1. Differentiate Emphysema and Chronic bronchitis.

Which one is blue bloaters and pink puffers

Emphysema Chronic Bronchitis

Pink Puffers
Why blue/pink? Because of their color and the way they
breathe through pursed lips on expiration.
Hypoxemia occurs late in the disease.
The damage is NOT in the bronchioles,
therefore no increased resistance (radius)
and therefore NO CO2 retention and NO
cyanosis pink
Blue Bloaters
Because of the presence of cyanosis of
the skin and mucous membranes.
Hypoxemia occurs early in the disease.
The damage is in the bronchioles,
therefore increase resistance (radius)
and therefore CO2 retention and
therefore cyanosis blue. Since there
is CO2 retention bloaters

Pathophysiology Refers to the damage and destruction
done to the walls of the alveoli, the tiny air
spaces in the lungs. The alveoli provide
oxygen to the bloodstream so when they
are destroyed, it is difficult for the person
with emphysema to breathe.
Symptoms Persistent cough, long-term mucus
production, shortness of breath, wheezing,
fatigue and an ongoing feeling that you’re
not getting enough air
Causes Cigarette smoking. Risk for emphysema is
associated with the duration of smoking
and the number of cigarettes smokes each
day
Dyspnea Occurs early on during the course of
disease
Hypoxemia & Hypoxemia and hypercapnia (respiratory
hypercapnia acidosis) later during disease course, in
the beginning they are fine (hence: pink
puffers)
Causes inflammation in the bronchioles
of the lungs. This irritation causes
increased amount of heavy mucus in the
lungs that overtime interfere with
breathing
Coughing up clear or white mucus,
shortness of breath, chest discomfort or
tightness, wheezing and fatigue
Cigarette smoking, secondhand smoke
and air pollution which irritates the
airways and leads to increased
inflammation
Occurs later in the disease course
Hypoxemia and hypercapnia (respiratory
acidosis) early in the disease (hence:
blue bloaters)

2. Come up with your own Nursing Diagnosis and Nursing Intervention

Nursing Diagnosis Nursing Intervention Rationale

Emphysema
Impaired gas exchange
related to alveolar
capillary membrane
destruction
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 Monitor and record vital signs  For baseline data
 Position the patient in semi-  To maintain airway
fowler’s position
 Encourage frequent position  Promote optimal chest expansion and
changes and deep breathing drainage of secretion
exercise
 For mobilization of secretions but avoid
 Instruct patient to increase water fluid overload
intake
 If wheezy they may need a breathing
 Auscultate lung sounds treatment If you hear crackles they
may have pneumonia and potentially
 Assessfrom
signs and symptoms
on 05-01-2023 03:02:07 GMT -05:00

https://www.coursehero.com/file/108647883/COPD-Chronic-Bronchitis-Emphysemadocx/
 hypercapnia.
 Assess the home environment for
irritants that impair gas exchange.
Help the patient adjust the home
environment as necessary
 Monitor ABGs
 Maintain an oxygen administration
device as ordered, attempting to
maintain oxygen saturation at
90% or greater.
 Suction as necessary.
 Administer medications as
prescribed.
 Instruct patient to limit exposure to
persons with respiratory
infections.
 Review the daily chest X-ray
examination, note the increase or
irregularities.
Chronic Bronchitis  Assess respiratory rate, depth.
Note use of accessory muscles,
Ineffective airway
pursed lip breathing, inability to
clearance related to
speak
excessive, thickened
mucous secretions
 Monitor blood pressure (BP),
heart rate (HR), and temperature.
 Administer supplemental oxygen
as ordered.
 Routinely monitor skin and
mucous membrane color
 Assist the patient to an optimal
upright position.
 Encourage patient to take several
deep breaths.
 Encourage patient to take a deep
breath, hold for 2 seconds, and
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could use suctioning
 Hypercapnia is the buildup of carbon
dioxide in the bloodstream
 Irritants in the environment decrease
the patient’s effectiveness in accessing
oxygen during breathing.
 Blood gases help to determine if the
patient is in respiratory acidosis.
 Supplemental oxygen may be required
to maintain PaO2 at an acceptable
level.
 Suction clears secretions if the patient
is not capable of effectively clearing the
airway. Airway obstruction blocks
ventilation that impairs gas exchange
 The type depends on the etiological
factors of the problem
 This is to reduce the potential spread
of droplets between patients.
 To know any changes or abnormalities
 Useful in evaluating the degree or
respiratory and chronicity of the
disease process,
 Hypertension and tachycardia related
to increased work of breathing,
leading to increased respiratory
distress and hypoxia.
 Adequate oxygenation facilitates gas
exchange and perfusion.
 Cyanosis maybe peripheral in nail
beds or central in lips or earlobes
 Sitting upright provides for an ideal
body alignment for maximum lung
expansion.
 Deep breathing promotes oxygenation
before controlled coughing.
 cough two or three times in
succession.
 Encourage use of incentive
spirometry, as appropriate.
 Promote systemic fluid hydration,
as appropriate.
 Administer medications as
ordered. For example,
bronchodilators, expectorants,
antibiotics, & diuretics
 Collaborate with respiratory
therapists.
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 Controlled coughing is accomplished
by closure of the glottis and the
explosive expulsion of air from the
lungs.
 Breathing exercises help maximize
ventilation.
 Adequate fluid intake enhances
liquefaction of pulmonary secretions
and facilitates expectoration of
mucus.
 All these medications either treat
inflammatory or infectious processes
or help improve breathing by reducing
airway resistance.
 The patient might benefit from
specialized treatment plans such as
chest physiotherapy or scheduled
nebulizer treatments.