would you remember the differences between chronic bronchitis and empyema for the enlex so remember empyema is characterized by air trapping and that's because over time smoking is going to damage the alvioli and now when the client exhales instead of that air exiting smoothly this alveoli has become like a floppy plastic grocery bag and so instead they'll exhale and this will just kind of collapse in on itself and trap all of that air in the alvioli so this leads to air trapping and hyperin these patients can't get air out and that's why people with empyema are our pink puffers they puff with that prolate breathing to try and force this air out so we are looking for signs consistent with air trapping and hyperinflation so would we see pale cool lower extremities well I certainly hope not that's going to be a sign of decreased profusion to the lower extremities like we would expect in peripheral artery disease but not in COPD then hyperresonance percussion would we see this with air trapping yes essentially these clients with empyema have so much trapped air with that barrel chest has become like a drum so when we percuss it it's very resonant so I would expect to see this then sharp chest pain on inspiration so that would be more expected with like a PE or pneumothorax I would only expect to see that in empyema if they had pneumonia so not just from empyema alone then a decreased hemoglobin and hematocrite so you might remember that COPD actually increases the hemoglobin and hematocrite because they're chronically hypoxemic so their body produces more red blood cells to just try and carry more oxygen around so it would not be this one so all right the only one consistent with air trapping for empyema is hyperresonance on percussion and we're correct great job