Definition

Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness
of breath due to over-inflation of the alveoli (air sacs in the lung). In people with
emphysema, the lung tissue involved in exchange of gases (oxygen and carbon dioxide) is
impaired or destroyed. Emphysema is included in a group of diseases calledchronic
obstructive pulmonary disease or COPD (pulmonary refers to the lungs). Emphysema is
called an obstructive lung disease because airflow on exhalation is slowed or stopped
because over-inflated alveoli do not exchange gases when a person breaths due to little or no
movement of gases out of the alveoli.
Emphysema changes the anatomy of the lung in several important ways. This is due to in part
to the destruction of lung tissue around smaller airways. This tissue normally holds these
small airways, called bronchioles, open, allowing air to leave the lungs on exhalation. When
this tissue is damaged, these airways collapse, making it difficult for the lungs to empty and
the air (gases) becomes trapped in the alveoli.
Normal lung tissue looks like a new sponge. Emphysematous lung looks like an old used
sponge, with large holes and a dramatic loss of springy-ness or elasticity. When the lung is
stretched during inflation (inhalation), the nature of the stretched tissue wants to relax to its
resting state. In emphysema, this elastic function is impaired, resulting in air trapping in the
lungs. Emphysema destroys this spongy tissue of the lung and also severely affects the small
blood vessels (capillaries of the lung) and airways that run throughout the lung. Thus, not
only is airflow affected but so is blood flow. This has dramatic impact on the ability for the
lung not only to empty its air sacs called alveoli (pleural for alveolus) but also for blood to
flow through the lungs to receive oxygen.
COPD as a group of diseases is one of the leading causes of death in the United States.
Unlike heart disease and other more common causes of death, the death rate for COPD
appears to be rising.









ANATOMY AND PHYSIOLOGY:
The respiratory system consists of all the organs involved in breathing. These include the
nose, pharynx, larynx, trachea, bronchi and lungs. The respiratory system does two very
important things: it brings oxygen into our bodies, which we need for our cells to live and
function properly; and it helps us get rid of carbon dioxide, which is a waste product of
cellular function. The nose, pharynx, larynx, trachea and bronchi all work like a system of
pipes through which the air is funneled down into our lungs. There, in very small air sacs
called alveoli, oxygen is brought into the bloodstream and carbon dioxide is pushed from the
blood out into the air. When something goes wrong with part of the respiratory system, such
as an infection like pneumonia, chronic obstructive pulmonary diseases, it makes it harder for
us to get the oxygen we need and to get rid of the waste product carbon dioxide. Common
respiratory symptoms include breathlessness, cough, and chest pain.

The Upper Airway and Trachea
When you breathe in, air enters your body through your nose or mouth. From there, it travels
down your throat through the larynx (or voicebox) and into the trachea (or windpipe) before
entering your lungs. All these structures act to funnel fresh air down from the outside world
into your body. The upper airway is important because it must always stay open for you to be
able to breathe. It also helps to moisten and warm the air before it reaches your lungs.

The Lungs
Structure
The lungs are paired, cone-shaped organs which take up most of the space in our chests,
along with the heart. Their role is to take oxygen into the body, which we need for our cells
to live and function properly, and to help us get rid of carbon dioxide, which is a waste
product. We each have two lungs, a left lung and a right lung. These are divided up into
lobes, or big sections of tissue separated by fissures or dividers. The right lung has three
lobes but the left lung has only two, because the heart takes up some of the space in the left
side of our chest. The lungs can also be divided up into even smaller portions, called
bronchopulmonary segments.
These are pyramidal-shaped areas which are also separated from each other by membranes.
There are about 10 of them in each lung. Each segment receives its own blood supply and air
supply.















Pathophysiology
PATHOPHYSIOLOGY

Tobacco smoke, Air Pollution




Inflammation of the Airway Epithelium




Infiltration of inflammatory Cells & Release of Cytokines
(Neutrophils, Macrophages, Lymphocytes, Leukotrines, Interleukins )


Breakdown of alveolar elasticity

Difficulty of breathing

Inability of the alveolar to expand
air was trapped inside the lungs ( barrel chest )

Inability of the lungs to
Circulate Sufficient Air

EMPHYSEMA




Personal Data

o Name: Patient E
o Address: St. Maria, Tarlac, City
o Age: 54 years old
o Birth date: November 1, 1960
o Religion: Roman Catholic
o Civil Status: Single
o Nationality: Filipino
o Occupation: Former Farmer
o Admitted on: June 21, 2009
o Height: 52
o Weight: 45
o Chief Complaint: D.O.B. (Difficulty of Breathing)

B. History of Past illness

Patient E stated that he experienced fever for almost 1 month last year 2013, but he can never
consult to the doctor to treat hes disease. He also added that he has cough and suddenly felt
pain on hes chest while breathing.

C. History of Present Illness

After one year he didnt expect that this would happen to him again. The patient says, that it
might be from working on their farm, he thought that it would just be a simple cough due to
tiring day but it lasted for about a month and he now suffer again from coughing and
difficulty of breathing. He noticed that he easily fatigability while doing some house hold
chores. And think that this is worse than last year.

Review of System

General Appearance

Weight loss Weight gain Anorexia
Fatigue Weakness Night sweats
Jaundice

Note: the patient is weak in appearance, he has jaundice color especially on hes sclera and
nails, he is easily fatigability when he do some house hold chores and experiencing night
sweat, he has weight loss because hes suffering dysphagia while eating.




Skin

Itch Bruising Rash Bleeding
Lesions Blister Ecchymoses Burns Drainage

Note: No abnormalities in skin found

Ears
Pain Discharge Tinnitus
*Hearing loss

Note: the patient has slightly hearing loss due to aging

Nose

Obstruction Epistaxis Discharges

Note: no abnormalities in skin found

Throat & Mouth

Sore throat Bleeding gums Tooth Ache
Tooth Decay

Note: No abnormalities in throat and mouth

Chest

Cough Hemoptysis Wheeze Pain in Respiration
Dyspnea Sputum Rales

Note: the patient has cough but unable to expel sputum that is why he has dyspnea when
breathing and upon auscultation patient hears Rales.


CVS

Chest pain Palpitation Dyspnea Edema
Orthopnea Others__________

Note: he felt pain on hes chest while coughing and breathing and hes pulse rate increase.

GIT

Intolerance Heartburn Nausea Jaundice
Vomiting Pain Bleeding Excessive Gas
Constipation Change in BM Melena

Note: jaundice was seen on hes sclera, nails and slightly on hes skin upon inspection.

Genito Urinary

Dysuria Nocturia Retension Polyuria
Dribbling Hematuria Flank Pain Tea colored urine
Oliguria

Note: patient experience Oliguria and tea colored urine due to concentration.

Neuro

Headaches Dizziness Memory Loss Fainting
Numbness Tingling Seizures
Paresis Paralysis
Others: ________________
Notes: No abnormalities in Neuro found.

Signs and Symptoms

1. Shortness of Breath
Also known as dyspnea, shortness of breath is the hallmark symptom of emphysema. Learn
more about breaking the dyspnea cycle, along with exercises to help you alleviate shortness
of breath.
2. Rapid Breathing
Tachypnea is the medical term for rapid breathing, which is another common symptom of
emphysema. Learn why people with emphysema suffer from tachypnea.

3. Chronic Coughing
A person with emphysema usually has a history of cigarette smoking accompanied by a long-
term, (chronic) cough. The cough may be either be productive (with sputum) or non-
productive (without sputum). Learn more about chronic cough and find out why COPD
causes increased mucus production.

4. Wheezing
Wheezing, especially during expiration, is a common finding among emphysema patients. A
wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during
breathing

5.Reduced Exercise Tolerance
Many people with emphysema have a reduced capacity for any type of exercise or activity.
This often gets worse over time, as the emphysema progresses.

6. Barrel Chest
Barrel chest is a rounded, bulging, barrel-like appearance of the chest, which is common in
the later stages of emphysema.


Recommendation
We recommend this study to:
The nursing students farther enlarge their knowledge and have a better understanding
on the disease entity being conferred on this study. We fully believe that familiarity on the
disease process, etiology, review of its anatomy and physiology, and assessment data would
add up to their way of doing nursing interventions, critical thinking skills and be more
efficient and responsible by means of being knowledgeable on the subject being studied. We
also recommend helping to disseminate this information to client and to significant others
about emphysema.













CENTRAL LUZON DOCTORS HOSPITAL
EDUCATIONAL INSTITUTION, INC.
(A wholly- owned Subsidiary of Central Luzon Doctors Hospital, Inc.)
Romulo Highway, San Pablo, Tarlac City
(045) 982 5019/ 982 5052/ 982 0264/ (045) 982 0780

CLINICAL FOCUS
Course Name: Nursing Care Management 106 Community

Course Description: It deals with the principles and techniques of nursing care management
of sick clients across the lifespan with emphasis on the adult and older persons with
alterations/problems in cellular aberration, acute biological crisis, including emergency and
disaster nursing.

Placement: BSN IV, NCM 106 Community
Total No. of Hours: 153 Hours
General Objectives:
At the end of 153 hours of clinical exposure the student should be able to utilize the nursing
process in the care of individuals and families in community setting. Relate with clients and
their family and the health team appropriately. Observe bioethical concept/ principles, core
values and nursing standards in the care of clients. Promote personal and professional growth
of self and others.















Week/ Objectives Activities Time
Alteration/References
Week 1
The students nurses
will be familiarize,
identify, and
recognize the
community and its
people, barangay
officials, family and
community problems.


The students nurses
will be able to identify
client with problems
in cellular aberration,
acute biological crisis
emergency and
disaster nursing.







Week 2
The students

Courtesy call RHU, Barangay officials,
and school principal.

Community tour



Task giving
Home visit/ interview
Case Findings :
a. Cellular aberrations
Tumors
b. Acute biological crisis/
multiorgan system dysfunction/
emergency
Cardiac failure, acute
myocardial infarction,
acute pulmonary failure,
acute renal failure, stroke,
ICP Metabolic
emergencies, massive
bleeding, extensive burns,
poisoning, emergency
illnesses and multiple
injuries.



8:00am 4:00pm
nurses will be
able to provide
nursing
intervention to
patients with
problems in
cellular
aberrations,
acute
biological
crisis
emergency
and disaster
nursing with
utilizing the
nursing
process.


Assessment
Nursing diagnosis
Planning for health restoration
and maintenance
Implementation
evaluation






Week 3

To acquire knowledge
on the principles of
management for
altered cellular
aberrations, acute
biological crisis
emergency and
disaster nursing.




To apply infection
control measures.











Lectures/Discussion
Determination and management
of cause.
Prevention of infection
Supportive management
Prevention of complication
Life saving interventions
(BLS,ACLS, First aid measures)
Personal protective equipment
Hazardous materials
Natural disaster

Health education on the prevention of
the infection
Actual application of infection control
measures
Application of standard precautions
(barrier) used with all clients
Referral system implementation
Follow up of cases





8:00 4:00pm






















Week 4

The students will be
able to describe the
needs of the patients
with problems in
cellular aberrations,
acute biological crisis
emergency and
disaster nursing







To student nurses will
be able to implement
appropriate health
education.

Assessment
Nursing diagnosis
Planning for health restoration and
maintenance
Implementation
Interview/counseling
Open forum
Use ICE (INFORMATION Education
Communication)
Leaflets
Brochure
Comics hand outs
Flyers


Apply the concepts and principles of
nursing care management utilizing the
nursing care process in the community
Referral system implementation
Follow up cases


8:00 4:00pm














Documentation



CASE FINDING DURING OUR FIRST
FUCKING DAY IN THE COMMUNITY.








COURTESY CALL TO THE HEALTH
WORKERS IN FUCKING
BARANGAY.










TAKING BLOOD PRESSURES
OF FUCKING PATIENTS.






























TAKING VITAL SIGNS AND ADVISING THE PATIENT TO
GO IN THEIR HEALTH CLINIC OR TO THE HOSPITAL
HIS CHECK UP.







FOLLOW UP VISIT TO THE PATIENT TO KNOW THE
RESULT OF HIS CHECK UP, AND LAB EXAMINATIONS.