Emphysema Case

Emphysema

Ashley Rousset

Med Surg. Quarter 3

Definition:

A condition of the lungs marked by an abnormal increase in the size of the air spaces, resulting in labored breathing and an increased susceptibility to infection. It can be caused by irreversible expansion of the alveoli or by the destruction of alveolar walls

Chief Complaint:

Patient visited office today with complaints of difficulty breathing, and chest tightening. These symptoms have been consistent and only seem to worsen according to patient.

Signs and Symptoms:

* Shortness of breath

* Wheezing

* Chest tightness

* Reduced capacity for physical activity

* Chronic coughing, which could also indicate chronic bronchitis

* Loss of appetite and weight

* Fatigue

Assessment:

* Is there an increased respiratory rate? No

* Is the patient short of breath just sitting in the examination room? Yes

* Is the chest cavity enlarged or barrel-shaped? Barrel-shaped

* Does the chest cavity sound hollower than it should? Yes

* Does exhalation take longer than it should? No

Is the movement of the diaphragm decreased? Yes

* Is the patient cyanotic (having a blue tinge to the skin color signifying lack of oxygen in the blood)? Yes

* Listening to the lungs, are there wheezes present, especially if the patient is asked to exhale quickly? Yes

Head to Toe:

Head and Neck

Normal

Vital Signs

Temperature- 98.6, Pulse 121 tachycardia , Respiration 10 dyspnea , Blood Pressure 145/90

Pain- In chest, pain leveled at a 9, patient decribes pain as if a Hippo was sitting on him. Patient also claims to have discomfort in lower extremeties rated at a 5.

Orientation

Oriented x4

Pupil Check

PERRLA -Yes

R_3mm__ to _2mm_ L_3mm_ to_2mm__

Bilateral Checks

Bilateral checks for comparison need to be done for:

* radial pulses - 120 irregular, tachycardia

* strength - weakness in extemeties lower and upper

* pedal pulses- weak cannot be determined

* capillary refill - >3 sec.

Skin

Poor skin turgor, presence of cyanosis, skin is pale and cold. Slight presence of edema. No breakdown present.

Breath Sounds

Right and left lungs both have sounds of wheezing present and hollow deep breathing, lung have labored breathing.

Bowel Sounds

active x 4

History

 Signs & Symptoms-Noted above

 Pertinent Past Medical History- No past history of asthma, Grandparents died of Lung Cancer ( smokers ). No other known problem in history or family history.

 Allergies- None

 Medications or Events leading up to the injury/illness--None

 See Risk Factors Below.

Risk Factors:

* __x__ Smoking. Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible, and the risk for all types of smokers increases with the number of years and amount of tobacco smoked.

* __28__Age. Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60.

* _yes___Exposure to second hand smoke. Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else's cigarette, pipe or cigar. Being around secondhand smoke increases your risk of emphysema.

* __yes, pt is in construction for 8 yrs____Occupational exposure to fumes or dust. If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you're more likely to develop emphysema. This risk is even greater if you smoke.

* _no____Exposure to indoor and outdoor pollution. Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants car exhaust, for instance increases your risk of emphysema.

* __no__HIV infection. Smokers living with HIV are at greater risk of emphysema than are smokers who don't have HIV infection.

* __no__Connective tissue disorders. Some conditions that affect connective tissue -- the fibers that provide the framework and support for your body are associated with emphysema. These conditions include cutis laxa, a rare disease that causes premature aging, and Marfan syndrome, a disorder that affects many different organs, especially the heart, eyes, skeleton and lungs.

Lab Work and Diagnostic Studies/ Results:

recommend certain tests, including:

* Spirometry and other pulmonary function tests (PFTs). These noninvasive tests can detect emphysema before you have symptoms. They measure how much air your lungs can hold and the flow of air in and out of your lungs. They can also measure how well your lungs deliver oxygen to your bloodstream.

* Arterial blood gases analysis. These blood tests measure how well your lungs transfer oxygen into, and remove carbon dioxide from, your bloodstream. Normal is between 50-60 mm Hg. __35mm Hg____

* Pulse oximetry. This test involves the use of a small device that attaches to your fingertip. The oximeter measures the amount