Respiratory Flashcards
Changes related to age
- loss of lung elasticity and increased rigidity
- decreased ciliary action
- forced expiratory volume is reduced
- blunting of cough & laryngeal reflexes
- alveoli are fewer in number and larger in size
- thoracic muscles become more rigid
- reduced basilar inflation
- calcification of the costal cartilage makes the rib cage more rigid
- decreased elastic recoil
- decreased chest wall compliance
- increased risk of infection
- decreased response to hypoxemia (low O2 in the blood)
- decreased response to hypercapnia (high CO2 levels in the blood)
- kyphosis
- lungs become smaller, less firm, lighter, and more rigid, and have less recoil
These changes cause less lung expansion, insufficient basilar inflation & decreased ability to expel foreign or accumulated matter
the lungs exhale less efficiently, increasing the residual volume and decreasing the vital capacity
max breathing capacity is reduced
Bronchiectasis
a condition where there’s a permanent abnormal widening of the airways due to inflammation
Thicker walls cause mucus to collect in these passages because the walls are not strong enough to cough out the mucus
The cilia are destroyed, causing an increased risk of infections and difficulty breathing (dyspnea)
Fremitus
vibration felt during palpation of the chest
vital capacity
max amount of air that can be exhaled after max inhalation
Nursing considerations for resp conditions
RECOGNIZE THE S&S:
-changes in the sputum
=purulent & foul-smelling with lung abscess or bronchiectasis
=red & frothy with pulmonary edema & left-sided heart failure
PREVENT COMPLICATIONS
-monitor
=resp rate & volume
=pulse (sudden increase may indicate hypoxia)
=BP (elevations can be caused by hypoxia)
=temp: for detecting infection & prevent stress on the resp & cardiovascular systems as they attempt to meet the O2 demands
-Assess for:
= Hx of smoking or resp problems
=coughing: frequency, depth & productivity
=quality of the secretions
=ruddy pink complexion
=cyanosis
=anteroposterior diameter
=reduced anteroposterior chest diameter DURING exhalation
=auscultate for adventitious sounds
IMPORTANCE OF ORAL CARE:
pieces of brittle teeth can break off, be aspirated & cause resp problems
interventions
Postural drainage
promote coughing
Complementary therapies
Promoting self-care: make sure that the pt knows how to use the bronchodilators
Performing postural drainage
for the position of lying face down can have adverse effects
-assess the pt’s tolerance & modify the position as needed
thorough oral hygiene & a period of rest should follow postural drainage
Assess the mucus using COCA (Color, odor, consistency, amount)
Hypoxemia
low O2 levels in blood
hypercapnia
high CO2 levels in blood
Acute bronchitis
inflammation usually from URTI (upper respiratory tract infection)
increased mucus, cough
can lead to pneumonia
NOT CONSIDERED AS PART OF COPD
ensuring safe O2 administration
O2 therapy should be used wisely, especially for older adults
COPD or chronic high levels of O2 from the O2 therapy can cause retention of higher amounts of CO2 as a way to compensate for the high O2 levels
this can cause CO2 narcosis
scope: 2L of O2 via nasal cannula
S&S of CO2 narcosis
confusion
muscle twitching
visual defects
profuse (excessive) perspiration
hypotension
progressive circulatory failure
cerebral depression (sleeping or deep comatose state)
Nursing considerations for O2 therapy
we can self administer 2L (or more depending on the facility policy) of O2
frequently check the gauge & the tubing/line for any objects blocking the tubing, kinks or any other problems
pts who breathe by mouth and have trouble sealing their lips may not fully benefit from the nasal cannula
MAKE SURE THAT THE FACE MASK IS TIGHTLY SEALED TO PREVENT LEAKAGE!!!!!
A pt who is insecure & anxious inside an 02 tent may spend the O2 for emotional stress & not gain the full benefit
nasal passages should be kept clean
some older ppl won’t become cyanotic when hypoxic. instead, they can be restless, irritable, or dyspneic (out of breath)
before discharge:
-assess the pt’s ability to use home oxygen
- the pt should be supervised until the pt or caregiver is comfortable & competent to perform it on their own
- the home environment needs to be evaluated for safety
be aware that there are also complementary therapies
monitor blood gas levels
promoting productive coughing
hard candies & other sweets increase secretions
breathing exercises
humidifiers
expectorants (loosens secretions & make coughing more productive)
promote fluid intake
nonproductive coughing can be a useless expenditure of energy
Promoting self-care
effective use of the bronchodilators/inhalers depend on the pt’s ability to use it and coordinate the spray with inhalation
areas that can be a problem is for older persons with:
-slower responses
- poorer coordination
- arthritic joints
- general weakness
the ability of the pt to properly use the inhaler should first be assessed prior to discharge
provide an assessment of the abilities of pts & family caregivers to manage ventilator-related care
