Diagnosis

As emphysema progresses, the amount of volume exhaled decreases.  This can be measured by a pulmonary function test called “Forced Expiratory Volume in 1 sec” (FEV1).  In exhalation with normal lungs, FEV1 is 80% (i.e. 80% of the volume of exhaled gas leaves within the first second of exhalation).  However, in emphysema, FEV1 < 80% and will progressively decline as the trapped air accumulates over years. This test is often done by a respiratory therapist.

Similarly, blood gases will change as emphysema progresses. Initially, oxygenation will be normal as inhalation is yet to be impaired by chronic inflammation.  However, as emphysema develops, there will be a retention of CO2 (i.e. hypercapnia) and an insufficient oxygenation (i.e. hypoxemia).  Blood oxygenation can be measured quickly with pulse oximetry by a nurse (see below) or blood chemistry by a medical laboratory technologist.  Blood gas analysis, performed by a respiratory therapist, can quantify the oxygen, carbon dioxide, and pH of blood.

Computed Tomography (CT)

This increase in trapped air can be visualized with medical radiography, specifically computed tomography (CT)

Role of CT During Diagnosis and Management of Emphysema by Sarah Ho, licensed under All Rights Reserved.

Treatment of Emphysema & complications

There is no cure for emphysema as lung tissue, when chronically injured, can not regenerate. Rather, treatment is for relief of symptoms as the lungs slowly inflate, yet lose gas exchange abilities & ventilation.  On occasion, an emphysema patient may not be able to manage their disease due to a change in their health or environment (i.e. an exacerbation of emphysema), thus needing medical care.

Role of Nursing during exacerbations from emphysema

Listen to Rob Kruger, a long-time nurse, speak about the journey a patient with an exacerbation will take from entry into Emergency Department.  He speaks about the many health care professionals the patient will encounter, with the nurse managing and coordinating the patient’s care.   He also describes the current roles in nursing and how many nurses are working in the Lower Mainland and within the province of BC.  He also shares a fun fact about nursing!

Management of a Patient with an Exacerbation of Emphysema by Rob Kruger, licensed under All Rights Reserved.

Section Review

• Emphysema is diagnosed with several data pointing to obstructed airways, particularly during exhalation.  This can be measured by the volume forcefully exhaled in 1 second (FEV1 performed by respiratory therapists) or imaged using medical radiography (CT).  Similarly, blood tests will reveal the amount of oxygen and carbon dioxide which may suggest COPD.
• Emphysema patients may encounter an additional respiratory challenge causing an exacerbation which may require medical intervention.  Should the patient be admitted into the Emergency Department or health care facility, a nurse will manage the patient and provide patient support while coordinating their investigations and treatments during their stay.  Upon leaving, the nurse will also educate the patient on how to manage their condition at home and avoid future exacerbations.

Review Questions