CH 16: Respiratory Changes Flashcards
respiratory effects of aging
-Connective tissue changes to the nose
-Reduced secretions in the submucosal gland
-Calcification of the trachea cartilage
-Reduction in size and weight of the lungs
–Decreased elastic recoil of the lungs during expiration
–Reduced elasticity of the alveoli
–Loss of skeletal muscle strength controlling the diaphragm
-Lose and brittle teeth may be aspirated
-Reduced cough and gag reflex
-Decreased gastric motility
-Immobility
assessment of respiratory function
Skin color for face, ears, neck, fingers, toes, nose
Chest Structure and Posture
Breathing Pattern
Cough
skin color respiratory assessment
-Pink and Ruddy – Emphysema and Hypoxia related to high carbon dioxide levels in the blood
-Bluish or Gray coloration due to from lack of oxygen binding to the hemoglobin
chest structure and posture respiratory assessment
Anterior – Posterior diameter increase – barrel chest (COPD)
Kyphosis -hunchback - decreased diaphragm strength - diaphragm
Lordosis - sway back - an abnormal inward curvature of the lumbar spine -
Scoliosis - a sideways curvature of the spine - lung expansion
breathing pattern respiratory assessment
Needing to sit in the tripod position to breathe
Use of accessory muscles to breathe
Pulse oximetry readings less than 92
cough in respiratory assessment
Note the presence, frequency, and characteristics of any cough that you may observe
respiratory health promotion
-influenza and pneumonia vaccines
-smoking cessation
-preventing immobility
-advised against treating respiratory problems themselves
-environmental factors
-oral health
respiratory conditions
Chronic Obstructive Pulmonary Disease (COPD)
-Asthma
-Chronic bronchitis
-Emphysema
Pneumonia
Influenza
Lung Cancer
Lung Abscess
factors of asthma
-can develop in older years
-high risk of complications of bronchiectasis, cardiac problems
-high rates of mortality
-assess for causative factors, triggers and education patient
-evaluate aerosol nebulizers use
-use of sympathomimetics can cause tachyarrythmias - use xopedex (no HR change)
-precaution: avoid adverse drug effects
-use of rescue inhaler
Causes persistent, productive cough; wheezing; recurrent respiratory infections; shortness of breath
chronic bronchitis
management of chronic bronchitis
-remove bronchial secretions - thick greenish color
-prevent obstruction of airway from inability to remove secretions
-maintain adequate fluid intake
-expectorate secretions
-if worsens - leads to emphysema
causes of emphysema
cigarette smoking
chronic bronchitis
chronic irritation from air pollutants
morphologic changes in the lung – destruction of alveoli
factors of emphysema
-increasing incidence in older adults
-cigarette smoking major role in development
-symptoms develop slowly, which can delay diagnosis and treatment
symptoms of emphysema
gradual dyspnea
chronic cough
hypoxia
fatigue
anorexia
weight loss
weakness
treatment of emphysema in older adults
Postural drainage, bronchodilators, avoid stress, and breathing exercises
education, nutrition and support for emphysema
Small feedings and high-protein supplements
pace activities
avoid extremely cold weather - bronchospasms
recognizing symptoms of infection
leading cause of death in older adults
pneumonia
contributing factors for pneumonia
Poor chest expansion
Shallow breathing
High prevalence of respiratory diseases that increase mucus production and bronchial obstructions
Decreased resistance to infection
Aspiration
Reduced mobility and debilitation
symptoms of pneumonia
Slight cough
fatigue
tachypnea
confusion
restlessness
pleuritic pain
minimal to no fever
**older adults may no have chest pain like younger populations
treatment for pneumonia
pneumococcal vaccines
Most frequent cause of serious illness and death in older adults
Influenza A
Less severe, but can still produce serious problems for older adults
Influenza B
symptoms of influenza
fever
myalgia
sore throat
nonproductive cough
effects of influenza on older adults
Destroys ciliated epithelial cells of the respiratory tract
-depresses mucociliary clearance, and can lead to the development of secondary bacterial infections, myositis, pericarditis, encephalitis, and Guillain-Barre Syndrome
preventative measures of influenza
Annual Flu Vaccines
Reduced contact with individuals who are known or suspected to have the flu
occurrence of lung cancer
most occur in patients older than 65 years
is lung cancer more common in men or women
higher incidence in men
african american
smoking
symptoms of lung cancer
dyspnea
coughing
chest pain
fatigue
anorexia
wheezing
respiratory infections
treatment of lung cancer
surgery
chemotherapy
radiotherapy
diagnosis of lung cancer
-xray
-bronchoscopy
causes of a lung abscess
pneumonia
tuberculosis
malignancy
trauma
aspiration of a foreign object
symptoms of lung abscess
anorexia
weight loss
elevated temp
chronic cough
diagnosis of lung abscess
same as other age groups
-bronchoscopy
-chest xray
treatment of lung abscess
postural drainage
high-protein
-high-calorie diet
general Nursing Considerations for Respiratory Conditions
-prompt medical attention with signs of respiratory infection
-atypical presentation
–no chest pain*****
–lower body temp
-changes in character of sputum
-nutritional needs-use of asccessory muscles uses a lot of calories
preventing complications of respiratory conditions
Monitor closely to minimize disability and prevent mortality
Assess to detect respiratory complications
assessing for respiratory complications
Respiratory rate and volume, pulse, blood pressure, temperature, neck veins, patency of airway, cough, secretions, and mental status
Look for signs of malnourishment, depression, social isolation
Assess functional capacity and ability to perform ADL
Allow frequent rest period to reoxygenate
ensuring safe oxygen administration
prudent use of oxygen
assessment of oxygen equipment
home oxygen safety -make sure adequate supply
evaluate home environment
carbon dioxide narcosis - used to high CO2 and low O2
monitor blood gases
characteristics of postural drainage to promote oxygenation
Used to remove bronchial secretions
Aerosol medications used prior to procedure
Consider positioning based on individual patient’s abilities
–Instruct older adults to change positions slowly and to rest for a few minutes in between position changes
Discontinue if dyspnea, palpitations, chest pain, diaphoresis, apprehension, or other signs of distress occur
Oral hygiene and rest after procedure
measures to promote productive cough
Hard candy increase secretions
Breathing exercises
Use of humidifier
Expectorants
Increase fluid intake
complementary therapies for respiratory conditions
-some herbs affect respiratory health
-aromatherapy may prove helpful
-assess for interactions with other medications
-hot, spicy foods open airways
-avoid mucous-forming
-nutrition assessment for cachexia
-some vitamins are beneficial
-acupuncture, acupressure, yoga, tai chi and massage
promoting self-care in respiratory conditions
-assess patients ability to use nebulizer correctly
-proper use and operation of supplemental oxygen, bi-pap, ventilators
–attention to physical, emotional and social needs of ventilator-dependent patients and their caregivers
why and how to provide encouragement for individuals with respiratory problems
Respiratory problems: frightening and produce anxiety
Need for psychological support and reassurance, especially during periods of dyspnea
Understanding of disease process and management
Encouragement to meet demands of chronic disease
Promptly seek medical attention if any changes in breathing, expectorant, or physical symptoms
why should we add protein to the diet of older adults with respiratory disorders
coughing causes pt to lose protein each time
