Emphysema: Fundamentals (Nursing)

00:00 Hi, welcome to our video on respiratory series. In this section, we're going to take a look at chronic obstructive pulmonary disease but specifically emphysema. Okay, so the US National Institute of Health or the NIH defines that there are 2 main forms of COPD, chronic obstructive pulmonary disease. There's chronic bronchitis and emphysema. Now, emphysema involves the damage to the lung tissue over time. So chronic bronchitis is long-term cough and mucus. Most patients have both sadly, but we're going to talk about these 2 diagnoses separately. In this video, we're going to look at emphysema. Now I always remember emphysema is blown-up, chronic bronchitis as gunked up. Now the American Thoracic Society talks about emphysema as it's a condition of the lungs and this is what it's characterized by, abnormal and permanent.

00:57 That's what matters, abnormal and permanent enlargement of the air spaces distal to the terminal bronchioles. It also has destruction of their walls. Okay, so after those terminal bronchioles we have the alveoli. They need to be like normal healthy ones, are little round clusters. Right? So in order for those alveoli to work well, their walls need to be intact. That's where emphysema is problematic. Remember your airways are getting bigger. You think like isn't that good? No, because why that lung tissue is getting bigger is because the walls between the alveoli are getting destroyed and that's why the tissue is getting bigger but it's also getting less efficient. Because those destroyed walls mean those alveoli can no longer exchange CO2 for O2, now we have a problem. So this is what the American Thoracic Society defines it as. Emphysema, abnormal and permanent, key phrases. Enlargement of the air spaces after the terminal bronchiole so the alveolar walls are destroyed. So, here's what happens. In emphysema, it causes damage to those really thin and fragile walls of the alveoli.

02:11 It's irreversible. That's why it's abnormal and permanent. Once those walls are destroyed, they're not coming back. So you can end up with these permanent holes in the lung tissue.

02:23 They're no longer efficient, they can't exchange CO2 for O2 so they are of no use to your patient. Now initially the patient's going to be short of breath just with exertion but that's going to get worse as the disease progresses. So they're going to have this shortness of breath because they have less oxygen getting to the blood. Well, why do emphysema patients have less oxygen getting to the blood? Because they have less functioning lung tissue. As the disease progresses, they have less and less functioning tissue that's why less oxygen gets to the blood and they're short of breath. So the lung tissue becomes kind of bigger, it's not as elastic as it was and we need those lungs to be able to inflate and move in and out just like we need the heart to be able to contract and open. If the lung tissue is not as elastic anymore and it's got areas of dead spots where it can exchange gas exchange, patient is going to have pretty significant respiratory problems. That's what I want you to think about when you're working with patients with emphysema. They have a very difficult time with shortness of breath and that's why. Their lung tissue is just not working the way it was intended to work.

03:33 Let's give you a graphic example. Now, look at the lobe on the right. That's normal. Look, you've got the trachea leads to the bronchi, the big ones that goes into the bronchioles. The little ones, look at that, those alveoli are intact. They have walls. Even though they're thin, they're dividing the different alveoli and you see those capillaries that are snug right around that. Right? That's where the CO2-O2 exchange happens. Now, look at the left lobe. We're giving you example on this one if we zoomed in on a patient who had emphysema. Now, these, just look at the normal alveoli cluster there. Look how it's kind of blown out, the air becomes trapped in there, the air exchange is no good anymore, and now you can see why the lung tissue is getting bigger. So this is the problem in emphysema. It's irreversible, permanent, abnormal enlargement because instead of following all the rules __ tiny little balls, now I got this blown out walls and things are stretched. And the tissue just isn't as elastic as it used to be. Air trapping is really difficult for a patient with emphysema. Normally, I breathe in, I breathe out. But in emphysema if they breathe in and try to breathe out air gets kind of trapped in there. That's why we have that circle with the arrow on it. Instead of it coming in and out like we want it to, it comes in and gets kind of stuck down there because of the changes that have happened to the alveoli.