16 Lecture Note PowerPoint Presentation The Respiratory System LEARNING OUTCOME 1 Identify normal changes of aging of the respiratory system. Gerontological Nursing, Second Edition Patricia A. Tabloski RESPIRATORY SYSTEM COMPONENTS Lungs Airways leading to the lungs Blood vessels serving the lungs Chest wall Gerontological Nursing, Second Edition Patricia A. Tabloski FIGURE 16-1 NORMAL ANATOMY OF THE LUNGS AND AIRWAYS. Gerontological Nursing, Second Edition Patricia A. Tabloski NORMAL AGE-RELATED CHANGES IN LUNG STRUCTURE AND FUNCTION Stiffening of elastin and the collagen connective tissue supporting the lungs Altered alveolar shape resulting in increased alveolar diameter Decreased alveolar surfaces available for gas exchange Increased chest wall stiffness Stiffening of the diaphragm Gerontological Nursing, Second Edition Patricia A. Tabloski FIGURE 16-2 NORMAL CHANGES OF AGING IN THE RESPIRATORY SYSTEM. Gerontological Nursing, Second Edition Patricia A. Tabloski CARDIOVASCULAR FUNCTION CHANGES THAT CAN ALSO AFFECT THE PULMONARY SYSTEM Increased stiffness of the heart and blood vessels, rendering these vessels less compliant to increased blood flow demands Diastolic dysfunction due to impaired diastolic filling Systolic dysfunction due to increased left ventricular afterload Decreased cardiac output with rest and with exercise Gerontological Nursing, Second Edition Patricia A. Tabloski IMMUNE FUNCTION CHANGES THAT CAN AFFECT PULMONARY FUNCTION A decrease in the nature and quantity of antibodies produced A decrease in effectiveness of the protective cilia of the respiratory tract in removing debris (remains) from the airways, allowing more foreign bodies to travel to the lungs Gerontological Nursing, Second Edition Patricia A. Tabloski IMMUNE FUNCTION CHANGES THAT CAN AFFECT PULMONARY FUNCTION Decreased production of antibodies after immunization Use of medications that can suppress immune function Gerontological Nursing, Second Edition Patricia A. Tabloski AGING-RELATED NEURON LOSS Increases reaction time Decreases the ability to respond to multiple complex stimuli May impair the ability to adapt and interact with the environment Gerontological Nursing, Second Edition Patricia A. Tabloski CHANGES THAT CAN AFFECT PULMONARY FUNCTION Loss of muscle tone Exacerbated by deconditioning Obesity Sedentary lifestyle Increased thoracic rigidity and osteoporotic changes to the spine (kyphosis) Deconditioning can be defined as the multiple, potentially reversible changes in body systems brought about by physical inactivity and disuse. Gerontological Nursing, Second Edition Patricia A. Tabloski CHANGES THAT CAN AFFECT PULMONARY FUNCTION Use of medications that can cause Fatigue Depression of the cough reflex Insomnia Dehydration Bronchospasm Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 2 Describe appropriate health promotion and disease prevention guidelines relating to the respiratory system. Gerontological Nursing, Second Edition Patricia A. Tabloski TEACH PATIENTS TO MINIMIZE OR AVOID ASTHMA ATTACKS Peak flow meter use Avoid allergens and triggers for attacks Dust Animals Cockroaches Tobacco smoke Wood smoke Strong odors and sprays Gerontological Nursing, Second Edition Patricia A. Tabloski TEACH PATIENTS TO MINIMIZE OR AVOID ASTHMA ATTACKS Avoid allergens and triggers for attacks Colds and infections Exercise Weather Pollens Molds Gerontological Nursing, Second Edition Patricia A. Tabloski MONITOR MEDICATIONS PRESCRIBED FOR RESPIRATORY PROBLEMS Therapeutic and side effects Monitor for interactions with other medications Gerontological Nursing, Second Edition Patricia A. Tabloski BE PERSISTENT IN EDUCATING AND URGING OLDER PATIENTS TO QUIT SMOKING Investigate community resources Availability of smoking cessation support groups Nicotine patches and gum Bupropion (Zyban) : is an atypical antidepressant and smoking cessation aid. Gerontological Nursing, Second Edition Patricia A. Tabloski ADDITIONAL EDUCATION FOR PATIENTS WITH COPD Avoid exposure to dust and fumes Avoid air pollution, including secondhand smoke Refrain from close contact with people who have colds or the flu Gerontological Nursing, Second Edition Patricia A. Tabloski ADDITIONAL EDUCATION FOR PATIENTS WITH COPD Avoid excessive heat, cold, and high attitudes Drink lots of fluids Maintain good lifestyle habits Have spirometry done routinely and understand the numbers Gerontological Nursing, Second Edition Patricia A. Tabloski VACCINATIONS Pneumococcal vaccine Influenza (yearly) Gerontological Nursing, Second Edition Patricia A. Tabloski EDUCATION FOR PATIENTS WITH PNEUMONIA Stop smoking Take 10 deep breaths an hour to aerate lungs and loosen secretions Drink plenty of fluids to keep secretions moist Take antibiotics or antivirals as prescribed and finish all medications Report any adverse reactions Gerontological Nursing, Second Edition Patricia A. Tabloski EDUCATION FOR PATIENTS WITH PNEUMONIA Avoid coughing in public and practice good handwashing Avoid contact with other who are ill, infants, and frail older persons Receive the pneumococcal vaccine as soon as possible after recovery and get a flu shot yearly Gerontological Nursing, Second Edition Patricia A. Tabloski PULMONARY EMBOLUS PREVENTION Minimize venous stasis by leg elevation Urge passive and active range of motion in the immobile older person Encourage early postoperative ambulation Place elastic compression stockings and pneumatic calf compression boots on the postoperative patient Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 3 Discuss the nurse’s role in caring for older persons with respiratory problems. Gerontological Nursing, Second Edition Patricia A. Tabloski ASTHMA CARE Assist the patient with spirometry testing Educate the patient regarding proper Use Metered-dose inhaler Nebulizer use Spacer use Peak flow meter Care of the respiratory equipment Gerontological Nursing, Second Edition Patricia A. Tabloski MEDICATIONS USED TO TREAT ASTHMA Inhaled corticosteroid therapy Oral corticosteroids Cromolyn sodium Inhaled beta2-agonists Methylxanthine (theophylline) Ipratropium bromide Gerontological Nursing, Second Edition Patricia A. Tabloski MEDICATIONS CONTRAINDICATED IN PATIENTS WITH ASTHMA Beta-blockers Nonsteroidal anti-inflammatory drugs (NSAIDs) Diuretics Antihistamines Angiotensin-converting enzyme (ACE) inhibitors Antidepressants Gerontological Nursing, Second Edition Patricia A. Tabloski PHYSICAL ASSESSMENT OF THE PATIENT WITH ASTHMA Observation of the overall shape and movement of the thorax during respiration Auscultation of the lungs, noting the presence of any crackles, wheezes, rhonchi, or pleural rubs Chest excursion Tactile and vocal fremitus Chest excursion was operationally defined as the difference in chest girth between tidal inspiration and tidal expiration at two separate sites Gerontological Nursing, Second Edition Patricia A. Tabloski MEDICATIONS USED TO TREAT COPD Are similar to those used to treat asthma Bronchodilators Inhaled corticosteroids Antibiotics Influenza and pneumococcal vaccines Expectorants Other drugs to treat associated symptoms such as diuretics, analgesics, cough suppressants, and anxiolytics Gerontological Nursing, Second Edition Patricia A. Tabloski COPD EDUCATION Additional methods used to help loosen and remove secretions Postural drainage Chest percussion Controlled coughing Tracheal suctioning Smoking cessation Gerontological Nursing, Second Edition Patricia A. Tabloski PHYSICAL ASSESSMENT OF THE PATIENT WITH COPD The same as for the patient with asthma Gerontological Nursing, Second Edition Patricia A. Tabloski DIAGNOSIS OF TB Purified protein derivative (PPD) skin test Given subdermally Area should be measured and recorded in 72 hours Gerontological Nursing, Second Edition Patricia A. Tabloski EDUCATE THE PATIENT WITH TUBERCULOSIS (TB) Take their medications at the same time daily Prevents the development of resistant Mycobacterium Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 4 Describe common diseases of the respiratory system. Gerontological Nursing, Second Edition Patricia A. Tabloski FACTORS CAUSING PREDISPOSITION TO RESPIRATORY DISEASES Age-related changes in the lungs Years of exposure to air pollutants and cigarette smoke The presence of comorbidities Gerontological Nursing, Second Edition Patricia A. Tabloski ASTHMA Reversible airflow inflammation Increased mucous production Increased airway responsiveness to a variety of stimuli Often ignored in the older person Can present as a newly diagnosed disease or as a chronic disease that the older person has lived with for many years Gerontological Nursing, Second Edition Patricia A. Tabloski COMMON SYMPTOMS OF AN ASTHMA ATTACK Coughing: may be worse at night Wheezing: usually high-pitched whistling sounds on expiration Shortness of breath Chest tightness Gerontological Nursing, Second Edition Patricia A. Tabloski ASTHMA DIAGNOSIS IN AN OLDER PERSON Results of pulmonary function tests Chest radiography Electrocardiography Complete blood count with differential Gerontological Nursing, Second Edition Patricia A. Tabloski FOUR CATEGORIES OF ASTHMA CLASSIFICATION Intermittent Mild persistent Moderate persistent Severe Criteria Duration of symptoms Presence and severity of nocturnal symptoms Results of spirometry Gerontological Nursing, Second Edition Patricia A. Tabloski ASTHMA TREATMENT GOALS Reduce the frequency and severity of symptoms Improve results of spirometry testing Gerontological Nursing, Second Edition Patricia A. Tabloski COPD RELATED TERM Used for two closely related diseases of the respiratory system, chronic bronchitis and emphysema Chronic bronchitis Narrowing of the large and small airways, making it more difficult to move air in and out of the lungs Gerontological Nursing, Second Edition Patricia A. Tabloski COPD TERMINOLOGY Emphysema Permanent destruction of the alveoli because of irreversible destruction of elastin, a protein in the lung that is important for maintaining the strength of the alveolar walls Gerontological Nursing, Second Edition Patricia A. Tabloski EMPHYSEMA Risk factors Smoking Family history Gerontological Nursing, Second Edition Patricia A. Tabloski COPD PATHOPHYSIOLOGY Walls of the small airways and alveoli lose their elasticity and thicken Closes off some of the smaller air passages and narrows the larger ones Air can enter the alveoli but becomes trapped due to the collapsed airways Affects gas exchange and pathological changes occur Gerontological Nursing, Second Edition Patricia A. Tabloski COPD PATHOPHYSIOLOGY Blood is poorly oxygenated and tissue perfusion is less efficient Carbon dioxide may accumulate to critical levels Respiratory acidosis Respiratory failure Strains the heart Right ventricle can enlarge and thicken Abnormal rhythms called cor pulmonale Gerontological Nursing, Second Edition Patricia A. Tabloski COPD SYMPTOMS Early Early morning cough with clear sputum Periods of wheezing during or after colds Shortness of breath on exertion Gerontological Nursing, Second Edition Patricia A. Tabloski COPD SYMPTOMS Late Mouth breathing Puffing Use of accessory muscles of breathing Inability to finish sentence without catching one’s breath Sleep in semi-sitting position Gerontological Nursing, Second Edition Patricia A. Tabloski COPD DIAGNOSIS Spirometry preferred Arterial blood gases (ABGs) Can be difficult to obtain Gerontological Nursing, Second Edition Patricia A. Tabloski COPD TREATMENT Oxygen Medications Bronchodilators Corticosteroids Antibiotics First sign of infection Yellow or green sputum Gerontological Nursing, Second Edition Patricia A. Tabloski COPD TREATMENT Medications Other drugs to treat associated symptoms Diuretics Analgesics Cough suppressants Anxiolytics Gerontological Nursing, Second Edition Patricia A. Tabloski COPD TREATMENT Other treatments Bullectomy or lung reduction Pulmonary rehabilitation Exercise Oxygen Nutritional support Intermittent mechanical ventilator support CPAP Gerontological Nursing, Second Edition Patricia A. Tabloski COPD TREATMENT Other treatments Relaxation techniques Breathing techniques Clearing airway passages Postural drainage Chest percussion Controlled coughing Tracheal suctioning Gerontological Nursing, Second Edition Patricia A. Tabloski TUBERCULOSIS (TB) OVERVIEW Airborne disease Spread by droplets when an infected person coughs, sneezes, speaks, sings, or laughs Adequate ventilation is the most important measure to prevent transmission Gerontological Nursing, Second Edition Patricia A. Tabloski TB IN OLDER PERSONS Can be a reactivation of old disease Can be a new infection due to exposure to an infected individual Gerontological Nursing, Second Edition Patricia A. Tabloski TB RISK FACTORS Living in an institution Diabetes mellitus Use of immunosuppressive drugs Malignancy Malnutrition Renal failure Gerontological Nursing, Second Edition Patricia A. Tabloski TB DIAGNOSIS Skin test (PPD) Chest X-ray Gerontological Nursing, Second Edition Patricia A. Tabloski TB TREATMENT Several antibiotics that are prescribed for 6 to 12 months Patients must take their medication at the same time every day to prevent resistance Gerontological Nursing, Second Edition Patricia A. Tabloski LUNG CANCER Responsible for almost one third of all cancer deaths in the United States Gerontological Nursing, Second Edition Patricia A. Tabloski LUNG CANCER At least 12 different types of tumors are included in the broad heading of lung cancer Squamous cell Adenocarcinomas Large cell carcinomas Small cell carcinomas (“oat cell”) Growth rate and metastasis rate vary by tumor type Gerontological Nursing, Second Edition Patricia A. Tabloski LUNG CANCER SYMPTOMS Vague and mimic the symptoms of other pulmonary illnesses Chronic cough Hemoptysis Chest pain Shortness of breath Fatigue, weight loss Frequent lung infections Gerontological Nursing, Second Edition Patricia A. Tabloski LUNG CANCER DIAGNOSIS CT scan MRI scan Pulmonary function tests Bronchoscopy with collection of lung tissue, cells, or fluids for analysis Gerontological Nursing, Second Edition Patricia A. Tabloski LUNG CANCER TREATMENT Surgical removal of the tumor or lung Chemotherapy Radiation Palliative care Gerontological Nursing, Second Edition Patricia A. Tabloski RESPIRATORY INFECTIONS Older adults may not cough, exhibit an elevated temperature, or show other classic signs of a respiratory infection Atypical symptoms include lethargy, falling, exhibiting loss of cognitive or physical function, or simply not eating or drinking Gerontological Nursing, Second Edition Patricia A. Tabloski UPPER RESPIRATORY INFECTIONS Most require no treatment Gerontological Nursing, Second Edition Patricia A. Tabloski SINUSITIS Inflammation of the mucosal lining of the paranasal sinuses that can lead to mucous stasis, obstruction, and subsequent infection Treatment Nasal decongestants Saline spray Acetaminophen Humidified air Gerontological Nursing, Second Edition Patricia A. Tabloski PNEUMONIA Most common type of infectious disease of the lung Gerontological Nursing, Second Edition Patricia A. Tabloski PNEUMONIA RISK FACTORS History of nosocomial pneumonia within the last 6 to 12 months Diagnosed lung disease (COPD) Recent hospitalization Nursing home residence Smoking Alcoholism Neurologic disease Gerontological Nursing, Second Edition Patricia A. Tabloski PNEUMONIA RISK FACTORS Immunosuppression Use of oxygen therapy Severe protein-calorie malnutrition Heart failure Antibiotic therapy during the previous month Eating dependency Enteral feeding by nasogastric tube. Gerontological Nursing, Second Edition Patricia A. Tabloski PNEUMONIA PATHOGENS Streptococcus pneumonia Haemophilus influenza Staphylococcus aureus Enterobacteriaceae Gerontological Nursing, Second Edition Patricia A. Tabloski PNEUMONIA SYMPTOMS Cough Fever Sputum production Fever may be absent in the older person Changes in function, appetite, continence, and other subtle symptoms may be the first signs of the onset of illness in the older adult Gerontological Nursing, Second Edition Patricia A. Tabloski PNEUMONIA ASSESSMENT Assess vital signs Inspect the thorax Auscultate the lungs Assess the skin for cyanosis Gerontological Nursing, Second Edition Patricia A. Tabloski PNEUMONIA DIAGNOSTIC TESTS Chest X-ray Blood culture Sputum specimen Pulse oximetry Blood chemistry analysis Gerontological Nursing, Second Edition Patricia A. Tabloski PNEUMONIA TREATMENT Antibiotic therapy Chest percussion Inhaled beta-adrenergic agonists Oxygen Rehydration Gerontological Nursing, Second Edition Patricia A. Tabloski PNEUMOCOCCAL VACCINATION Recommended for older persons over age 65, atrisk persons, and those with unknown immunization status 25% of older patients with risk factors have received the vaccine 80% effective Associated with reduction in pneumonia-related hospitalizations Gerontological Nursing, Second Edition Patricia A. Tabloski ACUTE BRONCHITIS An acute inflammation of the bronchi Usually a self-limiting viral illness Signs and symptoms similar to those of pneumonia Productive cough Chills, lethargy Low-grade fever Gerontological Nursing, Second Edition Patricia A. Tabloski ACUTE BRONCHITIS Treatment Rest Air humidification Use of cough suppressant Acetaminophen Gerontological Nursing, Second Edition Patricia A. Tabloski PULMONARY EMBOLISM An occlusion of a portion of the pulmonary vascular bed by an embolus consisting of a thrombus, an air bubble, or a fragment of tissue or lipids Result is shortness of breath, heart failure, or death Gerontological Nursing, Second Edition Patricia A. Tabloski PULMONARY EMBOLISM RISK FACTORS Clotting disorders Immobility Dehydration Recent surgery Atherosclerotic changes in the circulatory system Obesity Gerontological Nursing, Second Edition Patricia A. Tabloski PULMONARY EMBOLISM TREATMENT Intravenous administration of heparin Other anticoagulant therapy Warfarin therapy may be continued 3 to 6 months after discharge to prevent the formation of another pulmonary embolus Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 5 Identify the nursing assessment process and formulation of nursing diagnoses relating to the respiratory system. Gerontological Nursing, Second Edition Patricia A. Tabloski NURSING DIAGNOSES FOR THE OLDER PERSON WITH ASTHMA Activity Intolerance for those persons with exercise induced asthma Ineffective Airway Clearance for those with chronic cough with mucous production Ineffective Breathing Patterns for those with tachypnea and wheezing with poorly controlled asthma Gerontological Nursing, Second Edition Patricia A. Tabloski NURSING DIAGNOSES FOR THE OLDER PERSON WITH ASTHMA Altered Tissue Perfusion: Respiratory for those with hypoxemia Ineffective Management of Therapeutic Regimen, Individual for those who are unable or unwilling to monitor the peak flow recordings and adjust medications to prevent asthma attacks and exacerbations Gerontological Nursing, Second Edition Patricia A. Tabloski NURSING DIAGNOSES FOR THE OLDER PERSON WITH COPD Activity Intolerance for those persons with fatigue and air hunger Ineffective Airway Clearance for those with chronic cough with mucous production Ineffective Breathing Pattern for those with tachypnea and wheezing with advanced COPD Gerontological Nursing, Second Edition Patricia A. Tabloski NURSING DIAGNOSES FOR THE OLDER PERSON WITH COPD Altered Tissue Perfusion: Respiratory for those with hypoxemia Ineffective Management of Therapeutic Regimen, Individual for those who are unable or unwilling to refrain from cigarette smoking and adjust medications to prevent exacerbations Gerontological Nursing, Second Edition Patricia A. Tabloski NURSING DIAGNOSES FOR PNEUMONIA Risk for Infection based on advanced age or immunosuppression Altered Health Maintenance, based on poor nutrition, or tobacco or alcohol use Noncompliance, based on inability or unwillingness to take medications as prescribed Gerontological Nursing, Second Edition Patricia A. Tabloski NURSING DIAGNOSES FOR PNEUMONIA Ineffective Airway Clearance, based on altered cough reflex and excessive secretions Risk for Aspiration, based on diagnosis with neurological disease such as CVA or dementia Ineffective Tissue Perfusion, based on the presence of hypoxia Gerontological Nursing, Second Edition Patricia A. Tabloski NURSING DIAGNOSES FOR PULMONARY EMBOLISM Ineffective Breathing Patterns, Risk for Suffocation Activity Intolerance Gerontological Nursing, Second Edition Patricia A. Tabloski