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Nursing Care Plan for Emphysema - Assessment and Diagnosis

Nursing Care Plan for Emphysema Assessment
Definition of Emphysema

Emphysema is a condition in which the alveoli become stiff expands and continuously filled the air even after expiration. (Kus Irianto.2004.216)

Emphysema is a chronic obstructive disease due to lack of elasticity in the lungs and alveoli surface area. (Corwin.2000.435)


Classification

There are two major types of emphysema, which are classified based on the changes that occur in the lungs:
  1. Panlobular (panacinar), ie damage to the respiratory bronchi, alveolar ducts and alveoli. All air space in the little lobes much enlarged, with little inflammatory disease. The characteristics that have chest hyperinflation, and is characterized by dyspnea on exertion, and weight loss.
  2. Centrilobular (centroacinar), the pathological changes mainly occur in the center of the secondary lobes, and peripheral of acini remain good. Often there is chaos-ventilation perfusion ratio, which lead to hypoxia, hypercapnia (increased CO2 in the arterial blood), polycythemia and heart failure episodes right. The condition leads to cyanosis, peripheral edema, and respiratory failure.


Etiology

Some things that can lead to pulmonary emphysema, namely:
1. Cigarette
Smoking can lead to pathological disorders of the airway ciliary movement, inhibits the function of alveolar macrophages, causing hypertrophy and hyperplasia of bronchial mucous glands.

2. Pollution
Industry and air pollutants can also cause emphysema. The incidence and mortality rates of emphysema can be said to be always higher in areas with high concentrations of industrialization, air pollution as well as tobacco smoke, can cause interference with cilia inhibits the function of alveolar macrophages.

3. Infection
Respiratory tract infections will cause more severe lung damage. Diseases such as respiratory infections, pneumonia, acute bronchiolitis and bronchial asthma, can lead to airway obstruction, which in turn can lead to emphysema.

4. Genetic

5. Exposure to dust


Clinical Manifestations
  • Dyspnea.
  • On inspection: chest shape 'barrel chest'.
  • Chest breathing, abnormal breathing is not effective, and the use of accessory muscles of respiration (sternocleidomastoid).
  • On percussion: hyperresonance and decreased fremitus in all lung fields.
  • On auscultation: audible breath sounds with crackles, and expiratory length.
  • Anorexia, weight loss, and general weakness.
  • Distended neck veins during expiration.


Pathophysiology

Pulmonary emphysema is a lung development, accompanied by tearing of the alveoli that can not be recovered, can be either global or localized, the majority know the whole lung.

Charging excessive air with obstruction, occurs as a result of partial obstruction of the bronchi or bronchioles where the output of the air in the alveoli become more difficult than the input. In such a situation occurs that increases the accumulation of air in the distal alveoli.

In emphysema the narrowing of the airways, it can lead to narrowing of the airway obstruction and tightness, constriction of the airways caused by reduced lung elasticity.


Complication
  • Frequent infections of the respiratory tract.
  • The immune system is less than perfect.
  • The level of lung damage more severe.
  • Chronic inflammatory process in the airways.
  • Pneumonia.
  • Atelaktasis.
  • Pneumothorax.
  • Increase the risk of respiratory failure in patients.


Nursing Assessment  for Emphysema

1. Activity / Rest
Symptoms: Exhaustion, fatigue, malaise, inability to perform daily activities because of difficulty breathing, inability to sleep, need to sleep sitting up high, dyspnea at rest or in response to activity or exercise.
Symptoms: Fatigue, anxiety, insomnia, general weakness / loss of muscle mass.

2. Circulation
Symptoms: Swelling of the lower extremities.
Signs: Increased blood pressure, increased heart rate / severe tachycardia, dysrhythmias, distended neck veins, edema dependent, not associated with heart disease, heart sounds dim (which is associated with increased AP diameter of the chest), color of skin / mucous membranes: normal or gray / cyanosis, pallor may indicate anemia.

3. Foods / Liquids
Symptoms: Nausea / vomiting, poor appetite / anorexia (emphysema), inability to eat due to respiratory distress, permanent weight loss (emphysema), weight gain showed edema (bronchitis).
Signs: poor skin turgor, dependent edema, sweating, drop in body weight, decrease in muscle mass / fat subcutaneously (emphysema), abdominal Palpitations can cause hepatomegaly (bronchitis).

4. Hygiene
Symptoms: Decreased ability / enhancement needs help doing everyday activities.
Signs: Health less, body odor.

5. Respiratory
Symptoms: Shortness of breath (dyspnea hidden emergence as the prominent symptom of emphysema), especially at work, the weather or the recurrence of episodes of difficult airway (asthma), sense of chest pressure, inability to breathe (asthma)
"Air Hunger" chronic.
Shape settled with sputum production every day (especially when awake) for a minimum of 3 consecutive months each year at least 2 years. Sputum production (green, white and yellow) can be a lot of (chronic bronchitis)
Intermittent episodes of cough is usually not productive at an early stage can occur despite earning (emphysema)
A history of recurrent pneumonia: exposure to chemical pollution / respiratory irritants in the long term (eg, cigarette smoke) or dust / smoke (eg, abscess, or coal dust, sawdust)
The use of oxygen at night or continuously.

Signs: Respiratory: usually fast, slow, use of accessory muscles
Chest: hyperinflation with the elevation of the AP diameter, minimal movement of the diaphragm.
Breath sounds: may dim with expiratory wheezing (emphysema); spreads, soft or crackles, wheezing lungs throughout the area.
Percussion: hyperresonant the lung area
Color: pale with cyanotic lips and nail beds.

6. Security
Symptoms History of allergic reaction or are sensitive to substances / environmental factors, presence / recurrence of infection, redness / sweating (asthma).

7. Sexuality
Symptoms: Decreased libido.

8. Social interaction
Symptoms: The relationship of dependence, lack of support systems, improved inability / long illnesses.
Symptoms: Inability to / make maintaining respiratory sounds, physical mobility limitations, abnormalities with the family members.

9. Counseling / Learning
Symptoms: The use / abuse of drugs breathing, difficulty stopping smoking, regular alcohol use, failure to improve.



Nursing Diagnosis  for Emphysema

1. Impaired gas exchange related to ventilation-perfusion abnormalities secondary to hypoventilation.

2. Excess fluid volume related pulmonary edema.

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