The case study is about risk factors and the progress of emphysema. I will discuss how it affects a person’s daily life, its treatment and management. I will define the characteristics of disease and how we intervene through the physical assessments, tests results and formulation of care plan.
Exposure and/or prevention
Diagnosis and prescription
Intervention and implementation
Care plan and management
Emphysema is a long progressive lung disease, one of the individual chronic conditions of the COPD syndrome. It causes poor retention of oxygen in the patient’s lungs as “people with emphysema exhale as if something were obstructing the flow of air” (webmed.com/lung). Any pollutants or dirt that interferes with the physiology of the lungs will worsen the condition, like smoking, heredity, pollution and poor exercise. These inhalants will interfere with the function of the lung tissue hence will cause permanent damage to a person’s health. Emphysema is also called “air-filled” disease because of how it ends up trapping air in the lungs making it hard for a person to breathe out. Major cuts in smoking habits help the risks of contracting emphysema greatly.
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The major risk factor of emphysema is smoking, because tobacco smoke has chemical agents that destroy epithelial lining of the respiratory system. According to (cancer.org), tobacco has 7000 chemicals that will affect the cilia of the lung tissue, destroying the airway and the alveolar that make gas exchange possible. Major effects of smoking are that it damages alveoli, which are responsible for oxygen transference and absorption into the blood stream and breathe out carbon dioxide which displaces most of the oxygen. The main characteristic of emphysema is the inability for alveoli and bronchioles to perform their physiological duty of transporting gases to every part of the body. This case might be a result of a hereditary trait, which involves poor lung health from an infected parent. The person will be having AAt, a protein deficiency that makes it hard for a person to protect the elastic structures of the lung. If that is the case, the patient’s lungs are unable to repair the damaged cells and similar structures like the alveoli and bronchioles. The disease progression starts from the end of the respiratory system and works backwards, for example, as the alveoli get damaged gradually they inhibit full exhalation and retain all the gas volume hence demanding more breaths from the patient, and over time the requirements are no longer met by the peripheral cells and they shift the damage to the nearby cells. Eventually, more and more fluids are accumulated and the lung reduces in operational size and causes a decrease in lung capacity. What really happens is that once the cilia is destroyed, the airways become dirt because the cilia are no longer cleaning them, leading to the production of mucus and eventually bacteria and infection.
Emphysema happens in stages and affects different parts of the lung depending on the cause and risk factor. If smoking is the cause, the smoke does first hand damage because it causes physical hindrances to cilia cells to move body fluids and filter dirt because the smoke makes them harden, causing , over time destruction of those cilia. This has double impact because it leaves large sums of mucous and other secretions in the lungs, potentially causing a bacterial outgrowth. Further buildup increases the infection as well because there are conditions for growth supplied in the mucous. The continued exposure to this harmful condition requires that the affected cells be able to repair themselves but because they lack the proper elasticity and physical form to function properly in smoke, they begin to degenerate. This type of degeneration can also happen naturally over time with old age and the lungs falter but for people with a deficiency in digestive enzymes it can be deadly. For example, alpha-1-trypsin is a “digestive enzyme, most often found in the digestive tract, where it is used to help the body digest food.” (emedicinehealth.com).Therefore the trypsin will contact with the poorly functioning lung cells to allow trypsin to engulf those cells. They are digested really fast like food would be in the digestive tract, causing a similar effect of cellular distress like the smoke particles do. Unlike smoke particles though, this is much quicker, and decreases lung capacity drastically. “Disruption of normal lung maintenance leads to structural damage in emphysema” Goldklang & Stockley (2016).
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Any other bacteria or cell made of protein, whether harmful or not, becomes engulfed by the trypsin enzyme. Like smoking, any type of air pollution will have the same effect on the alveoli. The alveoli have a purpose of facilitating gaseous exchange with the lungs and the rest of the body through blood. If the lung contains any gas during inhalation other than what is normal, the pollution will displace the oxygen particularly and result in an inefficient system. Even though the patient might be breathing, there won’t be adequate gas exchange so, the patient is forced to inhale and exhale more to counteract the inefficiency. Likewise, any type of blockage to the airways will result in some discomfort and possibly spark emphysema growth. The sad thing about emphysema is it causes permanent damage to the lung tissue.
As is with any type of disease associated with emphysema, the blockage of airways will cause shortness of breath. It is one of the popular sign of emphysema. If the patient is unusually experiencing shortness of breath, apart from asthma, they might have emphysema considering their health background or contact with any of the risk factors. If the patient has long exposure to smoke, which causes inflammation it is possible they contracted COPD-like conditions. Another sign of emphysema is consistent coughing as a result of mucous buildup- always trying to clear the throat. An inability to exercise or exhaustion from any physical activity due to respiratory complication might indicate the development of emphysema. It does not show symptoms early. Usually when deprived of oxygen, a patient might suffer from blue skin colorations especially in the face and lips, this is a sign of cyanosis. Any indication of such symptoms is to be addressed and medical attention must be sought immediately. Getting help early helps to make educated options concerning someone’s life and /or even try to quit smoking if the person was a smoker.
Upon arrival at the doctor’s office, a record of your medical history will show whether you are at risk of emphysema or not. The doctor will need to check the anatomy of the patient, especially the size and any sounds like wheezing as the patient breathes. An x-ray is useful and will show if they are any masses of cells or mucous lodged in them. This is helpful in crossing off any other medical conditions like cancer as the cause of the symptoms. Pressure systems that digitally monitor how a patient breathe are also used, to measure capacity, oxygen absorbance and carbon dioxide ,the tests are all timed and measured across the normal range expected for the patient based on age, weight and activity. If the health record does not show hereditary traits of alpha-1-antitrypsin, an enzyme, a blood test can be used to conclude those levels. If there are ample amounts of white blood cells, it is a good indication that emphysema is progressing. This then leaves other tests for bronchitis, asthma, lung cancer and bronchitis from the blood results. There are many tests that can be done to rule out the presence of emphysema. Imaging tests, laboratory and lung function test should be done once the patient visits the doctor with symptoms of coughing, wheezing and shortness of breath.
Once the diagnosis has been made and indications of emphysema established, the doctor may ask the person to consider quitting smoking, if that was the cause. Depending on the severity of the disease, the person may start on bronchodilators which help open up airways. Other medications that are used to alleviate symptoms are steroids and antibiotics. There are also different types of therapies that a person can go for. Some get help with supplemental oxygen which they have to use daily at home and everywhere. Nutrition therapy will be the diet they are advised to take. Proper eating habits help to improve life. Because of the breathing problems, patients with emphysema can go for pulmonary rehabilitation where they are taught how to breathe well and certain techniques to engage in their breathing. There are diaphragmatic and pursed –lip breathing exercises which the patient may need to learn to do. Very few people qualify for lung transplants but it is another way of treating the disease. Others can have surgery called lung volume reduction where some parts of the affected lung are removed to allow fresh expansion of the lung tissue.”Bronchoscopic lung volume reduction with the use of one-way endobronchial valves is another potential treatment for patients with severe emphysema.” Rosenberg and Kalhan (2017). Good regular exercise, vaccinations and preventing pollutants and infections will help a person from fast progression of the disease. Bronchial spasms are caused by cold so emphysema patients are advised to keep themselves warm. It is always good to keep away from polluted industrial sites where fumes, smoke and occupational fuels can harm the lungs. The most important prevention is to quit smoking.
There is need for the doctor to give a patient the care plan when he/she leaves the doctor’s office. In order to reduce or prevent further attacks, patient must practice good hygiene. Hands must be washed all the time after visiting the toilet and keep the teeth in good health by brushing and flossing them regularly. The equipment that he/she uses for breathing treatments must be kept clean. That applies to the house at large which must be free of mold toxins and dust. Clean environments reduce further illnesses. Doctors’ orders must be carefully followed, taking the treatments on time as prescribed. Out of hospital follow-up is very important. The patient must need to have check-up with the family physician within three days of discharge from the hospital. They are also required to report any complications. The patient must maintain and eat balanced diet and drink a lot of fluids. Staying positive will help patient with emphysema to love longer. Patient are instructed how to do the pursed-lip breathing exercise. Flex and extend feet to prevent muscle atrophy. Family members are expected to make sure the patient takes the medication as prescribed. The house must always be clean, free of pollutants.
Emphysema is a complicated disease which can cause a lot of complications. Respiratory infections, pneumonia, respiratory failure and even death are all associated with the condition. There is a lot of stress and inflammation that one would experience as a result. Though emphysema can’t be cured, taking doctors’ advice is very important, consistently taking medications and taking care of oneself can help relieve symptoms. Seeking counseling and joining a support group will help coping with the disease prescribed medication accordingly and regular visits to the doctor as programmed.
- Davis, C. P., & Schiffman, G, (2015). Medicine Health http://www.emedicinehealth.com/script/main/art.asp?articlekey=58849&pf=3&page2], 2015
- www.mayoclinic.org Mayo clinic staff, 1998-2015 Mayo Foundation for Medical Education and Research.
- www.archinte.jamanetwork.com/articles March 1, 1930 Vol 45, No. 3
- www.webmd.com/lung 2015 WebMD, LLC
- www.cancer.org American Cancer Society, 2/13/15
- Emphysema. (2015, January 28). Retrieved October 12, 2018, from https://my.clevelandclinic.org/health/diseases/9370-emphysema/management-andtreatment
- Rosenberg, S. R., & Kalhan, R. (2017, June 09). Recent advances in the management of chronic obstructive pulmonary disease. Retrieved October 12, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473415
- Goldklang, M., MD, & Stockley, R., MD. (2016). Pathophysiology of Emphysema and Implications. Chronic Obstr Pulm Dis. 2016; 3(1): 454-458. Retrieved October 12, 2018, from https://journal.copdfoundation.org/jcopdf/id/1095/p
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