Case Study of Emphysema: Nursing Assessment, Pathophysiology, and Interventions

This case study focuses on the nursing assessment, pathophysiology, and interventions for a patient with emphysema. The report includes abnormal findings, nursing interventions, and the role of a physiotherapist.

Case study of chronic
health

Table of Content.
INTRODUCTION...........................................................................................................................3
Abnormal findings...........................................................................................................................3
Pathophysiology..............................................................................................................................4
Nursing interventions.......................................................................................................................4
Role of physiotherapist....................................................................................................................5
CONCLUSION................................................................................................................................6
References........................................................................................................................................7

INTRODUCTION
Emphysema is a lung condition which causes the shortness of breath which can effect the
the air sacs in the lungs (alveoli) are damage which can reduces the surface area of lung. The
main cause of this disease is long-term exposure to airborne irritant which include obacco,
smoking and air pollution. People with emphysema also have chronic bronchitis which leads to a
persistent cough. Emphysema is one of the most preventable respiratory illnesses because the
main cause of Emphysema is strongly linked to smoking (Seimetz & et. al., (2020)). In this
condition the air sacs in the lungs become damaged. Additionally, this report contains the
nursing assessment of the patient having emphysema, pathophysiology and nursing care
assessment.
Abnormal findings
Tom is investigated with the abnormal findings which include the respiratory system,
CVS and musculoskeletal system. With the help of nursing assement it is found that the blood
pressure is irregular and they have some respiratory issues. Nurses analysed that they have wet
cough with yellow sputum expecorated and Tom facing difficulties in taking breathing . The
bilateral cracakles are the the bothe bases of the lungs which causes the accumulation of the
mucus and fluid in the lungs. Nurses analysed these new obsevation in the morining assesment.
Nurses must focus on the respiratory sysytem because Tom facing more difficulties in breathing
and due to the respiratory diseses emphysemsa and they have wet cough in their avelvoi sac due
to the less surface area for gas exchange (Singla, Dharwal & Naura, (2020)). In that morning,
three new observation is analysed with the help of nursing assessment Tom have the peripheral
neruovascular indication with minor of numbness in which they loss the sensation of the left
foot. They have the issues in the left foot and they loss the senasation which is the new indication
of the Tom nursing assement. Due to loss of sensation of the left foot Tom face difficulting in
walking so they use the bottle for excreation toilet. Due to the shortness of breath they face many
difficulties in walking these problems are genrating due to the respiratory problems. Tom having
the moderate fall risk due to the new observation and current poor peripheral sensation and
perfusion. Three abnormal condition is found with the help of nursing assesement which fouced
by the healthcare staff because the new indication of abnormal sysmptoms of Tom may cause
fall in risk. Tom have face the difficultioes in walking due to the loss of senation of that
partuicular part and and shortness of breath. After the nursing assesment, three body system
requires more focus due to the the new indication and observation which includes CVS,
respiratory system and musculoskeletal system (Campos & et. al., (2019)). Three body systme of
Tom is more focused by the healthcare professional due to shortness of breath respiratory system
get more focused.The nursing assesement is improtant for the Tom because it can analysis the

difficulties which are faced by the Tom. Nursing staff should provide the best medical treatment
to theTom so that they can recover fast.
Pathophysiology
The clinical signs and symptoms for emphysema are the resultant of the airways damage
which involve alveolar sacs, alveolar ducts and alveolar along with the bronchioles. It has been
found that patient is now been diagnosed with exacerbation of emphysema which result
primarily into accelerated thick mucus secretion with alteration in the color and the magnitude.
It also result into shortness of breath in more rapid instance than before. Tom has also faced issue
to locomate to washroom so there is proximity of glass fabricator for them to avoid exertion
(Mallah & et. al., (2020)).
The expansion in the airspace destructed walls is notices which could be due to
proteinases, which decreases the surface area within alveolar and capillary surface area which
declines the rate of gas exchange. As the patient is addicted to smoking it can be Centrilobular
emphysema. With a long term exposure to such type of smoke, the inflammatory cells such as
neuterophills, macrophages and T- lymphocytes are activated. Over instance of emphysema
period with smoking continuation accelerated the patient risk for development of exacerbation of
lungs. Smokers with pre-diagnosed emphysema have a risk for development of infection in
overall trachea bronchial tree as there is increased magnitude of macrophage and CD8 T
lymphocytes in the airway lumen. This result in deterioration of the inflammatory cellular
patterns as there is sudden increase the inflammatory mediators including the cytokines, chemo-
kine receptors and eosinophils.
The enlargements in the air sacs along with the destruction of lungs susceptibility is
enhanced by the Elastase or the anti- elastase. This elastase and proteinase works against the
elastin and destroy the overall connective tissue within the parenchyma of the lungs. These
patients are at optimistic risk for the development of frequent exacerbation due to accelerated
airway expansion are at risk fo death. Additionally,risk for development of dynamic
hyperinflation, cardiovascular comorbidity and limitation in expiratory flow can be found. the
As it result in the faster deprive of lung function in patient which is result that patient is not
getting a result of taking antibiotics. It is advice that patient must incorporate the empiric
antibody therapy used with the aim to shortcoming risk development of mortality episode,
treatment failure or the sputum purulence. The overdose of smoking cause destruction of elastic
fibers due to which there is failure of elasticity. It further result in narrowing of vessels and lead
to condition of the air flow blockage in patient (Shimizu & et. al., (2018)).
Nursing interventions.
The possible nursing care interventions for Mr. Coates generally involve the following
steps which are as mentioned below:

Nursing interventions Rationale
The care nurses should access all the vital
signs and symptoms of Mr. Coates
respiration for at least every four hours.
The care nurses must assess the breathing
sounds via the auscultation.
The care nurses will do in order to assist in
creating an accurate and potential diagnosis
as well as can monitor an effectiveness of
the care clinical treatment. A wheezing
breath sound is generally essential signs of
an emphysema (Padilha, Sousa and Pereira,
2018).
The care nurses should administer the
supplementary oxygen as prescribed by the
healthcare professionals. They may
discontinue it if the level of SpO2 is
particularly above the target range.
It is significantly done because to enhance
the level of oxygen as well as can attain an
SpO2 value within the target range of 88 to
approximately about 92%.
The care nurses should administer the
emphysema medications as prescribed by
the healthcare professionals such as
steroids, bronchodilators or the
combination inhalers or nebulizers as well
as the antibiotic medications (Emphysema
Nursing Diagnosis and Nursing Care Plan,
2022).
The particular for this is such as
Bronchodilators like to relax or dilates the
muscles or the airways of Mr. Coates. The
steroids should be provided to decrease the
possible inflammation within the lungs. In
addition to this, the potential antibiotics
should be provided to him to effectively
treat his bacterial infection if present any.
The care nurse should perform a chest
physiotherapy like vibration and
percussion, if they are not contraindicated.
For the patient, nebulization using sodium
chloride may also be done as considered by
the healthcare professional. The steam
inhalation can also be performed.
The specific interventions should be done to
effectively facilitate the clearance of thick
secretion of airways.
In addition to this, there are also various other possible nursing care interventions that can be
used in Mr. Coates case scenario to overcome his illness and to recover as soon as possible. He
should be provided with inspiratory muscle trainings as it can aid him to enhance the breathing
issues or patterns in him. The care nurses should also provide knowledge about diaphragmatic
breathing as it can decrease the respiratory rate, enhances the alveolar ventilation as well as can
sometimes aid to Mr. Coates to expel as much as air during his expiration of breathing (Reed,
2020).
Role of physiotherapist.
A physiotherapist can play an essential role within the management of patients with
Coronary Obstructive Pulmonary Disorder. It can involve addressing the specific problems
mainly associating with the decreasing work of breathing, encouraging the clearance of airways.
In addition to this, it can also enhance the mobility as well as can promoting the rehabilitation
and contribution towards the provision of an effective non-invasive ventilation services as well.

In context with Mr. Coates case scenario, by using the Air Physio PEP devices in order to
effectively clean the airways as well as the condition of the lungs, the device will efficiently
assist within the recovery procedure or generally aid to maintain the emphysema of Mr. Coates
(Gore & et. al., (2021)).
It is been found that patient is carry through body pain and irritability due to
emphysema , therapy will help the patient to balance out their body functioning in the better
form. Therapist can provide the patient with manual therapy. Here the minute digital pressure is
provided patients on their pain variables on connective tissues to stimulate the accelerated blood
circulation in several part of the body. Counseling session must be organized for the patient by
the physiotherapist to provide accurate sleep therapy to them. Their mood and tiredness must be
regulate while providing them low dairy products with wholegrain foods to accelerate the energy
in patient. This can be performed by incorporating regular exercise in terms of 30-mins walk as
they will encourage the patients to locomate the small steps to adopt health y lifestyle choices
They must assist the waling aid to the patient which might end up their impairing mobility. To
facilitate the balance or co-ordination physiotherapist must order them in and out of bed practice
or sit to stand exercise. They must incorporate the functional electrical stimulation where the
electrical impulses are provided to prevent the risk of patient to fall-out. They must also
incorporate the usage of ankle foot orthosis for improved walking patterns in patients as it
supports the muscles movement Discharge planning is one of the important part of the
physiotherapist role as their role is to provide the comprehensive care to patients. It is need to be
done in safe and accurate manner to relay patient mobility back in optimistic manner. When not
done accurately it might result in poor patient health or satisfaction (Medrinal & Bonnevie,
(2022)).
CONCLUSION
From the above discussion, it is concluded that the emphysema is a lung condition which
is a serious diseases that may affect the overall respiratory system and sometime it may also lead
to cause death. Patient having emphysema may suffer from various difficulties which includes
shortness of breath, chest tightness and increased on the production of mucus. The main cause of
this diseases is due to over time exposure of tobacco, smoking and air pollution. There various
nursing care intervention which can help patient to overcome with their diseases and can avoid
the smoking. The nursing intervention may helps patient to recover and protect themselves from
damaging the respiratory system and muscovascular system. The health care professional team
focus on diagnosing and providing the best quality medical treatment to the patient by which
they can get over from their disease.

References
Books and Journals
Mallah, H., Ball, S., Sekhon, J., Parmar, K. & Nugent, K., (2020). Platelets in chronic obstructive
pulmonary disease: An update on pathophysiology and implications for antiplatelet
therapy. Respiratory Medicine, 171, p.106098.
Shimizu, K., Konno, S., Makita, H., Kimura, H., Kimura, H., Suzuki, M. & Nishimura, M.,
(2018).Transfer coefficients better reflect emphysematous changes than carbon
monoxide diffusing capacity in obstructive lung diseases. Journal of Applied
Physiology, 125(1), pp.183-189.
Medrinal, C. & Bonnevie, T., (2022). Physiotherapy during and after acute exacerbation of
COPD. Revue des Maladies Respiratoires.
Gore, S., Blackwood, J., Emily, H., & Natalia, F. (2021). Determinants of acute care discharge in
adults with chronic obstructive pulmonary disease. Physiotherapy Theory and Practice,
1-10.
Reed, J.M., 2020. Gaming in nursing education: recent trends and future paths. Journal of
Nursing Education, 59(7), pp.375-381.
Padilha, J.M., Sousa, P.A.F. and Pereira, F.M.S., 2018. Nursing clinical practice changes to
improve self‐management in chronic obstructive pulmonary disease. International
nursing review, 65(1), pp.122-130.
Seimetz, M., Sommer, N., Bednorz, M., Pak, O., Veith, C., Hadzic, S., ... & Weissmann, N.
(2020). NADPH oxidase subunit NOXO1 is a target for emphysema treatment in
COPD. Nature Metabolism, 2(6), 532-546.
Singla, E., Dharwal, V., & Naura, A. S. (2020). Gallic acid protects against the COPD-linked
lung inflammation and emphysema in mice. Inflammation Research, 69(4), 423-434.
Campos, K. K. D., de Oliveira Ramos, C., Martins, T. L., de Paula Costa, G., Talvani, A.,
Garcia, C. C. M., ... & Bezerra, F. S. (2019). Lycopene mitigates pulmonary
emphysema induced by cigarette smoke in a murine model. The Journal of Nutritional
Biochemistry, 65, 93-100.
Online:
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