Chapter 25Respiratory Conditions

Chapter 25Respiratory Conditions

Effect of Aging on the Respiratory SystemEffect 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 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 HealthFacilitating 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.)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.

AsthmaAsthma

• 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 BronchitisSymptoms of Chronic Bronchitis

• Persistent, productive cough

• Wheezing

• Recurrent respiratory infections

• Shortness of breath

Management of Chronic BronchitisManagement 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 EmphysemaFactors 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 EmphysemaSymptoms 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 EmphysemaMeasures to Treat Emphysema

• Postural drainage

• Bronchodilators

• Avoidance of stressful situations

• Breathing exercises

• Stopping cigarette smoking

Factors Contributing to the Development of Lung CancerFactors Contributing to the Development of Lung Cancer

• Chronic exposure to:

– Cigarette smoke

– Asbestos

– Coal gas

– Radioactive dusts

– Chromates

Symptoms of Lung CancerSymptoms of Lung Cancer

• Dyspnea

• Coughing

• Chest pain

• Fatigue

• Anorexia

• Wheezing

• Recurrent upper respiratory infections

Diagnosis and Treatment of Lung CancerDiagnosis and Treatment of Lung Cancer

• Diagnosis:

– Confirmed through chest roentgenogram, sputum cytology, bronchoscopy, and biopsy.

• Treatment:

– Surgery

– Chemotherapy

– Radiotherapy

Causes of Lung AbscessCauses of Lung Abscess

• Pneumonia

• Tuberculosis

• A malignancy

• Trauma to the lung

• Aspiration of foreign material

Symptoms of Lung AbscessSymptoms 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 ComplicationsPreventing 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 ObservationsNursing Observations

• Respiratory rate and volume

• Pulse

• Blood pressure

• Temperature

• Neck veins

• Patency of airway

Nursing Observations (cont.)Nursing Observations (cont.)

• Coughing (frequency, depth, productiveness)

• Quality of secretions

• Mental status

Complimentary TherapiesComplimentary 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-CarePromoting 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.

SourceSource

Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).