05.12.2020 in Nursing
Clinical Case

The pulmonary disorders represent one of the biggest threats to the health of mankind, leading to disability, premature death, and significant expenditures on the first aid, hospitalization, and medications. Moreover, most of such disorders, including emphysema, are developing in conjunction with other diseases, which contributes to the relevance of the problem. Therefore, the importance of the holistic approach to the issue can not be overestimated. The following work focuses on the comprehensive analysis of a clinical case of female emphysema patient, with the subsequent development of the plan of care.

Case Study Evaluation


Pulmonary emphysema is a disorder which is an integral part of chronic obstructive pulmonary disease (COPD). It is characterized by excessive stretching and deformation of the alveoli the components of lung tissue, resulting in the disruption of the transfer of oxygen and removal of carbon dioxide from the blood. The signs and symptoms of the disorder include the constant persistent shortness of breath which sometimes escalates to suffocation, a significant expansion of the intercostal spaces, barrel-shaped chest, decreased mobility of the diaphragm, and increased fatigue. The patient usually demonstrates only several of those signs, including the breathing problems and swollen chest. As a result, it is possible to assume that the disorder is yet to pass its initial stage, meaning that the load on the cardiovascular system caused by it is insignificant. However, without proper treatment, it will progress, resulting in the damage to elastic lung tissue, which impairs lungs functionality. The hyperventilation leads to adhesion of bronchi during exhalation and to the violation of pulmonary ventilation. At the final stage, the formation of the so-called valve mechanism causes swelling and hyperextension of the lung tissue, forming air cysts that can become the cause of recurrent spontaneous pneumothorax.

In the case of emphysema, the diagnostic testing has to include the traditional diagnostics and auscultation, complemented by several other methods, the choice of which depends on the situation. The first of them is the x-ray examination of the lungs that allows doctors to identify if the pulmonary tissue is affected by the disease. The computer tomography is increasingly used for the diagnosis and determination of the exact location of the bulls. Finally, the study of respiratory functions reveals the degree of impairment of functionality of the lungs.

There are several treatment options possible. The most common of them is the change of the lifestyle, which involves smoking cessation and breathing exercises. Next, it is possible to recommend oxygen therapy the inhalation of air with high oxygen content, which allows doctors to address the issueof hypoxemia. The adequate and thorough treatment of the disease which leads to emphysema chronic bronchitis or bronchial asthma, is an important component of the care that is carried in accordance with the holistic approach. Finally, in the case of bullous emphysema the one characterized by the presence of air cysts in the lungs, a surgical treatment is recommended with the focus on the removal of the affected lung tissue. It might be necessary in order to reduce the risk of spontaneous pneumothorax.


There is a certain difference between emphysema and the normal, healthy condition. First of all, the load on the cardiovascular system of a diseased person is higher than that of a healthy person. As a result, the risk of heart failure becomes more significant. Additionally, the body of the patient becomes more susceptible to various infectious diseases, namely pneumonia. This statement is supported by the materials presented in the case, especially by the presence of fever in the patient. It is possible to perceive it as a sign of the development of infectious disease. Finally, anxiety, depression, and sleep disorders are common conditions of patients with emphysema, while healthy people do not encounter them frequently.

Physical and Psychological Demands

The treatment of emphysema involves the changes in the lifestyle of the patient, resulting in the emergence of new physical demands. First of all, it is necessary to quit smoking, as the combustion products play the major role in the development of the disease. Next, the patient has to limit her exposure to harmful environmental factors, such as dust, smoke, and other chemicals contained in the air. Finally, she has to avoid significant physical loads due to the effect of the disorder on the cardiovascular system and increased fatigue.

The psychological demands of the patient include her family, namely the provision of moral support by them, which will allow the patient to cope with depression, thus contributing to the success of the treatment. Additionally, the patient must change the attitude toward her health, which can currently be described as uneven. She has to reconsider relatively unhealthy nutrition habits combined with the sedentary lifestyle and smoking, as well as the lack of understanding of the nature of the disease and resources that are at her disposal. Under such conditions, the outpatient treatment, which is usually utilized in case of emphysema, is likely to be inefficient due to the patients low level of responsibility.

Key Concepts

The patient, and potentially her family, must be informed of such key concepts of emphysema as the irreversibility of the destructive processes it causes and the possible complications, as well as its connection to the lifestyle of a person. In particular, they should be notified that the lack of adequate treatment of pulmonary emphysema leads to the progression of the disease, which results in disability due to the development of respiratory and heart failure. At the same time, despite emphysema being an irreversible process, the patients quality of life can be improved significantly through the compliance with the instructions of the healthcare professionals. In other words, it is necessary to convey the idea of the importance of the responsible behavior in the course of treatment to a patient, as well as to share the optimistic outlook with her.

Key  Personnel

The interdisciplinary team assembled for the purpose of emphysema treatment of the examined patient has to consist of the specific members. First of all, it must include pulmonologist a specialist that must oversee and coordinate the process of treatment as a whole. The importance of psychologist as a member of an interdisciplinary team can not be overestimated, as this specialist is responsible for the creation of the conditions for the successful change of the lifestyle of the patient. Additionally, the presence of oncologist and surgeon is desirable due to the smoking habits of the patient and the history of the cases of breast cancer in her family. Such professionals may be able to diagnose the disease at an early stage, performing a lumpectomy and removing the tumor tissue. Finally, in the case of the need for inpatient treatment, the team must include a registered nurse (RN) that has to maintain contact with the patient, educate her on the ways of leading the healthy lifestyle, and ensure the compliance with the care plan. Moreover, the RN must monitor the condition of the patient on the constant basis, informing the other members of the team about any changes in her health. As a result, it will be possible to make adjustments to the program of treatment.

Facilitators, Barriers, and Strategies

The primary facilitator of the successful treatment is the patients eagerness to participate in this process. In this case, it will be possible to receive feedback from her on the constant basis, as well as discuss the possible options, choosing the most optimal ones. On the other hand, one should take into account such barriers as the lack of support on the part of relatives and the patients low self-management skills. The first problem is likely to contribute to the development of depression, which may develop even faster as a result of emphysema. In turn, it may be difficult for the patient to concentrate on the prescriptions of healthcare specialists. The second issue may lower the efficiency of the outpatient treatment, which has to be dominant in the plan of care, resulting in the need for the presence of the RN at the patients side. In order to address the issues described above, it is necessary to implement the following strategies. First of all, it is imperative to establish a productive relationship between the patient and her relatives in particular, the former is to receive counseling in the field of family psychology. Next, it is essential to develop and implement educational programs that will provide the patient with knowledge about the maintenance of the healthy lifestyle.

Care Plan Synthesis

The plan of care for the patient suffering from emphysema must be based on the holistic approach, i.e. the treatment of the organism as a whole. Therefore, the first step is the analysis of the family history. It can define the so-called psychological inheritance related to the patterns of everyday lifestyle, which may help specialists to develop a tailored approach to the patient. Additionally, it is necessary to identify the genetic factors that may contribute to the development of various pathologies in this case, such as breast cancer. It is proved that in most cases, this disorder is caused by mutations in the BRCA1 and BRCA2 genes. By taking into account that a close relative of the patient has also suffered from this disorder, it is possible to say that the possibility of the similar scenario is quite high. Moreover, the fact that the patient was subjected to hysterectomy also places her in the group of risk, as such surgery is usually performed in case of malignant tumors of the uterus, cervix, or ovaries. Therefore, the monitoring by the oncologist has to be one of the components of the plan of care.

The next stage involves the collaboration between the pulmonologist, psychologist, and the social worker, focusing on the alleviation of the symptoms of respiratory failure and reduction of the further development of the disorder, as the full recovery is not possible. The pulmonologist is responsible for the treatment of the underlying disease asthma. By taking into account that it is characterized by the airways overreacting to different stimuli, narrowing and disrupting the normal flow of air during breathing, one can state that asthma attacks may provide for the further development of emphysema.

The psychologist has to work with the patient to ensure there will be no resistance to changes in her lifestyle, as well as provide the active involvement of the relatives in the patients life. This activity has to be based on the implementation of the three specific principles. The first of them is the principle of responsibility for ones health. Only reasonable attitude toward it enables the person to overcome the disease. Moreover, a healthy lifestyle, which is a necessity in the course of treatment of emphysema, is possible only under the condition that the patient wants to be healthy. The principle of comprehensiveness dictates the need to focus on all systems of the organisms rather than a particular organ. Finally, the principle of individualization states that each individual is unique, thus requiring a personalized approach.

After the patient is ready for the change of her lifestyle, it is possible to implement the core measures that focus on the alleviation of manifestations of emphysema. The first of them is the complete refusal of smoking, as it is the leading principle of prevention and treatment of the disorder. The primary reason for that is the fact that tobacco smoke causes migration of neutrophils white blood cells, to the terminal part of the respiratory tract, which has a destructive impact on the alveoli. Furthermore, smoking causes an imbalance of oxidants and antioxidants, which also causes damage to the alveolar walls. It necessary to point out that the effect of an abrupt smoking cessation is greater than of a gradual one. Moreover, the high motivation is the main determinant of success. This activity is to be complemented with a three-week course of oxygen therapy and massage, which will help to expand the bronchi, discharge sputum, and prevent hypoxemia. On the other hand, physiotherapy used to reduce the strain on the respiratory muscles has to be carried out on the constant basis. By taking into account that the patient has a fever, which may be a sign of the development of an infectious disease, it is necessary to include the drug therapy in the plan of care with the focus on antibiotics. At the same time, the sulfa drugs have to be omitted due to their allergenic effect.

Initially, all of the described measures have to be implemented under the supervision of the healthcare professionals. However, due to the outpatient nature of the treatment, it is necessary to include the self-management training program, as well as provide assistance in establishing the connection between the patient and her relatives. The final stage of the plan is the monitoring of the state of the patient on a regular basis, which has to be carried out both by pulmonologist and oncologist.

Additionally, it is imperative to consider the socio-cultural background of the patient during the implementation of the plan. First of all, as a widow that does not maintain constant contact with her children, she may encounter considerable challenges in the case of the outpatient treatment. The same can be said about her lack of knowledge about the disease and resources that are at her disposal, which is likely to stem from her education. In combination with the average income of the patient that does not exceed $40,000 per year, as well as with her relying on samples as a source of medication, the inpatient treatment may be unavailable to her, especially considering that her savings and health plan may be not enough to cover such expenditures.

By taking into account these facts, it is possible to formulate the following tailored approach to the treatment of emphysema. In particular, it is necessary to establish a partnership with the patient, making her not only the receiving side, but also an active participant in the process of the provision of care, thus reducing the need for the active intervention of healthcare professionals in this process. As a result, she will be able to receive the information about the treatment and make comments related to its quality and effect, having an opportunity to make immediate adjustments to the care plan. In turn, the efficiency of the therapy will increase significantly.


The reviewed clinical case has demonstrated the necessity of the comprehensive and holistic approach to the treatment of the disease. In particular, such factors as the genetic and behavioral family portrait of the patients, as well as their social-cultural backgrounds, have to be perceived as the object of analysis. The information derived in the course of this process is likely to provide an insight into the potential obstacles in regard to the provision of high-quality care, including pathologies, complications, social, cultural, and other factors. In turn, it may be possible to develop the strategies to address such issues. Moreover, the collaboration with the patient ensures the increased efficiency of the treatment as a whole. The presented plan of care is holistic and comprehensive, which allows to make a conclusion that the outcome is likely to be positive for the patient.

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