Emphysema
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Julienne Sanchez-SalazarEmphysema
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Julienne Sanchez-SalazarChapter 12
Emphysema
Slide 1
[Link],Excessivebronchialsecretions,
acommonsecondaryanatomicalterationofthelungs .
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Slide 2
[Link]
oftherespiratorybronchiolesintheproximalportionoftheacinus. Copyright 2006 by Mosby, Inc.
Anatomic Alterations of the Lungs
Slide 3
Permanent enlargement and deterioration of
the air spaces distal to the terminal
bronchioles
Destruction of pulmonary capillaries
Weakening of the distal airways, primarily the
respiratory bronchioles
Bronchospasm (with concomitant bronchitis)
Hyperinflation of alveoli (air-trapping)
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Etiology
Cigarette smoking
Genetic predisposition
Slide 4
Alpha1 protease inhibitor
Occupational exposure to chemical irritants
Exposure to atmospheric pollutants
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Overview of the Cardiopulmonary
Clinical Manifestations Associated
with EMPHYSEMA
The following result from the pathophysiologic
mechanisms caused by DistalAirwayand
AlveolarWeakening ( Figure 9-12)the major
anatomic alterations of the lungs associated
with emphysema (see Figures 12-1 and 12-2).
Slide 5
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[Link].
Slide 6
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Clinical Data Obtained at the
Patients Bedside
Vital signs
Slide 7
Increased respiratory rate
Increased heart rate, cardiac output,
blood pressure
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Clinical Data Obtained at the
Patients Bedside
Slide 8
Use of accessory muscles of inspiration
Use of accessory muscles of expiration
Pursed-lip breathing
Increased anteroposterior chest diameter
(barrel chest)
Cyanosis
Digital clubbing
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Clinical Data Obtained at the
Patients Bedside
Peripheral edema and venous distention
Slide 9
Distended neck veins
Pitting edema
Enlarged and tender liver
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Distended
NeckVeins
[Link](arrows).
Slide 10
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[Link],IrelandJ: Color atlas of diabetes,ed2,
London,1992,Mosby-Wolfe.
Slide 11
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Clinical Data Obtained at the
Patients Bedside
Slide 12
Cough, sputum production, hemoptysis
Chest assessment findings
Hyperresonant percussion notes
Wheezing
Diminished breath sounds
Diminished heart sounds
Decreased tactile and vocal fremitus
Crackles/rhonchi (when accompanied by bronchitis)
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[Link].
Slide 13
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Slide 14
[Link]
lungdiseases,breathsoundsprogressivelydiminish.
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Clinical Data Obtained from
Laboratory Tests and Special
Procedures
Slide 15
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Pulmonary Function Study
Expiratory Maneuver Findings
FVC
FEVT
FEF25%-75%
FEF200-1200
PEFR
MVV
FEF50%
FEV1%
Slide 16
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Pulmonary Function Study
Lung Volume and Capacity Findings
VTRVFRCTLC
Nor Nor
VCICERVRV/TLCratio
Nor
Nor
Slide 17
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Decreased Diffusion Capacity
(DLCO)
Slide 18
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Arterial Blood Gases
MildtoModerateEmphysema
Acute alveolar hyperventilation with
hypoxemia
pHPaCO2HCO3-PaO2
(Slightly)
Slide 19
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TimeandProgressionofDisease
DiseaseOnset
AlveolarHyperventilation
100
90
PaO2orPaCO2
80
Point at which PaO22
declines enough to
stimulate peripheral
oxygen receptors
70
60
PaO2
50
40
30
20
PaC
O
10
0
Figure4-2.PaO2andPaC02trendsduringacutealveolarhyperventilation.
Slide 20
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Arterial Blood Gases
SevereEmphysema
Chronic ventilatory failure with hypoxemia
pHPaCO2HCO3-PaO2
Normal (Significantly)
Slide 21
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TimeandProgressionofDisease
DiseaseOnset
AlveolarHyperventilation
ChronicVentilatoryFailure
100
90
Pa02orPaC02
80
70
60
Point at which PaO22
declines enough to
stimulate peripheral
oxygen receptors
Point at which disease
becomes severe and patient
begins to become fatigued
O2
C
a
50
40
30
Pa
O
20
10
0
Figure4-7.PaO2andPaCO2trendsduringacuteorchronicventilatoryfailure.
Slide 22
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Acute Ventilatory Changes Superimposed
on Chronic Ventilatory Failure
Slide 23
Acute alveolar hyperventilation on chronic
ventilatory failure
Acute ventilatory failure on chronic ventilatory
failure
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Oxygenation Indices
QS/QTDO2
O2ER
Slide 24
VO2
C(a-v)O2
Normal
Normal
SvO2
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Hemodynamic Indices
(Severe Emphysema)
Slide 25
CVP
RAP
PA
PCWP
Normal
CO
SV
SVI
CI
Normal
Normal
Normal
Normal
RVSWI
LVSWI
PVR
SVR
Normal
Normal
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Abnormal Laboratory Tests
and Procedures
Hematology
Increased hematocrit and hemoglobin
Electrolytes
Hypochloremia (chronic ventilatory failure)
Sputum examination
Slide 26
Streptococcus pneumoniae
Haemophilus influenzae
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Radiologic Findings
Chest radiograph
Slide 27
Translucent (dark) lung fields
Depressed or flattened diaphragms
Long and narrow heart
Enlarged heart
Increased retrosternal air space
(lateral radiograph)
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[Link]
andnarrowasaresultofbeingdrawndownwardbythedescendingdiaphragm.
Slide 28
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[Link]
retrosternalradiolucencywithincreasedseparationoftheaortaandsternummeasuring4.6cm,3
[Link]
costophrenicanglesareobtuse,andbothhemidiaphragmsareflat.(FromArmstrongPetal,editors:
Imaging of diseases of the chest,ed2,[Link],1995,Mosby.)
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Slide 29
Slide 30
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General Management of
Emphysema
Slide 31
Patient and family education
Behavioral management
Avoidance of smoking and inhaled irritants
Avoidance of infections
Proper nutrition instruction
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GOLD Standards
GlobalInitiativeforChronic
Obstructive
Lung
Disease
Slide 32
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Slide 33
[Link]:Managing chronic obstructive pulmonary
disease,Baltimore,2004,Version4.0,InternationalGuidelinesCenter.(From
GUIDELINESPocketcard:ManagingChronicObstructivePulmonaryDisease.
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Baltimore,2004,Version4.0,InternationalGuidelinesCenter.)
Figure11-4.(Close-ups).(FromGUIDELINESPocketcard:ManagingChronic
[Link],2004,Version4.0,International
GuidelinesCenter.)
Slide 34
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Figure11-4.(Close-ups).(FromGUIDELINESPocketcard:ManagingChronic
[Link],2004,Version4.0,International
GuidelinesCenter.)
Slide 35
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Figure11-4.(Close-ups).(FromGUIDELINESPocketcard:ManagingChronic
[Link],2004,Version4.0,International
GuidelinesCenter.)
Slide 36
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Figure11-4.(Close-ups).(FromGUIDELINESPocketcard:ManagingChronic
[Link],2004,Version4.0,International
GuidelinesCenter.)
Slide 37
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General Management of
Emphysema
Respiratory care treatment protocols
Slide 38
Oxygen therapy protocol
Bronchopulmonary hygiene therapy protocol
Aerosolized medication protocol
Mechanical ventilation protocol
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Additional Treatment Considerations
for Emphysema
Slide 39
Antibiotics
Inoculations against influenza and pneumonia
Alpha1 antitrypsin therapy
Lung volume reduction surgery
Lung transplantation
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Classroom Discussion
Case Study: Emphysema
Slide 40
