Ward Class

An Online Resource Site For Student Nurses

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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Respiratory Disorders: Emphysema



  • a type of Chronic Obstructive Pulmonary Disease involving the damage of alveoli (air sacs) in the lungs
  • three types: centriacinar, panlobar, and paraseptal
  • alveolar, bronchial, and bronchiolar tissue are damaged resulting in loss of recoil, air trapping, thoracic overdistension, accumulation of sputum, and loss of diaphragmatic muscle tone
  • results in carbon dioxide retention, hypoxia, and respiratory acidosis
  • caused mainly by cigarette smoking; other causes include infection, inhaled irritants, heredity, allergic factors, and aging
Assessment Findings
  • anorexia, fatigue, weight loss
  • difficulty of breathing, cough, sputum production
  • resonance to hyperresonance
  • decreased breath sounds with prolonged expiration
  • normal or decreased fremitus
  • diagnostic tests: pCO2 may be elevated or normal; pO2 normal or slightly decreased
Medical Management
  1. bronchodilators such as aminophylline, isoproterenol, terbutaline, and theophylline -->treat brochospasm
  2. corticosteroids like prednisone -->reduces inflammation
  3. Cautious low-flow oxygen delivery is prescribed for patients with emphysema (usually 1 to 3L/min by nasal cannula) due to long-standing hypercapnia; high levels of oxygen can obliterate to patient's respiratory drive
  4. postural drainage and chest physiotherapy -->remove bronchial secretions
  5. aerobic and breathing exercises-->enhance cardiovascular fitness and strengthen respiratory muscles
Surgical Management
  • surgery is relatively uncommon but there are times when patients need to undergo procedures such as bullectomy (removal of a large bullae that compresses the lung) or Lung Volume Reduction Surgery (LVRS)
Nursing Management
  1. administer medications as ordered: bronchodilators, antimicrobials (ampicillin, tetracycline) for bacterial infections, corticosteroids
  2. facilitate removal of secretion
    • ensure fluid intake of 3L per day
    • provide chest physiotherapy, teach coughing and breathing exercises
    • suction and provide oral hygiene as needed
  3. improve ventilation
    • maintain in semi- or high-Fowler's position
    • instruct on diaphragmatic breathing
    • encourage productive coughing after treatments (splint abdomen to produce expulsive cough)
    • instruct on pursed-lip breathing (prolonged, slow relaxed expiration) techniques
  4. provide client teachings prior to discharge
    • prevention of infection: avoid crowds, immunization for influenza and pneumonia
    • worsening of symptoms: fatigue, increased dyspnea, increased tightness of chest
    • importance of diet: high-carbohydrate, high-protein, increased vitamin C
    • control of environment: use of home humidifier at 30-50% humidity, wear scarf over nose and mouth in cold weather to prevent bronchospasm, avoid smoking and irritants
    • avoid abrupt changes in temperature
    • increasing activity tolerance: mild exercises, breathing techniques, have low-flow oxygen available as needed, frequent rest periods
Prognosis

Emphysema is an irreversible, chronic, and serious disease. If detected early and if the patient stops smoking immediately, treatment can slow the progress of the disease. Overall, prognosis for patients diagnosed with emphysema is poor. With supplemental oxygen and other treatments, patients may significantly improve their prognosis.

Prevention

The best way to prevent emphysema is to avoid smoking.



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