the respiratory system 16 lecture note powerpoint presentation

The Respiratory System

16Lecture Note PowerPoint Presentation

Gerontological Nursing, Second EditionPatricia A. Tabloski

LEARNING OUTCOME 1Identify normal changes of aging of the respiratory

system.


RESPIRATORY SYSTEM COMPONENTS

Lungs Airways leading to the lungs Blood vessels serving the lungs Chest wall


FIGURE 16-1NORMAL ANATOMY OF THE LUNGS AND AIRWAYS.


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


FIGURE 16-2NORMAL CHANGES OF AGING IN THE RESPIRATORY SYSTEM.


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


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


IMMUNE FUNCTION CHANGES THAT CAN AFFECT PULMONARY FUNCTION

Decreased production of antibodies after immunization

Use of medications that can suppress immune function


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


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.


CHANGES THAT CAN AFFECT PULMONARY FUNCTION

Use of medications that can cause Fatigue Depression of the cough reflex Insomnia Dehydration Bronchospasm


LEARNING OUTCOME 2Describe appropriate health promotion and disease

prevention guidelines relating to the respiratory system.


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


TEACH PATIENTS TO MINIMIZE OR AVOID ASTHMA ATTACKS

Avoid allergens and triggers for attacks Colds and infections Exercise Weather Pollens Molds


MONITOR MEDICATIONS PRESCRIBED FOR RESPIRATORY PROBLEMS

Therapeutic and side effects Monitor for interactions with other

medications


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.


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


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


VACCINATIONS

Pneumococcal vaccine Influenza (yearly)


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


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


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


LEARNING OUTCOME 3Discuss the nurse’s role in caring for older persons

with respiratory problems.


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


MEDICATIONS USED TO TREAT ASTHMA

Inhaled corticosteroid therapy Oral corticosteroids Cromolyn sodium Inhaled beta2-agonists Methylxanthine (theophylline) Ipratropium bromide


MEDICATIONS CONTRAINDICATED IN PATIENTS WITH ASTHMA

Beta-blockers Nonsteroidal anti-inflammatory drugs

(NSAIDs) Diuretics Antihistamines Angiotensin-converting enzyme (ACE)

inhibitors Antidepressants


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


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


COPD EDUCATION

Additional methods used to help loosen and remove secretions Postural drainage Chest percussion Controlled coughing Tracheal suctioning

Smoking cessation


PHYSICAL ASSESSMENT OF THE PATIENT WITH COPD

The same as for the patient with asthma


DIAGNOSIS OF TB

Purified protein derivative (PPD) skin test Given subdermally Area should be measured and recorded in 72

hours


EDUCATE THE PATIENT WITH TUBERCULOSIS (TB)

Take their medications at the same time daily Prevents the development of resistant

Mycobacterium


LEARNING OUTCOME 4Describe common diseases of the respiratory

system.


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


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


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


ASTHMA DIAGNOSIS IN AN OLDER PERSON

Results of pulmonary function tests Chest radiography Electrocardiography Complete blood count with differential


FOUR CATEGORIES OF ASTHMA CLASSIFICATION

Intermittent Mild persistent Moderate persistent Severe Criteria

Duration of symptoms Presence and severity of nocturnal symptoms Results of spirometry


ASTHMA TREATMENT GOALS

Reduce the frequency and severity of symptoms

Improve results of spirometry testing


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


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


EMPHYSEMA

Risk factors Smoking Family history


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


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


COPD SYMPTOMS

Early Early morning cough with clear sputum Periods of wheezing during or after colds Shortness of breath on exertion


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


COPD DIAGNOSIS

Spirometry preferred Arterial blood gases (ABGs)

Can be difficult to obtain


COPD TREATMENT

Oxygen Medications

Bronchodilators Corticosteroids Antibiotics

First sign of infection Yellow or green sputum


COPD TREATMENT

Medications Other drugs to treat associated symptoms

Diuretics Analgesics Cough suppressants Anxiolytics


COPD TREATMENT

Other treatments Bullectomy or lung reduction Pulmonary rehabilitation

Exercise Oxygen Nutritional support

Intermittent mechanical ventilator support CPAP


COPD TREATMENT

Other treatments Relaxation techniques

Breathing techniques Clearing airway passages

Postural drainage Chest percussion Controlled coughing Tracheal suctioning


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


TB IN OLDER PERSONS

Can be a reactivation of old disease Can be a new infection due to exposure to an

infected individual


TB RISK FACTORS

Living in an institution Diabetes mellitus Use of immunosuppressive drugs Malignancy Malnutrition Renal failure


TB DIAGNOSIS

Skin test (PPD) Chest X-ray


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


LUNG CANCER

Responsible for almost one third of all cancer deaths in the United States


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


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


LUNG CANCER DIAGNOSIS

CT scan MRI scan Pulmonary function tests Bronchoscopy with collection of lung tissue,

cells, or fluids for analysis


LUNG CANCER TREATMENT

Surgical removal of the tumor or lung Chemotherapy Radiation Palliative care


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


UPPER RESPIRATORY INFECTIONS

Most require no treatment


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


PNEUMONIA

Most common type of infectious disease of the lung


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


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.


PNEUMONIA PATHOGENS

Streptococcus pneumonia Haemophilus influenza Staphylococcus aureus Enterobacteriaceae


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


PNEUMONIA ASSESSMENT

Assess vital signs Inspect the thorax Auscultate the lungs Assess the skin for cyanosis


PNEUMONIA DIAGNOSTIC TESTS

Chest X-ray Blood culture Sputum specimen Pulse oximetry Blood chemistry analysis


PNEUMONIA TREATMENT

Antibiotic therapy Chest percussion Inhaled beta-adrenergic agonists Oxygen Rehydration


PNEUMOCOCCAL VACCINATION

Recommended for older persons over age 65, at-risk 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


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


ACUTE BRONCHITIS

Treatment Rest Air humidification Use of cough suppressant Acetaminophen


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


PULMONARY EMBOLISM RISK FACTORS

Clotting disorders Immobility Dehydration Recent surgery Atherosclerotic changes in the circulatory

system Obesity


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


LEARNING OUTCOME 5Identify the nursing assessment process and

formulation of nursing diagnoses relating to the respiratory system.


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


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


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


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


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


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


NURSING DIAGNOSES FOR PULMONARY EMBOLISM

Ineffective Breathing Patterns, Risk for Suffocation

Activity Intolerance

the respiratory system 16 lecture note powerpoint presentation

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