Emphysema


Etiology and Pathophysiology
■ Alveolar wall distention → ↑surface area for gas exchange, air trapping,
and ↑residual volume → ↑work to exhale, barrel chest, chronic
hypercapnia; may → right-sided heart failure (cor pulmonale)

Risk Factors
■ ↑Age, smoking, secondhand smoke, inhaled pollutants
■ Alpha antitrypsin deficiency

Signs and Symptoms

■ Barrel chest, clubbing of fingers
■ Pursed-lip breathing, ↓forced expiratory volume
■ Bronchodilators ineffective (unlike asthma)

Treatment

■ Smoking cessation
■ O2; meds: steroids and bronchodilators
■ Lung transplant

Nursing Management

■ Give O2 at ≤2L because with emphysema excessive exogenous O2
diminishes the respiratory drive and results in ↓breathing and ↑CO2
retention (CO2 narcosis). Normally ↑CO2 stimulates breathing. With
emphysema there is chronic ↑CO2 and as a result low O2 stimulates
breathing
■ Teach diaphragmatic and pursed-lip breathing to extend exhalation and
keep alveoli open
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