Jenny Schneider, a 47 year old librarian has come to her GP medical practice complaining of shortness of breath, fatigue and anxiety. “ I moved into management about 6 months ago after waiting for years for this job to come along and now I cannot even climb the stairs to my office without huffing and puffing, I have even cut back on my smoking, but that has not helped.” On examination Jenny is a thin caucasian female who looks older than her age. She has dyspnoea but is not cyanotic. She sits forward in a hunched position. She is unable to blow out a lit match placed 15-30 cm away.
Case Study 2
Vital Signs Height 1.69 cm Weight 54 kg BP 130/80; RR 31; P 110; Sp02 = 93% Blood Chemistry pH 7.31; pCO2 52mmHg pO2 70 HCO3 33 : CXR: PA radiograph reveals hyperlucency (dark areas) indicating hyperinflation of the lungsPulmonary function tests indicate increased residual volume and TLC as well as decreased FEV and VC.
Jenny is diagnosed with Emphysema
Emphysema is a long term, progressive disease of the human lungs, Emphysema causes shortness of breath due to over-inflation of the alveoli (which are air sacs in the lungs)
Lung tissue is involved in exchange of the gases it is impaired or destroyed. Emphysema is known as obstructive lung disease or COPD because air flow on exhalation is slowed or stopped because of over inflated alveoli do not exchange gaes when an individual breathes due to little or no movement of gases out of the alveoli
Pathology. Emphysema is characterised by poorly revisable air flow obstruction an abnormal inflammatory response in the lungs of the individual. the latter represents e innate adaptive imune responses long term exposure to noxious particles gases, mostly cigarette smoke.
Signs and symptoms of Emphysema
- Shortness of breath
- Tolarance for exercise decreses over time
- Barrel chest
When a doctor suspects Emphysema in the lungs he/she are paying attention to breathing sounds, heart sounds, and the individuals general physical appearance .
The Doctor will order a number of test to confirm the findings as well and the progression and status.
Tests that are used to conclude Diagnostic are;
- A chest X-Ray: this helps Doctors see any changes in the lung that may look abnormal.
- A lung function test: this gives the doctor specific information about how the individuals lungs work mechanically.
- If the individual has any family history of alpha-1-antitrypsin deficiency,
- A blood test: this is to check the white blood cell count.
Treatment and management
Treatment for Emphysema comes in many different forms. Generally doctors will recommend a step by step process for the best results. treatmenst include;
- Stop smoking - Bronchodilating medication - this allows the air passages to open ore fully and allow better air exchange.
- Steriod medication - this decreases inflammation in the body.
People that have a more serious case of Emphysema may have to have surgery.
Lung Volume reduction surgery and/or Lung transplants.
1. Auscultate lung sounds
2. Monitor ABG's
3. Encourage a healthy weight early stages of emphysema: overweight ate stages f emphysema: underweight
4. Monitor oxygen saturation
5. 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.
6. Breathing treatments and medications
7. Assess for/Administer influenza vaccine and pneumococcal vaccine
Emphysema, N., sounds, A., ABGs, M., underweight, E., saturation, M., Prepare for the worst: If the patient has been working very hard to breath for a long period of time and is getting worse, h., medications, B. and vaccine, A. (2018). Nursing Care Plan for Emphysema | NRSNG. [online] NRSNG. Available at: https://www.nrsng.com/care-plan/emphysema/ [Accessed 17 Sep. 2018].
George Schiffman, F. (2018). What Is Emphysema? Symptoms, Treatment & Life Expectancy. [online] eMedicineHealth. Available at: https://www.emedicinehealth.com/emphysema/article_em.htm [Accessed 17 Sep. 2018].