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Transcript of 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.
Gerontological Nursing, Second EditionPatricia A. Tabloski
RESPIRATORY SYSTEM COMPONENTS
Lungs Airways leading to the lungs Blood vessels serving the lungs Chest wall
Gerontological Nursing, Second EditionPatricia A. Tabloski
FIGURE 16-1NORMAL ANATOMY OF THE LUNGS AND AIRWAYS.
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
FIGURE 16-2NORMAL CHANGES OF AGING IN THE RESPIRATORY SYSTEM.
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
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.
Gerontological Nursing, Second EditionPatricia A. Tabloski
CHANGES THAT CAN AFFECT PULMONARY FUNCTION
Use of medications that can cause Fatigue Depression of the cough reflex Insomnia Dehydration Bronchospasm
Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 2Describe appropriate health promotion and disease
prevention guidelines relating to the respiratory system.
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
TEACH PATIENTS TO MINIMIZE OR AVOID ASTHMA ATTACKS
Avoid allergens and triggers for attacks Colds and infections Exercise Weather Pollens Molds
Gerontological Nursing, Second EditionPatricia A. Tabloski
MONITOR MEDICATIONS PRESCRIBED FOR RESPIRATORY PROBLEMS
Therapeutic and side effects Monitor for interactions with other
medications
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
VACCINATIONS
Pneumococcal vaccine Influenza (yearly)
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
LEARNING OUTCOME 3Discuss the nurse’s role in caring for older persons
with respiratory problems.
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
MEDICATIONS USED TO TREAT ASTHMA
Inhaled corticosteroid therapy Oral corticosteroids Cromolyn sodium Inhaled beta2-agonists Methylxanthine (theophylline) Ipratropium bromide
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
PHYSICAL ASSESSMENT OF THE PATIENT WITH COPD
The same as for the patient with asthma
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
LEARNING OUTCOME 4Describe common diseases of the respiratory
system.
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
ASTHMA DIAGNOSIS IN AN OLDER PERSON
Results of pulmonary function tests Chest radiography Electrocardiography Complete blood count with differential
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
ASTHMA TREATMENT GOALS
Reduce the frequency and severity of symptoms
Improve results of spirometry testing
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
EMPHYSEMA
Risk factors Smoking Family history
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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
Strains the heart Right ventricle can enlarge and thicken Abnormal rhythms called cor pulmonale
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
COPD DIAGNOSIS
Spirometry preferred Arterial blood gases (ABGs)
Can be difficult to obtain
Gerontological Nursing, Second EditionPatricia A. Tabloski
COPD TREATMENT
Oxygen Medications
Bronchodilators Corticosteroids Antibiotics
First sign of infection Yellow or green sputum
Gerontological Nursing, Second EditionPatricia A. Tabloski
COPD TREATMENT
Medications Other drugs to treat associated symptoms
Diuretics Analgesics Cough suppressants Anxiolytics
Gerontological Nursing, Second EditionPatricia A. Tabloski
COPD TREATMENT
Other treatments Bullectomy or lung reduction Pulmonary rehabilitation
Exercise Oxygen Nutritional support
Intermittent mechanical ventilator support CPAP
Gerontological Nursing, Second EditionPatricia A. Tabloski
COPD TREATMENT
Other treatments Relaxation techniques
Breathing techniques Clearing airway passages
Postural drainage Chest percussion Controlled coughing Tracheal suctioning
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
TB RISK FACTORS
Living in an institution Diabetes mellitus Use of immunosuppressive drugs Malignancy Malnutrition Renal failure
Gerontological Nursing, Second EditionPatricia A. Tabloski
TB DIAGNOSIS
Skin test (PPD) Chest X-ray
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
LUNG CANCER
Responsible for almost one third of all cancer deaths in the United States
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
LUNG CANCER TREATMENT
Surgical removal of the tumor or lung Chemotherapy Radiation Palliative care
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
UPPER RESPIRATORY INFECTIONS
Most require no treatment
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
PNEUMONIA
Most common type of infectious disease of the lung
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
PNEUMONIA PATHOGENS
Streptococcus pneumonia Haemophilus influenza Staphylococcus aureus Enterobacteriaceae
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
PNEUMONIA ASSESSMENT
Assess vital signs Inspect the thorax Auscultate the lungs Assess the skin for cyanosis
Gerontological Nursing, Second EditionPatricia A. Tabloski
PNEUMONIA DIAGNOSTIC TESTS
Chest X-ray Blood culture Sputum specimen Pulse oximetry Blood chemistry analysis
Gerontological Nursing, Second EditionPatricia A. Tabloski
PNEUMONIA TREATMENT
Antibiotic therapy Chest percussion Inhaled beta-adrenergic agonists Oxygen Rehydration
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
ACUTE BRONCHITIS
Treatment Rest Air humidification Use of cough suppressant Acetaminophen
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
PULMONARY EMBOLISM RISK FACTORS
Clotting disorders Immobility Dehydration Recent surgery Atherosclerotic changes in the circulatory
system Obesity
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia A. Tabloski
LEARNING OUTCOME 5Identify the nursing assessment process and
formulation of nursing diagnoses relating to the respiratory system.
Gerontological Nursing, Second EditionPatricia 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 EditionPatricia 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 EditionPatricia 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 EditionPatricia 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 EditionPatricia 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 EditionPatricia 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 EditionPatricia A. Tabloski
NURSING DIAGNOSES FOR PULMONARY EMBOLISM
Ineffective Breathing Patterns, Risk for Suffocation
Activity Intolerance