Mr. C.Y., age 71, has had significant emphysema for 6 years.

He has reduced his cigarette smoking since mild congestive heart was diagnosed (right-sided heart failure--refer to Chapter 18). He has been admitted to the hospital with a suspected closed pneumothorax and respiratory failure. 1. Describe the pathophysiologic changes in the lungs with emphysema, and explain how these affect oxygen and carbon dioxide levels in the blood. Emphysema is the deterioration of the alveolar walls and permanently inflates the alveolar air space. With the breakdown of the alveolar sacs you lose surface area for gas exchange, which means carbon dioxide and oxygen are not being exchanged at the rate they should be. Emphysema also contributes to the deterioration of the capillaries affecting the diffusion of gases. The loss of the elastic fibers, limits the recoil effect of the alveolar sacs on expiration. Deterioration of other structures such as the bronchial tubes leads to obstruction of airflow. Possible over inflation of the lungs, that can result in collapse of the lungs. Eventually leading to tissue loss, creating a solid mass where the lung once inflated and deflated. 2. Explain the possible role of smoking in Mr. C.Y.'s case and its general effects on respiratory function. Cigarette smoking is toxic; it contains chemicals like carbon monoxide, formaldehyde, nicotine, and toluene. It is a harsh irritant to your airways. Smoking destroys the normal function of the lungs by increasing the production of mucus, destroying the lung tissue and killing the cilia that move the mucus. If Mr. C.Y. continues smoking he will only get worse, need an oxygen tank. He will eventually it get to the point where he has to be on a ventilator to breathe. 3. What significant characteristics related to emphysema and heart failure would you expect to observe in Mr. C.Y.? I would expect to see hyperventilation and pulmonary hypertension, as the pulmonary blood vessels are destroyed and hypoxia sets in that causes pulmonary vasoconstriction and increases pressure in the pulmonary circulation increased resistance to the right ventricle to the point of failure, therefore I would expect to see a failed right ventricle, wheezing, coughing, rapid heart rate, high blood pressure, low lung function, and faulty valves. 4. Explain how a pneumothorax has probably occurred in the presences of emphysema. Pneumothorax is defined as the presence of air or gas in the pleural cavity which can impair oxygenation and ventilation. One of the signs of emphysema is a deterioration of the tissues of the lungs and surrounding organs. If the deterioration becomes so bad that a hole manifests in the lung cavity it will deflate the lung and cause pneumothorax or allowing air into the lungs pleural space.

5. Explain how a pneumothorax has precipitated respiratory failure, using the effects in lung function and gas exchange in your answer. Include the criteria for respiratory failure. Pneumothorax causes atelectasis, dyspnea, a couch, and mild to severe chest pain. You get unequal expansion; hypoxia develops, leading to a sympathetic response, causing tachycardia, hypoventilation, and interference with venous return leading to low blood pressure. As Hypoventilation continues you are not getting adequate oxygen into the blood, in cooperation with the emphysema, and minor congestive heart failure, respiratory failure is inevitable. Respiratory failure is an inadequate exchange of gases within the respiratory system, resulting in the levels of arterial oxygen, and carbon dioxide not to be maintained within their normal ranges. 6. Explain why caution must be exercised in administering oxygen to Mr. C.Y. One must be cautious with administering oxygen to Mr. C.Y., mainly because of the pneumothorax or collapse lung, and could cause it to tear the lining again. Also the emphysema limits the amount of air that flows across the lungs. With hardened alveolar sacs the amount of air that can even be processed is minimal and someone would need to be monitored as to not completely destroy the lung. 7. Mr. C.Y. is resting quietly. Suggest three complications of immobility that could develop in Mr. C.Y. and one preventive measure that could be taken for each. With immobility a person runs the ricks of increased cardiac workload, thrombus formation, and stasis of respiratory secretions. An increase in of heart rate due to the lack of breathing and possible blood clotting from laying down and all the other illness he is facing and with the patient still smoking. One preventative measure is to get him up and move him around a few times a day, keeping his blood moving through his body to decrease the risk of thrombosis and keep the mucus flowing in the proper direction as well as his heart pumping properly. 8. Explain how congestive heart failure develops from emphysema. Congestive heart failure is a byproduct of emphysema or COPD, because your oxygen levels are low, your heart is overworking to keep the body properly supplied with the oxygen levels it requires. You are deteriorating your capillaries around the heart and lungs, corroding veins and arteries. When all if these illnesses combine the heart is going to over work itself and finally stop working entirely. 9. Describe respiratory therapy that might be helpful to Mr. C.Y. Respiratory Therapy is the treatment or management of acute and chronic breathing disorders, through the use of respirators or the administration of medication in aerosol form. These types of treatments would be helpful in the case of Mr. C.Y. because, he is not breathing properly and the body requires oxygen. With low steady doses of oxygen and learning to breath with his condition he will be able to add a few months or years onto his life. Instead of starving for air and continuing to over work his lungs, heart, and push himself to the point of exhaustion. With aggressive treatment, Mr. C.Y. recovered and returned home.

10. Suggest some reason why Mr. C.Y. may not receive adequate nutrition and hydration at home. Mr. C.Y. might not be receiving adequate nutrition or hydration at home due to age, finances, having a lack of energy from oxygen deprivation as well as the constant fight to get up and move around. Just going from the bedroom to the living room and the kitchen is a struggle for elderly people in general let alone someone fighting respiratory illnesses. 11. Suggest other support measures that would be useful in this case. In this case it would most likely be recommended that he move into a rehabilitation location so that he can be supervised, making sure he receives proper nutrition and hydration, gets his daily exercise, and can be monitored for his medication and respiratory therapy. There is also the option of having an in home nurse, and visiting therapist, if he is not willing to relocate. If he still has family around they might want to consider moving in with him.