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QUESTION
CH is a sixty-three-year-old man who has had emphysema problems for many years. History: He smoked for twenty years before quitting.
The nurse meets CH for the first time. In performing a physical assessment, the healthcare provider would expect CH to have a “barrel” configuration to the chest. What is the underlying pathological process that contributed to the “barrel” chest configuration?
Lab values were drawn during the last physician visit; would you expect arterial gases to be normal or abnormal? Identify the pathological process involved in your response. CH and other patients with emphysema are at risk for what complications because of the pathologic process of their disease?
Patients with long term or chronic emphysema tend to develop a bulging shaped chest that resembles the shape of a barrel named a barrel chest. It occurs because the lungs are chronically overinflated with air, so the rib cage stays partially expanded all the time. (Mayo Clinic, 2013) Air trapping causes hyperexpansion of the chest, which puts the muscles of respiration at a mechanical disadvantage. (McCance, 2014) This barrel chest appearance makes breathing less efficient and aggravates the shortness of breath for these patients.
CHs lab work previously obtained would most likely show a low PaO2 due to his chronic respiratory disease. Being the first time seeing this patient it would be important to determine what this patients appropriate PaO2 would be. Early in the disease process emphysema patients are able to maintain normal blood gases however having emphysema for many years, CH is likely to show low PaO2 and increased CO2. Chronic inflammation also can have significant systemic effects including weight loss, muscle weakness, and increased susceptibility to comorbidities, such as infection. (McCance, 2014) Malnutrition and muscle wasting is a major problem due to the increased work of breathing and energy expenditure of patients with emphysema. Educating these patients on diet and nutrition is very important and needs to be stressed with these patients.

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