This patient has previously been diagnosed with emphysema, and the radiographs that were taken in association with this visit indicate that this diagnosis is correct and accurate. Indications of hyperinflation of the lungs associated with emphysema include a low sitting diaphragm which may be flat, increased lucency of the lung fields, increased anterior-posterior diameter, increased retrosternal air, and a vertically aligned heart (Chandrasekhar). As both increased anterior-posterior diameter and hyperinflation of the lungs was noted on radiographs in conjunction with her history of shortness of breath, it can be determined that she is suffering from J43.9, emphysema, unspecified.
Nursing interventions for emphysema, as ordered, should be aimed at improving the patient’s ability to breath and eliminating her shortness of breath as well as educating her about healthier habits. She should be taught about emphysema and should be encouraged to actively participate in treatments and therapy. Nurses should teach her about the goals of her treatments such as symptoms relief, prevention of progression, improve tolerance of exercise, and treatment of worsening of complications (Boka, 2014).
The most important aspect of the nurse’s job in the intervention of this patient is working towards the cessation of smoking. Boka notes “Studies have shown that a less than 10-minute discussion by a physician can motivate a patient to quit smoking.” A plan leading to the cessation of smoking cigarettes is an imperative portion of an overall emphysema treatment plan for this patient. While some people feel that the difficulty associated with smoking cessation is due to nicotine addiction, this is a falsehood. The habit of smoking is a conditioned response which is associated with stimuli such as oral fixation, psychosocial stressors, habit, and intense marketing campaigns by the tobacco industry. Based on the reasons that people smoke, a smoking cessation protocol that addresses many different functions of smoking will benefit this patient (Boka, 2014).
Moving from a status of smoking to nonsmoking requires the patient go through a variety of stages. The patient will move from precontemplation, contemplation, preparation, action, and maintenance. Programs and plans to help the patient move to a status of nonsmoking should include self-help education, group therapies, physician-delivered treatments, and community involved programs. Patient education, follow-up support, prevention of relapse, healthy lifestyle change advice, setting up social support systems, and pharmacological agents Advice for healthy lifestyle changes are all critical nursing interventions for the patient with emphysemia and continues to smoke cigarettes. Regarding smoking cessation, nicotine replacement will assist with the withdrawl effects such as anger, anxiety, depression, concentration difficulty, fatigue, and irritability (Boka, 2014).
Pharmacological interventions as prescribed by a physician will aid this patient. Bronchodilators should be provided for in order to improve airflow via dilating airways to alleviate symptoms but do not change the progression of the disease. Phosphodiesterase inhibitors increase intracellular cAMP which in turn leads to bronchodilation. Emphysema is associated with inflammation. Therefore, physicians often prescribe inhaled or oral corticosteroids. These drugs reduce inflammation and can substantially change the illness. Patients who have emphysema often have a comorbidity of infection with S pneumoniae, Pseudomonas, H influenzae, and Moraxella catarrhalis in the lower airways. The culture of the lower airways will be helpful to determine the best antibiotic choice. Mucolytic agents are often indicated to improve chest comfort and to decrease coughing. These agents are useful but have not been determined to improve lung functionality. As the patient has shortness of breath upon activity, she is most likely also experiencing hypoxia. Oxygen therapy can help improve the survival rate of patients with emphysema (Boka, 2014).
Beyond pharmaceuticals, there are other therapies that the nurse should include in working with this emphysema patient. To improve breathing, nurses could participate in chest physiotherapy via postural drainage and coupage. This should be done a few times per day. Respiratory treatments should be scheduled one hour before and after meals. These meals should be of high calorie and protein rich. These nutrients will assist the body with healing. The patient should also be taught to drink at least three liters of fluids per day to help loosen secretions in the respiratory system. Daily activity should also be encouraged. While the patient has indicated that she experiences shortness of breath upon exercise, easing into more activity will help to build up a tolerance.
The nurse should assist the patient to stay compliant with the physicians orders. Medications should be given as prescribed and how the patient responds to the medication should be included in the medical record. The respiratory functionality should be monitored regularly and well as the patients’ complete blood count. The nurse should also be cognizant of any potential complications of emphysema such as respiratory failure, respiratory tract infections, pneumothorax, cor pulmonale, and peptic ulcer (Nursing File Staff, 2010).
Overall, the nurse should work with this emphysema patient through a multi-modal approach. The education and training plan will teach the patient about their disease, the benefits of smoking cessation and how to treat their illness. Offering supportive care will give them the best way to stop smoking and will also add in mental health care as well to fight depression. The nurse should advocate with daughters to include them in her care. Working with all of the doctor’s orders and these nursing interventions will provide a complete and balanced care plan (Nursing File Staff, 2010).
- Boka, K. (2014, October 23). Emphysema Treatment & Management. Retrieved from MedScape: http://emedicine.medscape.com/article/298283-treatment
- Chandrasekhar, A. (n.d.). Chronic obstructive lung disease ( COPD) / Emphysema. Retrieved from Stritch School of Medicine: http://www.stritch.luc.edu/lumen/MedEd/Radio/curriculum/Medicine/emphysema.htm
- Nursing File Staff. (2010, October 18). Interventions for Emphysema. Retrieved from NursingFile.com: http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-emphysema.html