Destruction of the alveoli shapes and functionality. Normally alveoli are little pouches of springy grapes, but patients with emphysema have misshapen pouches that are not springy. This causes CO2 to stay in the alveoli and not exhale out of the body as well as making it harder for O2 to enter into the alveoli. High levels of CO2 (which is acidic) can cause complications such as respiratory alkalosis.
Exposure to lung irritants in the air: smoke, air pollutants, chemicals, dust, etc. for prolonged periods of time and with repeated exposure.
Clear, even, non-labored breathing while maintaining optimal oxygenation for patient.
Emphysema Nursing Care Plan
- Chronic cough
- Difficulty in breathing
- May notice they are avoiding certain activities that they used to participate in and now cannot due to breathing difficulties… “I used to play with the grandkids, now I can’t.”
- Chest tightness/pain
- Shortness of Breath- especially upon exertion
- Oxygen saturation
- Blue/Gray lips/fingernails- especially upon exertion
- Inability to speak full sentences (have to stop to breath)
- Barrel chest
Nursing Interventions and Rationales
Auscultate lung sounds
- If wheezy they may need a breathing treatment
If you hear crackles they may have pneumonia and potentially could use suctioning.
- Blood gases help to determine if the patient is in respiratory acidosis.
- To interpret the ABG you must know normal ABG values.
- pH: 7.35-7.45
- Respiratory acidosis is when the pH is below 7.35 and the PaCO2 is above 45.
Encourage a healthy weight Early stages of emphysema: overweight Late stages of emphysema: underweight
- Having access weight on the patient decreases the space for the lungs to expand. Plus, generally those who lose weight are also moving more to lose the wieght, double win.
- In later stages of emphysema, the patient can be very thin (barrel chested) and it is important to make sure they are getting the proper nutrition so their body is at optimal performance (for that patient).
Monitor Oxygen saturation
- This is subjective as you need to make sure to understand the patient’s baseline. Plan the oxygen monitoring with the physician.
- Give oxygen as ordered and needed. Be careful about turning their drive to breath off by giving too much O2, as a general rule, emphysema patients should be kept around 88%-92%.
Prepare for the worst: If the patient has been working very hard to breath for a long period of time and is getting worse, be prepared with an airway cart. And for the love of the airway, have your respiratory therapist aware of the patient!
- Safety! Plus you do not want to wait until the impending airway closure happens to try to secure their airway. Sometimes the patient will be sedated and intubated to try to correct any respiratory acidosis or alkalosis
Breathing treatments and medications
- Beta-Agonists: Such as albuterol work as bronchodilators
- Anticholinergics: Such as Ipratropium work to relax bronchospasms
- Corticosteroids: Such as Fluticasone work as an anti-inflammatory
Assess for/Administer influenza vaccine and pneumococcal vaccine
- Preventing complications such as influenza or pneumonia is important because the lungs are already working harder to keep the body balanced with oxygen and CO2, an increased risk of infection only complicates the patient’s ability to breathe.