Emphysema

Emphysema is one of the lung disorders classified as chronic obstructive pulmonary disease (COPD). In emphysema, damage to the air sacs in the lungs reduces their ability to pick up oxygen from the air we breathe.

Causes

Cigarette smoking is the leading cause. Others are air pollution, allergies, and infections. Dust or chemical-filled air at work can cause emphysema. The disease becomes more likely as we get older.

Signs/Symptoms

The most common symptom is gradually increasing difficulty in breathing that grows worse over a period of many years. Finally, breathing becomes difficult even when you're resting. You may also cough up small amounts of sputum or have swelling in your feet and hands. People with emphysema tend to have very pink skin, to be thin, and have a barrel-shaped chest.

Care

Treatment is aimed at helping you breathe more easily. If the problem is severe, you may need a stay in the hospital, where you can get oxygen, breathing treatments, and medicine.

Risks

If you don't follow your doctor's directions, this disease will get worse, ending in death. However, the illness can be controlled with medicine, exercise, and diet.

WHAT YOU SHOULD DO

• You will breathe easier if you take your medicine exactly as directed. If you feel it is not helping, call your doctor. Do not quit taking it on your own.
• If you are prescribed antibiotics, continue to take them until they are all gone--even if you feel well.
• If your medicine makes you drowsy, do not drive or use heavy equipment.
• Quit smoking. It's probably the cause of your emphysema, and will certainly make it worse. If you are having trouble quitting, ask your doctor for help.
• Try to avoid anything that makes your breathing harder, such as things that you're allergic to and polluted air.
• Try to avoid people who have colds or the flu. Get shots to prevent the flu and pneumonia.
• Eat foods that have plenty of protein, vitamins, and minerals in them. Your doctor can give you some suggestions.
• If you are coughing up sputum, do not eat or drink foods that contain milk. They can make sputum thicker.
• If you do not have to limit the amount of liquids you drink, drink 8 to 10 (soda-can sized) glasses of water each day. This helps thin the sputum so it can be coughed up more easily.
• To help keep your lungs free of infection, take 2 or 3 deep breaths and then cough. Do this often during the day.
• A humidifier will help keep the air moist and your sputum thin, making it easier to cough up. Be sure to keep your humidifier free of fungus. Clean it every day.
• Stay inside during very cold or hot weather, or on days when the air pollution is high. If you work in a polluted area, you may need to change jobs.
• When you are active, you may feel short of breath. Here are some breathing exercises that may relieve the problem:
  • Breathe with pursed or puckered lips (as if you are playing the trumpet).
  • Breathe using your diaphragm. Put one hand on your abdomen and breathe in so that the hand moves outward or up. Breathing this way allows your lungs more room to expand and take in air.
• If you use medicine that you inhale, follow these steps:
  • First, shake the inhaler.
  • Breathe out slowly, all the way.
  • Put the mouthpiece of the inhaler in your mouth or 2 inches away (about half a finger's length), or use the spacer (a piece of plastic-like tubing that attaches to the inhaler).
  • Breathe in and push down on the inhaler at the same time (to create the mist).
  • Hold your breath for about 10 seconds.
  • Breathe out slowly through puckered lips or through your nose.
  • If you need to take 2 puffs, wait 2 to 5 seconds before taking the second one.
  • Gargling after using your inhaler may help relieve burning in your throat.

Call Your Doctor If...

• Your sputum gets thicker even though you're taking your medicine and drinking water as directed.
• You cough up sputum that is bloody, yellow, or green.
• Your nail beds stay gray or blue even after you are breathing easier.
• You have a high temperature.
• You have chest pain or trouble breathing during exercise that does not go away with rest.

Seek Care Immediately If...

• You are feeling confused, dizzy, or very drowsy, and have swollen hands and feet and blue or pale lips and nail beds.
• You have chest pain or trouble breathing even while resting.
• If you have these symptoms, call 911 or 0 (operator) to get to the nearest hospital or clinic. Do not drive yourself!

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may encounter the following procedures and equipment during your stay.

• Activity: At first you will need to rest in bed, with a few pillows to keep you sitting up a little. This will help your breathing. Do not lie flat. Once you are breathing more easily, you will be allowed to increase your exercise.
• Oxygen: You may need extra oxygen at this time. It is given either by a mask or nasal prongs. Tell your doctor if the oxygen is drying out your nose or if the nasal prongs bother you.
• Pulse Oximeter: While you are getting oxygen, you may be hooked up to a pulse oximeter (ox-IM-uh-ter). It is placed on your ear, finger, or toe and is connected to a machine. It measures the oxygen in your blood.
• IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
• Medicines: The drugs below will help you breathe easier. They can be taken by mouth or given in your IV.
  • Antibiotics: If you have an infection in the lungs, you'll be given antibiotics to clear it up.
  • Bronchodilators (bronk-o-DIE-lay-tors): The medicines may be needed to help open your lung's airways.
  • Steroids (STAIR-oids): You may be given one of these drugs to decrease the swelling and inflammation of the tissue in your lungs.
• Breathing Treatments: A machine will be used to help you inhale medicine. A therapist will help with these treatments. They will help open your airways so you can breathe easier. At first you may need them frequently. As you get better, you may only need them when you are having trouble breathing.
• Postural Drainage: A nurse may tap your back briskly with his or her hands. This helps loosen the sputum in your lungs so you can cough it up more easily.
• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• ECG: Also called a heart monitor, an electrocardiograph (e-lec-tro-CAR-dee-o-graf), or EKG. The patches on your chest are hooked up to a TV-type screen or a small portable box (telemetry unit). This screen shows a tracing of each heartbeat. Your heart will be watched for signs of injury or damage.
• 12 Lead ECG: This test makes tracings from different parts of your heart. It can help your doctor decide whether there is a heart problem.
• Chest X-ray: This picture of your lungs and heart is used to monitor your condition.
• Blood Gases: Blood taken from an artery in your wrist, elbow, or groin is tested for oxygen.

Blood: Usually taken for testing from a vein in your hand or from the bend in your elbow.

Nursing Management

impaired Gas Exchange may be related to alveolar capillary membrane changes/destruction, possibly evidenced by dyspnea, restlessness, changes in mentation, abnormal ABG values.

ineffective Airway Clearance may be related to increased production/retained tenacious secretions, decreased energy level, and muscle wasting, possibly evidenced by abnormal breath sounds (rhonchi), ineffective cough, changes in rate/depth of respirations, and dyspnea.

Activity Intolerance may be related to imbalance between O2 supply and demand, possibly evidenced by reports of fatigue/weakness, exertional dyspnea, and abnormal vital sign response to activity.

imbalanced Nutrition: less than body requirements may be related to inability to ingest food (shortness of breath, anorexia, generalized weakness, medication side effects), possibly evidenced by lack of interest in food, reported altered taste, loss of muscle mass and tone, fatigue, and weight loss.

risk for Infection: risk factors may include inadequate primary defenses (stasis of body fluids, decreased ciliary action), chronic disease process, and malnutrition.*

Powerlessness may be related to illness-related regimen and healthcare environment, possibly evidenced by verbal expression of having no control, depression over physical deterioration, nonparticipation in therapeutic regimen; anger, and passivity.