emphysema practice questions
What is panlobular emphysema
19. What is panlobular emphysema? Panlobular (pancinar) is the most severe but less common type. It is the abnormal weakening and enlargement of all alveoli distal to the terminal bronchioles, respiratory bronchioles, alveolar duct and alveolar sacs.
What fluid order should the emphysema patient have?
3 liters of fluid per day.
What age are you most likely to get emphysema?
40-60 years of age
What is the life expectancy after diagnosis?
5 years
What is cyanosis
A blueish appearance of the skin. This includes the fingernails and lips as well.
What are some signs and symptoms of emphysema?
Accessory muscle use- braced and leaned forward (tripod position), pursed-lip breathing, cachectic or malnourished, yellow fingers possible from smoking, digital clubbing, polycythemia, cor pulmonale, jugular venous distention, and edema (if cor pulmonale), increased respiratory rate, heart rate and dry nasopharyngeal carcinoma.
What medication or treatment is available for alpha one antitrypsin patient
Administration of prolastin
How many smokers will develop damage of the alveoli and when will it start to show up?
All smokers will develop damage of the alveoli. Symptoms will show between ages 35-40 years old.
What is the rare inherited deficiency of the protein that protects the elastic function of lungs?
Alpha-1 antitrypsin deficiency; seen in emphysema.
What are the risk factors of emphysema
Alpha1-antitrypsin deficiency; genetic disorder affecting the lungs, liver, and rarely the skin; smoking; age; second-hand smoke; occupational exposure and pollution.
What is a bleb?
Bleb is the accumulations of air within the layers of the visceral pleura. This is usually smaller than bulla
What are some treatments for emphysema
Bronchial hygiene, lung reduction, breathing techniques, oxygen, mechanical ventilation and lung transplant.
What is a bulla
Bulla is air pockets greater than one centimeter in the lung parenchyma.
What is centrilobular/centriacinar emphysema?
Centrilobar/Centriacinar is the abnormal weakening and enlargement of the respiratory bronchioles and alveoli in the proximal portion of the acinus. It is related to inflammation.
What is Centrilobular emphysema?
Centrilobular is the most common type. Its form begins at the respiratory bronchioles and spread peripherally and involves the upper half of the lungs
What are the major pathological changes associated with emphysema
Changes include permanent enlargement and destruction of the air spaces distal to the terminal bronchioles, destruction of pulmonary capillaries, weakening of the distal airways primarily the respiratory bronchioles and air trapping and hyperinflation
What will you observe on the hands of the client with emphysema?
Clubbing of the fingernail beds
What can be observed in pulmonary function test on patients with emphysema?
Decreased forced expiratory flow, increased total lung capacity, residual volume, and functional residual capacity, increased residual capacity over total lung volume and low diffusion.
What is the definition of diffusing capacity of the lungs of carbon monoxide
Diffusing capacity of the lungs of carbon monoxide is a medical test that determines how much oxygen travels from the alveoli of the lungs to the bloodstream.
How would ventilation be affected by emphysema?
Easy compliance and low recoil manifesting as hard to breathe out and patients will often pant when they breathe.
What is one symptom you experience in the later stages of emphysema
Frequent lung infections
What dietary prescription is most appropriate for a patient with emphysema
Frequent small meals to prevent tiring
What is referred to as a Hoover's sign
Hoover's sign is the inward movement of the lower lateral chest wall during each inspiration that indicates severe hyperinflation
What will be seen on a chest x-ray and CT scan of patients with emphysema
Hyperlucent with black lung due to gas trapping and increase functional residual capacity bulla and/or blebs, prominent pulmonary arteries, flatten diaphragm, blunted costophrenic angle, and bullous lesions.
What are the symptoms of emphysema
Increased A-P diameter (barrel chest appearance), accessory muscle usage, prolonged exhalation, shortness of breath, coughing, wheezing, hyper-resonant or decreased breath sounds, pursed-lip breathing, cyanosis and chronic cough.
What happens when the lungs do not recoil properly?
Increased compliance (floppy airways), premature airway closure leading to air trapping, hyperinflation, and increased residual volume, functional residual capacity, and total lung capacity
What happens to alveolar walls in emphysema?
It enlarges and then degenerates
What are the four pathophysiologies behind emphysema?
It has these pathophysiologies: lungs respiratory defenses are broken down by foreign invaders from cigarette ingredients; inflammatory immune cells appear and transport antigens to the bronchial lymphatic tissue layer. Macrophages release enzymes that destroy the lungs epithelial barrier; loss of alveolar wall decrease in elastic recoil in lungs that reduces airflow; and, loss of alveolar supporting structures airway narrows which further limits airflow.
When should a patient with potential emphysema see a doctor
It is advisable to see a doctor when experiencing unexplained increase in shortness of breath at rest or during activity that interfere with daily activities.
What is Bullous Emphysema
It is also known as BLS, occurs in one or both lungs and is characterized by the presence of one or several abnormally large air spaces surrounded by relatively normal lung primarily on distal airways involving alveolar ducts and sacs. Some causes: shows inspiratory flow rates as normal but cannot get air out (gas trapping).
definition of emphysema
It is defined pathologically as the presence of permanent enlargement of the alveoli where lung tissue is damaged and air-trapping occurs. It causes elastin destruction with an abnormal weakening and permanent enlargement of air spaces distal to the terminal bronchioles with destruction of the alveolar walls and pulmonary capillaries.
How will chronic obstructive pulmonary disease affect gas exchange
It is harder to breathe out, there is a build-up of carbon dioxide in lungs resulting in acidosis.
How is the onset of this disease
It is usually a slow onset
How is emphysema similar to chronic bronchitis
It is very similar, except the airways have obstruction due to the reduced elastic recoil of the lungs. The inspiratory flow rates are normal if the patient has pure emphysema. The patient has dyspnea initially only on exertion with it intensifying at variable rates until shortness of breath at rest.
How would emphysema affect gas exchange?
Less surface area in alveolar walls which will cause the patient to need oxygen therapy.
What flow rates of oxygen are appropriate for a patient with emphysema?
Low flow — <2.5 L/min; never exceed 2.5L in chronic obstructive pulmonary disease. This is to prevent to loss of the hypoxic drive.
What is the treatment for someone with severe emphysema?
Lung volume reduction surgery.
How is emphysema diagnosed?
Medical history questionnaire, physical examination of body, imaging tests like x-rays and computed tomography, laboratory tests and lung function tests.
Will all smokers developing emphysema?
No, only if you're genetically susceptible.
What happens when the inner walls of the air sacs weaken and rupture
One large air space instead of many small reduces amount of surface area and reduces amount of oxygen to reach blood
What is the characteristic of the alveoli in this disease?
Over-enlarged and under-ventilated so that air is trapped in alveoli
What is panlobular/pancinar emphysema?
Panlobular/Panacinar is an abnormal weakening and enlargement of all air spaces distal to the terminal bronchioles. It is related to alpha1-antitrypsin deficiency.
What is the classification of patients with emphysema?
Patients with this disease are classified as a pink puffer. The show pursed-lip breathing. Patient has both a red complexion and rapid respiratory rate and has a barrel chest. They use accessory muscles of inspiration.
What kind of damage of the alveoli does emphysema cause?
Permanent and irreversible
What are pink puffers
Pink puffers are characterized as severe emphysema with relatively little information of the airway, increase dyspnea often appear anxious, marked weight loss often appearing malnourished, hyperlucent lungs, small heart with normal ABG. The term is derived from the reddish complexion in the patient.
What can you do to treat a patient with low oxygen saturation levels?
Provide oxygen therapy.
What is a physical therapy for lungs that improves symptoms of emphysema
Pulmonary rehabilitation
What parts of the lungs does centrilobular emphysema affect?
Respiratory bronchioles and upper lobes
What parts of the lungs does panlobular emphysema affect?
Respiratory bronchioles, alveolar ducts, and alveolar sacs which are destroyed by elastase.
What is the risk factor for panlobular emphysema?
Severe deficiency of Alpha1-antitrypsin poses a strong risk factor.
What position is best on patients with emphysema that has a severe dyspneic episode?
Sitting upright with arms folded on the overbed table.
What is the pathogenesis of emphysema
Slowly damages the alveoli (air sacs) in the lungs and makes it progressively harder to breathe. The inner walls of the air sacs weaken and rupture.
causes of emphysema
Smoking, chronic irritation and inflammation, infections, pollutants, long-term exposure to airborne irritants and alpha one anti-trypsin deficiency.
What happens in the pathophysiology of emphysema?
The alveoli and the small distal airways are affected by this disease that is followed by the larger airways. The bronchioles lose their stability which leads to the collapse in the airways resulting in gas to be trapped distally. It develops when the production and activity of ant protease are not sufficient to counter the harmful effects of excess protease production. Destruction of the alveolar walls and the breakdown of elastic tissue and collagen is the result of this. In addition, destruction of alveolar sacs, loss of recoil, increased compliance (floppy airways), exhalation incomplete and requires energy, V/Q mismatch, chest and heart becomes long and narrow, and diaphragm flattens.
What are manifestations of emphysema?
The appetite decreases while the weight decreases and the anterior-post diameter of the chest increases.
What is the problem with exhaling with emphysema patients
The damaged alveoli do not work properly, the old air becomes trapped in lungs and it prevents oxygen-rich air from flowing in.
What can immunizations do?
They can help to prevent the disease
What can be visibly seen on patients with emphysema?
They have grunting, pursed lips, and rapid breathing.
What are the distinguishing factors of emphysema?
Thin build, barrel chest, pursed-lip breathing, reddish skin, use of accessory muscles, hyper-resonance percussion, decreased breath sounds, prolonged expiration, decreased heart sounds, hyperinflation showing on chest x-ray, decreased carbon monoxide diffusing capacity and Hoover's sign.
What are the tiny air sacs in lungs called?
alveoli
What is the increase in anterior-posterior diameter of emphysema typically called?
barrel chest
most common type of emphysema
centrilobular
How will patients with emphysema appear
cyanotic (pink puffer)
What is most associated with the development of emphysema is?
history of smoking
2 types of emphysema
panlobular and centrilobular
What position is best for clients with emphysema under normal circumstances
semi fowler's or higher
What is the first symptom seen with this disease?
shortnesa of breath
most common cause of emphysema
smoking
