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Prepared by:- Prof. BLESSY THOMAS, MSc NURSING
VICE PRINCIPAL, FNCON,SPN
DEFINITION
 Emphysema is an abnormal permanent enlargement of the air
spaces distal to terminal bronchioles, accompanied by destruction
of their walls and without obvious fibrosis.
 Emphysema of lung is defined as hyper inflation of the lung ais
spaces due to obstruction of non respiratory bronchioles as due to
loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
INCIDENCE
 All age groups are equally affected.
 More common in men than women.
 More common in smoking people
 Occurs uses after 60‘s.
RISK FACTORS /CAUSES
 Smoking cigarettes / passive smokers
 Inhaling toxins or other irritants.
 Genetic factors.
 Exposure to pollution.
 Due to frequent lower respiratory infections.
 HIV infection.
 Alteration in normal defence mechanism.
 Infection.
 Ageing after 50‘s or 60 ‘s .
TYPES OF EMPHYSEMA
Centriacianar Emphysema
Panacinar Emphysema
Para septal Emphysema
Irregular Emphysema
Centri lobular/Centriacinar/ Proximal acinar
 Dilatation of respiratory Bronchiole.
 Occurs in chain smokers/Coa/mine workers.
 Upper lobes are severely involves .
 Can Co-exist with chronic bronchitis.
 Begins in the respiratory bronchioles and spreads
mainly in the upper half of the lungs.
 This is the most common type of emphysema.
Panacinar emphysema (Pan lobular)
 Can occurs in smokers.
 Commonly resides in the lower half of the
lungs and destroys the tissue of the air
sacs, causing a distinctive, uniform
enlargement of air spaces.
 It is associated with a genetic disease.
Para septal Emphysema (Distal acinar)
 Involves the distal airway structures
alveolar ducts & alveolar sacs.
 It can leads to pneumothorax.
 Giant Bullae’s can be seen.
 Tends to localize around the septa or
pleura.
 It’s often associated with inflammatory
processes, such as prior lung infections.
Irregular
Can be seen anywhere in the
respiratory tubules and
alveolar sacs or ducts
PATHOPHYSIOLOGY
 Healthy lungs.
 Healthy alveoli & others structures.
 Harm particular trapped in alveoli.
 Inflammatory response triggered.
 Inflammatory chemicals dissolve alveolar septum.
 Formation of large air cavity lined with carbon deposits.
 Increased ventilatory dead space.
 Leads to clinical manifestation.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
CLINICAL MANIFESTATIONS
 Cough in the morning
 Cough with clear sputum
 Wheezing.
 Shortness of Breath.
 Deceased exercise tolerance.
 Rapid breathing.
 Clubbing of fingers.
 Fat intolerance.
 Blush lips.
 Cyanosis.
 Fatigue.
 Barrel chest
 Edema in ankles and legs.
 Loss of appetite.
 Weight loss.
 Breathing through pursed lips.
 Desire to lean forward to improve breathing.
 Cardiomegaly (right chamber ).
 Heart failure
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
Lean forward position
DIAGNOSTIC EVALUATION
 History Collection
 Physical examination
 Chest X ray (abnormally large lungs)
 ABG Arterial Blood cell court.
 Pulse oximetry
 Sputum examination
 ECG
Management
 Pharmacological Management
 Beta-agonists – for relaxation of clearances smooth muscles mucociliary
 Anti cholinergic – for relaxation of bronchial smooth musk.
 Bronchodilators – Albuterol
- Formoterol
- Salmeterol
 Corticosteroid – aerosol spray.
 Oxygen Therapy To improve oxygen delivery to lungs.
 Pulmonary Rehabilitation – Supportive measures for smoking
cessation.
- Breathing exercises
- Spiro metric exercises
 Nutritional Therapy
 Balanced diet
 Postural drainage – helps to remove the section
Surgical Management
1) Lung volume reduction surgery – In this surgery the diseased
part of the lungs (30%) will be removed so that the
remaining healthy lung tissue can perform better.
 Types
Median sternotomy
Video assisted thoracoscopy
Bronchoscope surgery.
Median sternotomy
In this procedure parts of
diseased lungs is removed and
tissue reattached using a sapling
device.
Video assisted thoracoscopy
Can be performed unilaterally
or bilaterally.
1) Bullectomy
 In case of presence of large Bulla. It
is performed through bronchoscopy.
1) Lung Transplantation
 It is the procedure in which the
diseased lungs totally removed and
door lung will be transplanted.
Nursing Management
 Breathing Retraining
 Pulsed – lip breathing
 Diaphragmatic breathing
 Effective coughing
 Chest physiotherapy
 Postural drainage
 Nebulization therapy
Nursing Diagnosis
 Impaired gas exchange related to impaired ventilation.
 Ineffective airway clearance due to ineffective coughing and large
amount of secretions.
 Impaired nutrition due to less in take with diseased appetite due to
medication and anxiety.
 Anxiety due to breathing problem and fear of suffocation.
 Activity intolerance related to dyspnoea.
 Sleep Disturbance related to breathing difficulty.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT

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NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT

  • 1. Prepared by:- Prof. BLESSY THOMAS, MSc NURSING VICE PRINCIPAL, FNCON,SPN
  • 2. DEFINITION  Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.  Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
  • 3. It is a type of chronic obstructive pulmonary disease. It is a progressive disease of lungs.
  • 4. INCIDENCE  All age groups are equally affected.  More common in men than women.  More common in smoking people  Occurs uses after 60‘s.
  • 5. RISK FACTORS /CAUSES  Smoking cigarettes / passive smokers  Inhaling toxins or other irritants.  Genetic factors.  Exposure to pollution.  Due to frequent lower respiratory infections.  HIV infection.  Alteration in normal defence mechanism.  Infection.  Ageing after 50‘s or 60 ‘s .
  • 6. TYPES OF EMPHYSEMA Centriacianar Emphysema Panacinar Emphysema Para septal Emphysema Irregular Emphysema
  • 7. Centri lobular/Centriacinar/ Proximal acinar  Dilatation of respiratory Bronchiole.  Occurs in chain smokers/Coa/mine workers.  Upper lobes are severely involves .  Can Co-exist with chronic bronchitis.  Begins in the respiratory bronchioles and spreads mainly in the upper half of the lungs.  This is the most common type of emphysema.
  • 8. Panacinar emphysema (Pan lobular)  Can occurs in smokers.  Commonly resides in the lower half of the lungs and destroys the tissue of the air sacs, causing a distinctive, uniform enlargement of air spaces.  It is associated with a genetic disease.
  • 9. Para septal Emphysema (Distal acinar)  Involves the distal airway structures alveolar ducts & alveolar sacs.  It can leads to pneumothorax.  Giant Bullae’s can be seen.  Tends to localize around the septa or pleura.  It’s often associated with inflammatory processes, such as prior lung infections.
  • 10. Irregular Can be seen anywhere in the respiratory tubules and alveolar sacs or ducts
  • 11. PATHOPHYSIOLOGY  Healthy lungs.  Healthy alveoli & others structures.  Harm particular trapped in alveoli.  Inflammatory response triggered.  Inflammatory chemicals dissolve alveolar septum.  Formation of large air cavity lined with carbon deposits.  Increased ventilatory dead space.  Leads to clinical manifestation.
  • 13. CLINICAL MANIFESTATIONS  Cough in the morning  Cough with clear sputum  Wheezing.  Shortness of Breath.  Deceased exercise tolerance.  Rapid breathing.  Clubbing of fingers.  Fat intolerance.  Blush lips.  Cyanosis.
  • 14.  Fatigue.  Barrel chest  Edema in ankles and legs.  Loss of appetite.  Weight loss.  Breathing through pursed lips.  Desire to lean forward to improve breathing.  Cardiomegaly (right chamber ).  Heart failure
  • 17. DIAGNOSTIC EVALUATION  History Collection  Physical examination  Chest X ray (abnormally large lungs)  ABG Arterial Blood cell court.  Pulse oximetry  Sputum examination  ECG
  • 18. Management  Pharmacological Management  Beta-agonists – for relaxation of clearances smooth muscles mucociliary  Anti cholinergic – for relaxation of bronchial smooth musk.  Bronchodilators – Albuterol - Formoterol - Salmeterol  Corticosteroid – aerosol spray.  Oxygen Therapy To improve oxygen delivery to lungs.
  • 19.  Pulmonary Rehabilitation – Supportive measures for smoking cessation. - Breathing exercises - Spiro metric exercises  Nutritional Therapy  Balanced diet  Postural drainage – helps to remove the section
  • 20. Surgical Management 1) Lung volume reduction surgery – In this surgery the diseased part of the lungs (30%) will be removed so that the remaining healthy lung tissue can perform better.  Types Median sternotomy Video assisted thoracoscopy Bronchoscope surgery.
  • 21. Median sternotomy In this procedure parts of diseased lungs is removed and tissue reattached using a sapling device. Video assisted thoracoscopy Can be performed unilaterally or bilaterally.
  • 22. 1) Bullectomy  In case of presence of large Bulla. It is performed through bronchoscopy. 1) Lung Transplantation  It is the procedure in which the diseased lungs totally removed and door lung will be transplanted.
  • 23. Nursing Management  Breathing Retraining  Pulsed – lip breathing  Diaphragmatic breathing  Effective coughing  Chest physiotherapy  Postural drainage  Nebulization therapy
  • 24. Nursing Diagnosis  Impaired gas exchange related to impaired ventilation.  Ineffective airway clearance due to ineffective coughing and large amount of secretions.  Impaired nutrition due to less in take with diseased appetite due to medication and anxiety.  Anxiety due to breathing problem and fear of suffocation.  Activity intolerance related to dyspnoea.  Sleep Disturbance related to breathing difficulty.