Patho Patho #73


What is the pathophysiology of the “barrel-chest” appearance of clients with emphysema?


  1. A barrel chest is a sign of impending respiratory failure.
    • Rationale:

      This answer choice is not correct because a barrel chest is an expected manifestation associated with long term emphysema and not a sign of impending respiratory failure.

  2. Destruction of the bronchi by irritants causes air leaks and over inflation of the chest cavity.
    • Rationale:

      This answer choice is not correct because the barrel chest appearance is caused by destruction of the alveoli, not the bronchi.

  3. Air trapping within inelastic alveoli leads to a rigid, rounded appearance to the chest wall.
    • Rationale:

      This answer is correct because barrel chest results from air trapping within inelastic alveoli in clients with long term emphysema.

  4. Mucus plugging and bronchoconstriction contribute to the barrel chest appearance.
    • Rationale:

      This answer choice is not correct as this is a description of the pathophysiology of an asthma attack rather than the barrel chest appearance associated with emphysema.


The focus of this question is asking the nurse to identify the underlying pathophysiology behind the classic barrel chest associated with emphysema. Emphysema is a form of COPD in which the alveoli are damaged and their elasticity is eventually lost. The loss of elastic recoil within the alveoli leads to air trapping within the lower air sacs and the characteristic “barrel chest” appearance seen in emphysema.


Learning Outcomes

Emphysema is a chronic respiratory disorder of the lower airways usually caused by long term smoking. Emphysema can also be caused by a genetic deficiency of the protective protein, alpha-1 antitrypsin. The underlying etiology eventually leads to destruction of the alveoli which causes them to lose their elasticity. Loss of elasticity leads to air trapping and the classic 1:1 AP:lateral ratio of the chest seen in emphysema clients.

Test Taking Tip

When studying pathophysiology, make sure to learn and understand the underlying patho of not only the disease process, but also the classic manifestations associated with the disease process.

Video Rationale