Nursing Guide to Emphysema: Nursing Diagnosis, Interventions, & Care Plans

Emphysema is a chronic, progressive lung condition that falls under the umbrella of chronic obstructive pulmonary disease (COPD). It is characterized by the destruction of alveolar walls, leading to reduced surface area for gas exchange and impaired oxygenation. Patients with emphysema typically experience shortness of breath, chronic cough, and difficulty in physical exertion.  

Emphysema primarily affects individuals who smoke or have prolonged exposure to lung irritants. It is a serious, life-limiting condition, often progressing over time and requiring long-term management. 

Etiology and epidemiology 

The primary cause of emphysema is long-term exposure to irritants that damage the lungs, most notably cigarette smoke. Other risk factors include exposure to air pollution, chemical fumes, and dust.  

In rare cases, emphysema can be caused by a genetic condition called alpha-1 antitrypsin deficiency, which affects the lung’s ability to protect itself from enzymatic damage. Emphysema predominantly affects older adults, with the highest prevalence seen in individuals over the age of 40. Smoking accounts for up to 80% of all COPD cases, making tobacco cessation a critical preventive measure. 

Risk factors for emphysema include: 

• Smoking (the most significant risk factor) 
• Long-term exposure to air pollution or occupational chemicals 
• Genetic predisposition (alpha-1 antitrypsin deficiency) 
• Older age 
• Male gender (men are more commonly affected) 

Emphysema ICD-10 code 

The ICD-10 code for emphysema is J43.9 – Emphysema, unspecified. 

Emphysema diagnosis 

Diagnosis of emphysema is based on a combination of clinical evaluation, pulmonary function tests, and imaging studies. 

1. Patient history and physical exam: Common symptoms include dyspnea, chronic cough, and a history of smoking or exposure to lung irritants. On examination, patients may present with barrel chest, decreased breath sounds, and prolonged expiration. 
2. Spirometry: The gold standard diagnostic test for emphysema, spirometry measures forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). A reduced FEV1/FVC ratio < .07 which confirms airflow obstruction. 
3. Chest X-ray: This may show hyperinflated lungs, flattened diaphragm, and increased retrosternal air space. 
4. CT scan: High-resolution CT (HRCT) is more sensitive in detecting emphysema and can visualize the destruction of alveolar walls and bullae formation. 
5. Alpha-1 antitrypsin testing: In individuals with no history of smoking or early onset, testing for alpha-1 antitrypsin deficiency may be indicated. 

Management 

There is no cure for emphysema, but treatment focuses on symptom control, slowing disease progression, and improving quality of life. 

1. Smoking cessation: The most critical intervention in managing emphysema. Even late-stage patients can benefit from quitting smoking. 
2. Bronchodilators: Inhaled bronchodilators (such as beta-agonists or anticholinergics) help relax and open airways. 
3. Corticosteroids: Inhaled corticosteroids may reduce airway inflammation, though they are usually prescribed for patients with frequent exacerbations. 
4. Oxygen therapy: Long-term oxygen therapy is indicated for patients with chronic hypoxemia to prevent complications such as pulmonary hypertension. 
5. Pulmonary rehabilitation: A structured exercise program that improves endurance and breath control, helping patients manage daily activities with less discomfort. 
6. Surgical options: In advanced cases, lung volume reduction surgery (LVRS) or lung transplantation may be considered. 

Emphysema nursing care plan 

Nursing considerations 

Patients with emphysema often require long-term care focused on managing chronic symptoms, preventing exacerbations, and promoting independence in daily activities. 

Assessment 

• Respiratory status: Monitor for signs of respiratory distress, such as increased work of breathing, accessory muscle use, and tachypnea. 
• Oxygen saturation: Regularly assess oxygen levels using pulse oximetry and titrate supplemental oxygen as prescribed. 
• Breath sounds: Auscultate for wheezes, crackles, or diminished breath sounds, which may indicate airway obstruction or infection. 
• Smoking status: Assess the patient’s readiness to quit smoking and offer resources for cessation. 

Nursing diagnosis/risk for 

• Impaired gas exchange related to alveolar destruction and decreased lung capacity. 
• Ineffective airway clearance related to increased mucus production and weakened respiratory muscles. 
• Activity intolerance related to decreased oxygenation and dyspnea. 
• Risk for infection related to impaired mucociliary clearance. 

Interventions 

• Oxygen therapy: Administer supplemental oxygen to maintain SpO2 levels at 88-92%, ensuring the patient’s oxygen requirements are met without suppressing respiratory drive. 
• Medication administration: Ensure timely administration of bronchodilators, corticosteroids, and mucolytic agents. Educate the patient on proper inhaler techniques. 
• Smoking cessation support: Provide counseling, nicotine replacement therapies, and referrals to smoking cessation programs. 
• Pulmonary rehabilitation: Encourage participation in rehabilitation programs that focus on breathing exercises, physical conditioning, and disease management strategies. 
• Positioning: Assist the patient to a high Fowler’s position to ease breathing and improve lung expansion. 
• Breathing techniques: Teach pursed-lip breathing and diaphragmatic breathing to promote more effective ventilation and reduce dyspnea. 

Expected outcomes 

• The patient will demonstrate improved gas exchange, as evidenced by stable oxygen saturation and decreased dyspnea. 
• The patient will effectively clear secretions and maintain patent airways. 
• The patient will participate in activities of daily living with minimal assistance. 
• The patient will remain free from respiratory infections and exacerbations. 

Individual/caregiver education 

• Smoking cessation: Educate the patient and family about the critical importance of quitting smoking. Provide resources for counseling and support groups. 
• Medication management: Instruct the patient on the correct use of inhalers, bronchodilators, and oxygen therapy. Ensure they understand the need for regular medication adherence to prevent exacerbations. 
• Breathing exercises: Teach techniques like pursed-lip breathing to help the patient manage breathlessness during activities. 
• Infection prevention: Advise the patient on proper hand hygiene, vaccinations (influenza and pneumococcal), and avoiding exposure to respiratory infections. 

Nursing care plan 

Nursing considerations 

Patients with emphysema often require long-term care focused on managing chronic symptoms, preventing exacerbations, and promoting independence in daily activities. 

Assessment 

• Respiratory status: Monitor for signs of respiratory distress, such as increased work of breathing, accessory muscle use, and tachypnea. 
• Oxygen saturation: Regularly assess oxygen levels using pulse oximetry and titrate supplemental oxygen as prescribed. 
• Breath sounds: Auscultate for wheezes, crackles, or diminished breath sounds, which may indicate airway obstruction or infection. 
• Smoking status: Assess the patient’s readiness to quit smoking and offer resources for cessation. 

Nursing diagnosis/risk for 

• Impaired gas exchange related to alveolar destruction and decreased lung capacity. 
• Ineffective airway clearance related to increased mucus production and weakened respiratory muscles. 
• Activity intolerance related to decreased oxygenation and dyspnea. 
• Risk for infection related to impaired mucociliary clearance. 

Interventions 

• Oxygen therapy: Administer supplemental oxygen to maintain SpO2 levels at 88-92%, ensuring the patient’s oxygen requirements are met without suppressing respiratory drive. 
• Medication administration: Ensure timely administration of bronchodilators, corticosteroids, and mucolytic agents. Educate the patient on proper inhaler techniques. 
• Smoking cessation support: Provide counseling, nicotine replacement therapies, and referrals to smoking cessation programs. 
• Pulmonary rehabilitation: Encourage participation in rehabilitation programs that focus on breathing exercises, physical conditioning, and disease management strategies. 
• Positioning: Assist the patient to a high Fowler’s position to ease breathing and improve lung expansion. 
• Breathing techniques: Teach pursed-lip breathing and diaphragmatic breathing to promote more effective ventilation and reduce dyspnea. 

Expected outcomes 

• The patient will demonstrate improved gas exchange, as evidenced by stable oxygen saturation and decreased dyspnea. 
• The patient will effectively clear secretions and maintain patent airways. 
• The patient will participate in activities of daily living with minimal assistance. 
• The patient will remain free from respiratory infections and exacerbations. 

Individual/caregiver education 

• Smoking cessation: Educate the patient and family about the critical importance of quitting smoking. Provide resources for counseling and support groups. 
• Medication management: Instruct the patient on the correct use of inhalers, bronchodilators, and oxygen therapy. Ensure they understand the need for regular medication adherence to prevent exacerbations. 
• Breathing exercises: Teach techniques like pursed-lip breathing to help the patient manage breathlessness during activities. 
• Infection prevention: Advise the patient on proper hand hygiene, vaccinations (influenza and pneumococcal), and avoiding exposure to respiratory infections. 

References 

1. Nurse.com: Emphysema Clinical Guide 
2. Mayo Clinic: Emphysema Overview 
3. American Lung Association: Emphysema Information 
4. COPD Foundation: COPD Management 
5. ICD-10 Data: J43.9 Emphysema, unspecified 
6. Emphysema - StatPearls - NCBI Bookshelf 

Resources 

• American Lung Association: Offers resources on emphysema, smoking cessation, and pulmonary rehabilitation programs. 
• National Institutes of Health (NIH): Provides up-to-date research on COPD and its management. 
• COPD Foundation: Supports patients with COPD and emphysema through education, support groups, and research initiatives.