Nursing Care Plan (NCP) for Emphysema

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Outline

Pathophysiology

Emphysema is when the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and lose their elasticity and rupture, creating larger air spaces instead of small ones. This will reduce the surface area of the lungs and cause CO2 to stay in the alveoli and not be exhaled out of the body. As well as making it harder for O2 to enter into the alveoli.

Etiology

Exposure to lung irritants in the air: smoke, air pollutants, chemicals, dust, etc. for prolonged periods of time and with repeated exposure.

Desired Outcome

Clear, even, non-labored breathing while maintaining optimal oxygenation and optimal ventilation for patients.

Emphysema Nursing Care Plan

Subjective Data:

  • Chronic cough
  • Difficulty breathing 
  • Notice avoiding certain activities 
  • Chest tightness/pain

Objective Data:

  • Wheezing
  • SOB- especially upon exertion 
  • Oxygenation saturation decrease 
  • Blue/grey lips or fingernails 
  • Inability to speak full sentences 
  • Swelling/edema 
  • Tachycardia 
  • Barrel chest 
  • “Pink puffers” (difficulty catching their breath, face redden while gasping for air)

Nursing Interventions and Rationales

Auscultate lung sounds If wheezy they may need a breathing treatment If you hear crackles, they may have pneumonia and potentially could use suctioning.
Monitor ABGs Blood gases help to determine if the patient is in respiratory acidosis.
Encourage a healthy weight Early stages of emphysema: overweight Late stages of emphysema: underweight Having excess weight on the patient decreases the space for the lungs to expand. In later stages of emphysema, the patient can be very thin (barrel-chested) and it is important to make sure they are getting the proper nutrition, so their body is at the optimal performance (for that patient).
Monitor Oxygen saturation ****Give oxygen as ordered and needed. Be careful about turning their drive to breath off by giving too much O2, as a general rule, emphysema patients should be kept around 88%-92%. ****
Breathing treatments and medications- Beta-Agonists: Such as albuterol work as bronchodilators

Anticholinergics: Such as Ipratropium work to relax bronchospasms

Corticosteroids: Such as Fluticasone work as an anti-inflammatory

Assess for/Administer influenza vaccine and pneumococcal vaccine Preventing complications such as influenza or pneumonia is important because the lungs are already working harder to keep the body balanced with oxygen and CO2, an increased risk of infection only complicates the patient’s ability to breathe.

Writing a Nursing Care Plan (NCP) for Emphysema

A Nursing Care Plan (NCP) for Emphysema starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey everyone. Today, we are going to be creating a nursing care plan for emphysema. So, let’s get started. First, we’re going to go over the pathophysiology. So, emphysema is when the air sacs of the lungs or the alveoli are damaged over time; the inner walls are weakened, and they lose their elasticity and rupture, which creates larger air sacs. This will reduce the surface area of the lungs and cause CO2 to stay in the alveoli and not be exhaled out of the body; this makes it harder for the O2 to enter into the alveoli. Some nursing considerations: you want to do a full respiratory assessment, monitor ABGs, O2 saturation, maintain a healthy weight, administer medications, and administer the influenza and the pneumococcal vaccine. Some desired outcomes: you’re going to have clear, even, non-labor breathing while maintaining optimal oxygenation and optimal ventilation for the patient. 

So, we’re going to go ahead and create our care plan. We’re going to have some subjective data and we’re going to have some objective data that we’re going to be writing down. So, we’re going to see what we are, are we going to see with our patients? So, with our patients, some of the subjective data you’re going to have is a chronic cough and difficulty breathing. These patients have a very hard time breathing. Some objective data: you guys probably have heard it before – they are the pink puffers. And what does that mean? Pink puffers. Basically, they’re having difficulty catching their breath. So, they’re red in the face while they’re gasping for that air. You’ll also notice with these patients, they may have some wheezing and tachycardia, or an increased heart rate. Some other things they’ll notice is avoiding certain activities because they won’t be able to breathe as easily, some chest tightness and pain, some shortness of breath, especially upon exertion, and decreased O2 saturation. You might see some blue gray lips or clubbing on the fingernails and an inability to speak full sentences. Swelling, edema, and barrel chest are pretty common with these patients. 

So, some interventions: we want to make sure that we’re going to auscultate those lung sounds. So, we’re going to listen to those lungs. If they’re wheezy, they may need a breathing treatment. If you hear any crackles, they may have pneumonia, and that could be potentially in need of some use of suctioning. Some other interventions: we’re going to be monitoring the ABGs; blood gases are going to help determine if they are in any sort of respiratory acidosis. We want to encourage a healthy weight, especially early stages of emphysema – they are overweight, and in late stages of emphysema, they’re underweight. So, they’re going to monitor their weight. Having excess weight on a patient decreases the space for the lungs to be able to expand. In the later stages of emphysema, the patient can be very thin or barrel chested. And it’s very important to make sure that they’re getting enough proper nutrition so that their body is at the optimal performance for that patient. We also want to monitor their O2 sats. We want to give oxygen as ordered as needed, but you want to be careful about turning their drive to breathe off by giving them too much. So, as a general rule and a super, super important thing that I want you guys to know is that any emphysema patient should be kept around 88 to 92%. Very, very important. Another invention for these patients is going to be giving them any sort of breathing treatments and medication. So certain medications we would give are beta agonists. There’s also long-acting bronchodilators and corticosteroids. So, with the beta agonist, such as albuterol, they work as bronchodilators. They’re going to help open up the airway for the patients. Long-acting bronchodilators, such as spiriva, work to relax any sort of bronchospasms, and corticosteroids, such as fluticasone, work as anti-inflammatory. So, these are great medications for the patient. Another intervention we want to do, we want to assess and or administer the influenza vaccine and the pneumococcal vaccine. So, the influenza and the pneumococcal. So, we want to prevent any sort of complications such as influenza or pneumonia, which is important because the lungs are already working harder to keep the body balanced with the oxygen and the CO2. So, an increased risk of infection only complicates the patient’s ability to breathe. 

So, we’ve got our completed care plan. We’re going to go ahead and go through some key points. So, pathophysiology etiology emphysema is when the air sacs and the lungs where the alveoli are damaged over time, the inner walls of the sacs weaken, losing their elasticity and rupturing can be caused by exposure to irritants in the air, such as smoking chemicals, and air pollutants. Some subjective and objective data: You’ll see with the patient, they’ll have a chronic cough, difficulty breathing, and wheezing. It’s those pink puffers, right? Tachycardia decreased O2 saturation, inability to speak in full sentence, blue, gray lips, and barrel chested. We want to make sure we’re doing a respiratory assessment. So, we want to make sure we’re monitoring their ABGs, monitoring their O2 sats, encouraging a healthy weight, giving medications and vaccines. So, we want to make sure that we’re educating them on these meds and also educating the importance of the influenza and the pneumococcal vaccines to prevent any further complications. All right, we are completed with this care plan. 

You guys did amazing. We love you guys. Go out, be your best self today and as always happy nursing.

 

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