Transcript Chapter 19 Respiration

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Chronic obstructive pulmonary disease
(COPD): group of diseases including asthma,
chronic bronchitis, and emphysema
Kyphosis: curvature of the spine
Elastic recoil: lungs’ ability to expand and
contract
Total lung capacity: maximum volume that
lungs can expand during fullest inspiration
Vital capacity: maximum amount of air that
can be expelled following maximum
inspiration
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Respiratory health vital for physically,
mentally, and socially active life
Lifetime of insults to respiratory system
takes its toll during older age
Respiratory diseases leading to cause of
disability; fourth leading cause of death
Positive health practices promote effective
breathing
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Respiratory problems develop easily; difficult
to manage
Changes occur in upper airway paths, nose,
and trachea
Reduce cough
Lungs reduce in size and weight
Decreased elastic recoil
Alveoli less elastic
Reduction in vital capacity; increase residual
volume
Loose or brittle teeth can be aspired
Is the following statement True or
False?
Loose teeth that are infected can break or
dislodge, leading to lung abscesses,
infections, and aspirated tooth fragments.
True
Often overlooked in the prevention of
respiratory problems is the significance of
a healthy oral cavity as infections of the
oral cavity can lead to respiratory
infections.
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Prevention of infection
Influenza and pneumonia vaccines important
Avoiding exposure to people with respiratory
infections
Deep-breathing exercises
Smoking cessation
Immobility major threat
Caution with self-treatment of respiratory
issues
Review of medications
Consider environmental factors
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Chronic obstructive pulmonary disease: group
of diseases; higher in women and smokers
◦ Asthma
◦ Chronic bronchitis
◦ Emphysema
◦ Lung cancer
◦ Lung abscess
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Can develop in older years
High risk of complications of bronchiectasis,
cardiac problems
High rates of mortality
Assess for causative factors and educate
patient
Evaluate aerosol nebulizers’ use
Precaution: avoid adverse drug effects
Older adults who have asthma should be aware
of which potential side effect of
sympathomimetic bronchodilating nebulized
drugs?
a. Respiratory infection
b. Cardiac arrhythmias
c. Elevated serum potassium
d. Peptic ulcer
b.
Cardiac arrhythmias
Overuse of sympathomimetic
bronchodilating nebulizers creates a risk
of cardiac arrhythmias leading to sudden
death.
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Causes persistent, productive cough;
wheezing; recurrent respiratory infections;
shortness of breath
Management of chronic bronchitis
◦ Remove bronchial secretions
◦ Prevent obstruction of airway
◦ Maintain adequate fluid intake
◦ Expectorate secretions
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Increasing incidence in older adults
Causes: chronic bronchitis, chronic irritation,
and morphologic changes in the lung
Cigarette smoking major role in development
Symptoms develop slowly; may resemble agerelated changes; can delay diagnosis, treatment
Treatment
◦ Postural drainage, bronchodilators, avoid
stress, and breathing exercises
◦ Smoking cessation
Education and support
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Increasing incidence in 65 years and older
Higher incidence in men than in women
Incidence and mortality rate varies in ethnic
groups
Incidence in smokers twice as nonsmokers
Symptoms: dyspnea, coughing, chest pain,
fatigue, anorexia, wheezing, and respiratory
infections
Diagnosis: CT scan, bronchoscopy, sputum
cytology, and biopsy
Treatment: surgery, chemotherapy, and
radiotherapy
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Causes: pneumonia, tuberculosis, malignancy,
trauma, and aspiration
Symptoms: anorexia, weight loss, elevated
temperature, and chronic cough
Diagnosis: same as other age groups
Treatment: postural drainage; high-protein,
high-calorie diet
Which of the following potential age-related
changes may result in a lung abscess from
aspiration of foreign material?
a. Decreased elastic recoil of the lungs
b. Increase in residual volume of the lung
c. Decreased pharyngeal reflexes
d. Increased elasticity of the alveoli
c. Decreased pharyngeal reflexes
Lung abscess may result from pneumonia,
tuberculosis, malignancy, or trauma to
the lung. In addition, aspiration of
foreign material can also cause a lung
abscess, which is a risk to older adults
who have decreased pharyngeal reflexes.
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Recognizing symptoms
Prompt medical attention with signs of
respiratory infection
Atypical presentation
◦ No chest pain
◦ Lower body temperature
Changes in character of sputum
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Monitor closely to minimize disability and
prevent mortality
Assess to detect respiratory complications
◦ Respiratory rate and volume; pulse; blood
pressure; temperature; neck veins; patency
of airway; cough; secretions; mental status
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Prudent use of oxygen
◦ Carbon dioxide narcosis
◦ Monitor blood gases
Assessment of oxygen equipment: gauge at
prescribed level, oxygen flow
Home oxygen safety
Evaluate home environment
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Used to remove bronchial secretions
Aerosol medications used prior to procedure
Consider positioning based on individual
patient’s abilities
Discontinue if dyspnea, palpitations, chest
pain, apprehension, or other signs of distress
occur
Oral hygiene and rest after procedure
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Coughing is important in removal of
secretions
Nonproductive coughing is useless and
stressful
Measures to promote productive cough
◦ Hard candy to increase secretions
◦ Breathing exercises
◦ Use of humidifier
◦ Expectorants
◦ Increase fluid intake
Good handwashing and oral hygiene essential
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Some herbs affect respiratory health
Aromatherapy may prove helpful
Assess for interactions with other
medications
Hot, spicy foods open airways
Avoid mucus-forming foods
Some vitamins beneficial
Acupuncture, acupressure, yoga, Rolfing, and
massage
Yoga, as a complementary therapy in the
treatment of respiratory conditions, acts to
a. Relax the diaphragm and promote
breathing
b. Increase deep breathing and tissue
oxygenation
c. Decrease the potential for apnea
d. Improve elastic recoil in the lung
b.
Increase deep breathing and tissue
oxygenation
The practice of yoga can promote deep
breathing and good oxygenation of
tissues.
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Assess patient’s ability to use nebulizers
correctly
Proper use and operation of ventilators
◦ Attention to physical, emotional, and social
needs of ventilator-dependent patients
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Respiratory problems: frightening and
produce anxiety
Need for psychological support and
reassurance
Understanding of disease process and
management
Encouragement to meet demands of chronic
disease