Chapter 15
Respiration and Circulation
Factors That Can Alter Tissue Perfusion
• Cardiovascular Disease
– Arteriosclerotic heart disease, hypertension,
congestive heart failure, varicosities
• Other Diseases
– Diabetes mellitus, cancer, renal failure
• Blood Dyscrasias
– Anemia, thrombus, transfusion reactions
Factors That Can Alter Tissue Perfusion
(cont.)
• Hypotension
– Anaphylactic shock, hypovolemia, hypoglycemia,
hyperglycemia, orthostatic hypotension
• Medication Side Effects
– Antihypertensives, vasodilators, diuretics,
antipsychotics
• Other Conditions
– Edema, inflammation, prolonged immobility,
hypothermia, malnutrition
Assessing Tissue Circulation
• Review the individual’s health history.
• Evaluate vital signs.
• Inspect the tissues.
• Note signs or symptoms.
Indications of Ineffective Tissue Perfusion
• Hypotension
• Tachycardia; decreased pulse quality
• Claudication
• Edema
• Loss of hair on extremities
• Tissue necrosis; stasis ulcers
• Dyspnea; increased respirations
Indications of Ineffective Tissue Perfusion
(cont.)
• Pallor; coolness of skin
• Cyanosis
• Decreased urinary output
• Delirium (altered cognition and level of consciousness)
• Restlessness
• Memory disturbance
Interventions to Improve Tissue
Circulation
• Maintain blood pressure within an acceptable range.
• Prevent and eliminate sources of pressure on the body.
• Remind or assist patients to change positions frequently.
• Prevent pooling of blood in the extremities.
• Encourage physical activity.
• Prevent hypothermia, maintaining body warmth.
Interventions to Improve Tissue
Circulation (cont.)
• Monitor drugs for the side effect of hypotension.
• Educate to reduce risks.
• Periodically evaluate physical and mental health to
identify signs and symptoms of altered tissue perfusion.
Measures to Prevent Respiratory
Infections in Older Adults
• Obtain vaccines.
• Avoid exposure to people with infections.
• Seek medical attention if signs of infection appear.
• Report changes in character of sputum.
Using Oxygen with the Elderly
• Monitor blood gases.
• Observe the patient for symptoms of carbon dioxide
narcosis:
– Confusion
– Muscle twitching
– Visual defects
– Profuse perspiration
Using Oxygen with the Elderly (cont.)
– Hypotension
– Progressive degrees of circulatory failure
– Cerebral depression
Interventions for Ineffective Breathing
Patterns
• Instruct patient in breathing exercises.
• Control symptoms that could threaten effective
respirations.
• Raise head of bed at least 30° when patient is lying
down.
Interventions for Ineffective Breathing
Patterns (cont.)
• Instruct patient to turn, cough, and deep breathe at least
once every 2 hours.
• Monitor rate, depth, and rhythm of respirations; coloring;
coughing pattern; blood gases; and mental status.
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).