Transcript lecture 15: ch16 The Respiratory System

16
Lecture Note PowerPoint Presentation
The Respiratory
System
LEARNING OUTCOME 1
Identify normal changes of aging of the respiratory
system.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
RESPIRATORY SYSTEM COMPONENTS
Lungs
 Airways leading to the lungs
 Blood vessels serving the lungs
 Chest wall

Gerontological Nursing, Second Edition
Patricia A. Tabloski
FIGURE 16-1
NORMAL ANATOMY OF THE LUNGS AND AIRWAYS.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
FIGURE 16-2
NORMAL CHANGES OF AGING IN THE RESPIRATORY SYSTEM.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
IMMUNE FUNCTION CHANGES THAT CAN
AFFECT PULMONARY FUNCTION
Decreased production of antibodies after
immunization
 Use of medications that can suppress immune
function

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
CHANGES THAT CAN AFFECT PULMONARY
FUNCTION

Loss of muscle tone
Exacerbated by deconditioning
 Obesity
 Sedentary lifestyle
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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.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
CHANGES THAT CAN AFFECT PULMONARY
FUNCTION

Use of medications that can cause
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Fatigue
Depression of the cough reflex
Insomnia
Dehydration
Bronchospasm
Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 2
Describe appropriate health promotion and disease
prevention guidelines relating to the respiratory system.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
TEACH PATIENTS TO MINIMIZE OR AVOID
ASTHMA ATTACKS
Peak flow meter use
 Avoid allergens and triggers for attacks

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Dust
Animals
Cockroaches
Tobacco smoke
Wood smoke
Strong odors and sprays
Gerontological Nursing, Second Edition
Patricia A. Tabloski
TEACH PATIENTS TO MINIMIZE OR AVOID
ASTHMA ATTACKS

Avoid allergens and triggers for attacks
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Colds and infections
Exercise
Weather
Pollens
Molds
Gerontological Nursing, Second Edition
Patricia A. Tabloski
MONITOR MEDICATIONS PRESCRIBED FOR
RESPIRATORY PROBLEMS
Therapeutic and side effects
 Monitor for interactions with other medications

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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.

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
VACCINATIONS
Pneumococcal vaccine
 Influenza (yearly)

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 3
Discuss the nurse’s role in caring for older persons with
respiratory problems.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
ASTHMA CARE
Assist the patient with spirometry testing
 Educate the patient regarding proper Use
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Metered-dose inhaler
Nebulizer use
Spacer use
Peak flow meter
Care of the respiratory equipment
Gerontological Nursing, Second Edition
Patricia A. Tabloski
MEDICATIONS USED TO TREAT ASTHMA
Inhaled corticosteroid therapy
 Oral corticosteroids
 Cromolyn sodium
 Inhaled beta2-agonists
 Methylxanthine (theophylline)
 Ipratropium bromide

Gerontological Nursing, Second Edition
Patricia A. Tabloski
MEDICATIONS CONTRAINDICATED IN
PATIENTS WITH ASTHMA
Beta-blockers
 Nonsteroidal anti-inflammatory drugs (NSAIDs)
 Diuretics
 Antihistamines
 Angiotensin-converting enzyme (ACE) inhibitors
 Antidepressants

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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
Gerontological Nursing, Second Edition
Patricia A. Tabloski
MEDICATIONS USED TO TREAT COPD

Are similar to those used to treat asthma
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Bronchodilators
Inhaled corticosteroids
Antibiotics
Influenza and pneumococcal vaccines
Expectorants
Other drugs to treat associated symptoms such as
diuretics, analgesics, cough suppressants, and
anxiolytics
Gerontological Nursing, Second Edition
Patricia A. Tabloski
COPD EDUCATION

Additional methods used to help loosen and
remove secretions
Postural drainage
 Chest percussion
 Controlled coughing
 Tracheal suctioning


Smoking cessation
Gerontological Nursing, Second Edition
Patricia A. Tabloski
PHYSICAL ASSESSMENT OF THE PATIENT
WITH COPD

The same as for the patient with asthma
Gerontological Nursing, Second Edition
Patricia A. Tabloski
DIAGNOSIS OF TB

Purified protein derivative (PPD) skin test
Given subdermally
 Area should be measured and recorded in 72 hours

Gerontological Nursing, Second Edition
Patricia A. Tabloski
EDUCATE THE PATIENT WITH
TUBERCULOSIS (TB)
Take their medications at the same time daily
 Prevents the development of resistant
Mycobacterium

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 4
Describe common diseases of the respiratory system.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
ASTHMA DIAGNOSIS IN AN OLDER PERSON
Results of pulmonary function tests
 Chest radiography
 Electrocardiography
 Complete blood count with differential

Gerontological Nursing, Second Edition
Patricia A. Tabloski
FOUR CATEGORIES OF ASTHMA
CLASSIFICATION
Intermittent
 Mild persistent
 Moderate persistent
 Severe
 Criteria

Duration of symptoms
 Presence and severity of nocturnal symptoms
 Results of spirometry

Gerontological Nursing, Second Edition
Patricia A. Tabloski
ASTHMA TREATMENT GOALS
Reduce the frequency and severity of symptoms
 Improve results of spirometry testing

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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
Gerontological Nursing, Second Edition
Patricia A. Tabloski
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
Gerontological Nursing, Second Edition
Patricia A. Tabloski
EMPHYSEMA

Risk factors
Smoking
 Family history

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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
Gerontological Nursing, Second Edition
Patricia A. Tabloski
COPD PATHOPHYSIOLOGY
Blood is poorly oxygenated and tissue perfusion
is less efficient
 Carbon dioxide may accumulate to critical levels

Respiratory acidosis
 Respiratory failure
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Strains the heart
Right ventricle can enlarge and thicken
 Abnormal rhythms called cor pulmonale

Gerontological Nursing, Second Edition
Patricia A. Tabloski
COPD SYMPTOMS

Early
Early morning cough with clear sputum
 Periods of wheezing during or after colds
 Shortness of breath on exertion

Gerontological Nursing, Second Edition
Patricia A. Tabloski
COPD SYMPTOMS

Late
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Mouth breathing
Puffing
Use of accessory muscles of breathing
Inability to finish sentence without catching one’s
breath
Sleep in semi-sitting position
Gerontological Nursing, Second Edition
Patricia A. Tabloski
COPD DIAGNOSIS
Spirometry preferred
 Arterial blood gases (ABGs)


Can be difficult to obtain
Gerontological Nursing, Second Edition
Patricia A. Tabloski
COPD TREATMENT
Oxygen
 Medications

Bronchodilators
 Corticosteroids
 Antibiotics

First sign of infection
 Yellow or green sputum

Gerontological Nursing, Second Edition
Patricia A. Tabloski
COPD TREATMENT

Medications

Other drugs to treat associated symptoms
Diuretics
 Analgesics
 Cough suppressants
 Anxiolytics

Gerontological Nursing, Second Edition
Patricia A. Tabloski
COPD TREATMENT

Other treatments
Bullectomy or lung reduction
 Pulmonary rehabilitation

Exercise
 Oxygen
 Nutritional support


Intermittent mechanical ventilator support

CPAP
Gerontological Nursing, Second Edition
Patricia A. Tabloski
COPD TREATMENT

Other treatments

Relaxation techniques


Breathing techniques
Clearing airway passages
Postural drainage
 Chest percussion
 Controlled coughing
 Tracheal suctioning

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
TB IN OLDER PERSONS
Can be a reactivation of old disease
 Can be a new infection due to exposure to an
infected individual

Gerontological Nursing, Second Edition
Patricia A. Tabloski
TB RISK FACTORS
Living in an institution
 Diabetes mellitus
 Use of immunosuppressive drugs
 Malignancy
 Malnutrition
 Renal failure

Gerontological Nursing, Second Edition
Patricia A. Tabloski
TB DIAGNOSIS
Skin test (PPD)
 Chest X-ray

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LUNG CANCER

Responsible for almost one third of all cancer
deaths in the United States
Gerontological Nursing, Second Edition
Patricia A. Tabloski
LUNG CANCER

At least 12 different types of tumors are included
in the broad heading of lung cancer
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Squamous cell
Adenocarcinomas
Large cell carcinomas
Small cell carcinomas (“oat cell”)
Growth rate and metastasis rate vary by tumor type
Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LUNG CANCER DIAGNOSIS
CT scan
 MRI scan
 Pulmonary function tests
 Bronchoscopy with collection of lung tissue, cells,
or fluids for analysis

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LUNG CANCER TREATMENT
Surgical removal of the tumor or lung
 Chemotherapy
 Radiation
 Palliative care

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
UPPER RESPIRATORY INFECTIONS

Most require no treatment
Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
PNEUMONIA

Most common type of infectious disease of the
lung
Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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.

Gerontological Nursing, Second Edition
Patricia A. Tabloski
PNEUMONIA PATHOGENS
Streptococcus pneumonia
 Haemophilus influenza
 Staphylococcus aureus
 Enterobacteriaceae

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
PNEUMONIA ASSESSMENT
Assess vital signs
 Inspect the thorax
 Auscultate the lungs
 Assess the skin for cyanosis

Gerontological Nursing, Second Edition
Patricia A. Tabloski
PNEUMONIA DIAGNOSTIC TESTS
Chest X-ray
 Blood culture
 Sputum specimen
 Pulse oximetry
 Blood chemistry analysis

Gerontological Nursing, Second Edition
Patricia A. Tabloski
PNEUMONIA TREATMENT
Antibiotic therapy
 Chest percussion
 Inhaled beta-adrenergic agonists
 Oxygen
 Rehydration

Gerontological Nursing, Second Edition
Patricia A. Tabloski
PNEUMOCOCCAL VACCINATION
Recommended for older persons over age 65, atrisk 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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
ACUTE BRONCHITIS

Treatment
Rest
 Air humidification
 Use of cough suppressant
 Acetaminophen

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
PULMONARY EMBOLISM RISK FACTORS
Clotting disorders
 Immobility
 Dehydration
 Recent surgery
 Atherosclerotic changes in the circulatory system
 Obesity

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 5
Identify the nursing assessment process and formulation
of nursing diagnoses relating to the respiratory system.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
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

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES FOR PULMONARY
EMBOLISM
Ineffective Breathing Patterns, Risk for
Suffocation
 Activity Intolerance

Gerontological Nursing, Second Edition
Patricia A. Tabloski