Chapter 25 Respiratory Conditions

Effect of Aging on the Respiratory System Reduction in vital capacity and an increase in residual volume –Less air exchange and more air and secretions remaining in the lungs. Drier mucous Lung abscesses, infections, and the aspiration of tooth fragments. Relaxed sphincters and slower gastric motility

Measures to Improve Indoor Air Install air filters in heating and air conditioning systems. Vacuum regularly. Damp-dust furnishings. Discourage cigarette smoking. Open windows to air out rooms. Maintain green houseplants to help detoxify the air.

Facilitating Respiratory Health Include measures to prevent respiratory infections in every care plan. Promote deep breathing exercises Avoid smoking Avoid immobility Advise older adults not to treat symptoms of respiratory infection independently

Facilitating Respiratory Health (cont.) Discuss the impact of drugs on respiration Review environmental factors that can influence respiratory health. Promote health of the oral cavity.

Asthma Can be a lifelong problem or develop in old age. Can create cardiac problems due to the extra stress it places on the heart. Elders need to identify causative and contributing factors and aid in their reduction. Risks with sympathomimetic bronchodilating nebulizers should be explained to elders.

Symptoms of Chronic Bronchitis Persistent, productive cough Wheezing Recurrent respiratory infections Shortness of breath

Management of Chronic Bronchitis Remove bronchial secretions and prevent obstruction of the airway –Maintain good fluid intake and expectorate secretions. Avoid chronic respiratory irritation –E.g., smoking. Help older adults prevent respiratory infections

Factors Contributing to Emphysema Chronic bronchitis Chronic irritation from dusts or certain air pollutants Morphologic changes in the lungs –Distention of the alveolar sacs, rupture of the alveolar walls, and destruction of the alveolar capillary bed Cigarette smoking

Symptoms of Emphysema Symptoms are slow in onset; may cause delayed treatment. –Increased dyspnea not relieved by sitting upright. –Chronic cough –Hypoxia, fatigue, anorexia, weight loss, and weakness –Recurrent respiratory infections –Malnutrition, congestive heart failure, and cardiac arrhythmias

Measures to Treat Emphysema Postural drainage Bronchodilators Avoidance of stressful situations Breathing exercises Stopping cigarette smoking

Factors Contributing to the Development of Lung Cancer Chronic exposure to: –Cigarette smoke –Asbestos –Coal gas –Radioactive dusts –Chromates

Symptoms of Lung Cancer Dyspnea Coughing Chest pain Fatigue Anorexia Wheezing Recurrent upper respiratory infections

Diagnosis and Treatment of Lung Cancer Diagnosis: –Confirmed through chest roentgenogram, sputum cytology, bronchoscopy, and biopsy. Treatment: –Surgery –Chemotherapy –Radiotherapy

Causes of Lung Abscess Pneumonia Tuberculosis A malignancy Trauma to the lung Aspiration of foreign material

Symptoms of Lung Abscess Anorexia Weight loss Fatigue Temperature elevation Chronic cough Sputum production may occur, but this is not always demonstrated in older persons.

Preventing Respiratory Complications Assess vital signs. Use oxygen safely. –Keep flow at prescribed level. –Prevent kinking or blockage of tube. Use modified procedure for postural drainage for older adults. Use measures to promote removal of secretions.

Nursing Observations Respiratory rate and volume Pulse Blood pressure Temperature Neck veins Patency of airway

Nursing Observations (cont.) Coughing (frequency, depth, productiveness) Quality of secretions Mental status

Complimentary Therapies Herbs with mucus-secreting effects and expectorant effects Aromatherapy with eucalyptus, pine, and lavender Hot, spicy foods to open air passages Dietary supplements including zinc, proteolytic enzymes, and vitamins A, C, E, and B6 Acupuncture and acupressure Yoga

Promoting Self-Care Assess patient’s ability to use nebulizers properly. Assess the ability of caregivers in other settings to properly provide care. Encourage older adults to obtain pneumococcal and influenza vaccines. Be aware of the psychosocial implications of respiratory conditions.

Source Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN ).