Shortness of breath is the
outstanding symptom reported by individuals suffering
from this disorder. Other symptoms include:
Additional symptoms that
may be associated with this disease:
nasal flaring
eyes bulging
dizziness
difficulty
breathing, lying down
anxiety, stress
and tension
ankle, feet and
leg swelling
unintentional
weight loss
headache (may be
worse in the morning)
fatigue
impaired ability
to concentrate
Awakening many
times at night
Awakening from
sleep not rested
memory loss
clubbing of the
fingers or toes
PHYSICAL EXAMINATION
A physical examination will show decreased breath sounds,
wheezing and rales (crackles) and prolonged exhalation.
It will take an emphysema patient twice as long to exhale
as it does to inhale, as they have a hard time getting
the air out of their lungs. The chest may be enlarged on
the right side, or there may be an increased front to
back diameter of the chest (called a barrel shaped
chest). Patients generally look very tired, these are all
signs of insufficient oxygen.
SOME COMMON
MISCONCEPTIONS
Because emphysema patients usually look just fine,
caregivers have a hard time realizing that they need help
with so many simple things. When a patient with emphysema
is eating, they are using all their accessory muscles to
breath. A person that does not have emphysema uses only
the chest muscles and their accessory muscles can be used
to lift and pull. This is not so in the patient with
emphysema. This is why eating is so difficult, they are
using their muscles for a duel purpose and they will tire
very easily. If they eat a large meal, their diaphragm is
lifted, and they are unable to take deep breaths, and
they need to do this to function. So, eating is a very
difficult task for a resident with emphysema.
Bathing requires this same muscle usage as breathing
(accessory muscles). When bathing they are moving around
and using their upper body, the same muscles they use to
breathe, and are in a moist atmosphere which causes more
coughing and increased shortness of breath. All these
things for an ordinary person are easy, yet for a
resident with emphysema, this is very difficult and can
be exhausting.
Most patients with emphysema will sleep with two or more
pillows, this makes breathing easier, and as the disease
progresses they may even need to sleep in a hospital bed
or a recliner as this upright position helps them to
breath easier.
Many residents with emphysema seem short-tempered but
this is not always the case. It is much easier for them
to say a few words and get a point across than it is to
elaborate and become so short of breath that they cannot
finish what they want to say without stopping a few
times. This happens with a lot of residents, and they
fail to say "please", or to make long narrative
sentances They are not demanding or short tempered, they
do this because it is much easier and they really don't
have the breath.
Some of the things that you may be able to do to help a
respiratory patient with emphysema is to ask questions
that require a yes or no answer. Try and schedule meals
and bath with time between so that they can rest before
the next task. Offer small meals more frequently so they
don't get quite as full at one sitting. All of these
things will help the resident and the caregiver have a
much better understanding of each other.
Tests that help confirm the diagnosis:
arterial blood gases ( this shows how much oxygen is in
the blood and will be reduced in
patients with emphysema.
Serum alpha-1 antitrypsin ( showing a deficiency)
Chest X-ray
Pulmonary function tests (which will show a decrease in
the lung capacity, the inability
to take in and blow out a normal breath).
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