INTRODUCTION

Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of
breath due to over-inflation of the alveoli (air sacs in the lung). In people with emphysema, the
lung tissue involved in exchange of gases (oxygen and carbon dioxide) is impaired or destroyed.
Emphysema is included in a group of diseases called chronic obstructive pulmonary disease or
COPD (pulmonary refers to the lungs). Emphysema is called an obstructive lung disease because
airflow on exhalation is slowed or stopped because over-inflated alveoli do not exchange gases
when a person breaths due to little or no movement of gases out of the alveoli.

Emphysema changes the anatomy of the lung in several important ways. This is due to the
destruction of lung tissue around smaller airways. This tissue normally holds these small
airways, called bronchioles, open, allowing air to leave the lungs on exhalation. When this tissue
is damaged, these airways collapse, making it difficult for the lungs to empty and the air (gases)
becomes trapped in the alveoli.

Normal lung tissue looks like a new sponge. Emphysematous lung looks like an old used sponge,
with large holes and a dramatic loss of “springy-ness” or elasticity. When the lung is stretched
during inflation (inhalation), the nature of the stretched tissue wants to relax to its resting state.
In emphysema, this elastic function is impaired, resulting in air trapping in the lungs.
Emphysema destroys this spongy tissue of the lung and also severely affects the small blood
vessels (capillaries of the lung) and airways that run throughout the lung. Thus, not only is
airflow affected but so is blood flow. This has dramatic impact on the ability of the lung not only
to empty its air sacs called alveoli (pleural for alveolus) but also for blood to flow through the
lungs to receive oxygen.

General objectives

This research focuses on the advancement of our skills in managing and administering the
extensive range of our nursing interventions to our client with TB Arthritis. This will further expand our
knowledge on this particular disease. We may be able to extend to our client a holistic approach of care
and services that would somehow contribute to the improvement of the client's current status. It also aims
to develop in us, student nurses the proper nursing care needed in order to provide an effective nursing
management in a hospital set-up until the client is ready for discharge.

Specific objectives
This case provides several specific objectives to serve as a guideline in completion of the above general
objective:
a. To establish rapport to the patient.
b. Gather medical history and laboratory findings that will help determine the cause of the
client’s underlying medical condition.
c. Perform physical assessment to futher support the .
d. Illustrate and explore the Anatomy and Physiology of the affected System.
e. Explain the Pathophysiology of the case to help determine its progression.
f. Make a drug study for the TB Arthritis, their action, side effects and nursing
responsibilities.
g. Formulate Nursing Care Plan as a framework for individualized care for the client.
h. Provide discharge planning and render health teachings to the client and significant other
that will promote continuous self-care.

Discharge Planning
Medication
The patient has home medication to continue the following instructions:
Atravent 1 Neb + 2cc NSS every 4 hours for Nebulization
Cefadox 200mg 1 tablet twice a day for complete 10 days
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Vastarel MR 35mg twice a day 1 tablet
Mepirocin Ointment apply to Tracheal Stoma twice a day
Prednisone 5mg ½ tablet for twice a day in 2 days then 5mg ½ tablet for once a day in 2
days then disc
Ansimar 400mg 1 tablet for twice a day
Exercise
Mild exercise can increased oxygen utilization and re-train muscle to help improve the
tissue.
Encouraged the patient to pursed-lip breathing to prolong exhalation and increase airway
pressure during expiration, thus reducing the amount of trapped air and the amount of
airway resistance.
Instructed the patient to Inhale through the nose while slowly counting to 3 then blow it
slowly and evenly against pursed lips while tightening the abdominal muscles.
Pursing the lips increases intratracheal pressure; exhaling through the mouth offers less
resistance to expired air.
Turn side by side to prevent bedsore.
Instructs the patient to flexion and extension or rotate his foot.
Treatment
Nebulization
Tracheal Suction
Oxygen Therapy
Health Teaching
Placed in a semi-Fowler’s position to facilitate ventilation, promote drainage and prevent
strain on the suture lines.
Instruct the family to encourage breathing exercise to promote lung expansions.
The member of the family keeps paper and pencil or a Magic Slate within the patient’s
reach at all times to ensure a means of communication.
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Instruct the family to avoid air pollutants such as smoke, dust or aerosol sprays which
may initiate brochospasm.
Nebulizer Therapy
Instructed the patient to breath through the mouth, taking slow, deep breaths and then
to hold for a few seconds then breathing out. At end of inspiration to increase
intrapleural pressure and reopen collapsed alveoli.
Instructed the family to avoid replacing the nebulizer cup and the tube to the dust and
smoke area, away from open window.
Avoid putting the equipments in the dishwasher area.
Instructed the family to wash the mouthpiece in a warm water and mild detergent.
They can also use vinegar solution by soaking for 30 minutes then rinse through
water, allow drying with a paper towel and put it in a zipper plastic bag.
Tracheal Suctioning
Instructed the patient to perform hand hygiene and use glove before performing to
prevent contamination and spread of.
Do not suction for longer than 10 seconds to prevent suctioning air in the lungs.
Oxygen Therapy
Instructed the patient to keep oxygen tank at least15 feet away from matches, candles,
gas stove or other source of flame. Also keep away from TV, radio, and other
appliances at least 5 feet.
Out-Patient Follow-up
Instruct the patient to follow-up check up on July 23, 2009 at room 106B at 4 pm.
Instruct family to return to their attending physician for scheduled check-up and
consultation.
Advise family to report to the physicians any complaints.
Diet
Diet as Tolerated but be careful and be selective to the foods.
Encourage the patient to increase fluid intake to keep the mucus thin and help clear
airway.
Eat meals when their energy levels are at their highest which is usually in the morning.
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Eat slowly and chewed food thoroughly to avoid becoming breathless while eating and to
prevent choking.
Limit salty food, consuming too much can cause the body to retain water and make
breathing become difficulty.
Eat food with balance nutritious food.
Eat food with contains Vitamin C for development and maintenance of the blood vessels
and scar tissues.
Spiritual
Encourage the family to pray together.
Encouraged the patient to think positive to all happen to his life.
Instructed the family to build up his spiritual fighting to help himself treating.
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