessed on Dec. 11, 2022
- Doenges, M. E., Moorhouse, M. F. (1993). Nurses’s Pocket Guide: Nursing Diagnoses with Interventions (4th Ed.). F.A. Davis Company.
