Tabloski ch16 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

The Respiratory System

16

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Define normal changes of aging of the respiratory system.

2. Describe appropriate health promotion and disease prevention guidelines relating to the respiratory system.

3. Discuss the nurse’s role in caring for older persons with respiratory problems.


Learning Objectives

4. Classify common diseases of the respiratory system.

5. Identify the nursing assessment process and formulation of nursing diagnoses relating to the respiratory system.


Introduction

• During a normal day, the average person takes 25,000 breaths and inhales more than 10,000 liters of air.

• The lungs have a series of built-in barriers and defenses to protect function and life; however, with aging and disease, damage to the lungs can occur.


Anatomy and Physiology

• The respiratory system is composed of the lungs, the airways leading to the lungs, the blood vessels serving the lungs, and the chest wall.

• The right lung has three lobes (upper, middle, and lower). To leave space for the heart, the left lung has two lobes (upper and lower).


Anatomy and Physiology

• This coordinated system enables the lung to perform its primary function of rapidly exchanging oxygen from inhaled air with the carbon dioxide in the blood.


Normal Changes of Aging

• The following changes occur in lung structure and function with normal aging:–Stiffening of elastin and the collagen

connective tissue supporting the lungs–Altered alveolar shape resulting in

increased alveolar diameter


Normal Changes of Aging

• The following changes occur in lung structure and function with normal aging:–Decreased alveolar surface area

available for gas exchange– Increased chest wall stiffness–Stiffening of the diaphragm


Respiratory Diseases Common in Older People

• Age-related changes in the lungs, years of exposure to air pollutants and cigarette smoke, and presence of comorbidities may predispose the older person to respiratory diseases and pulmonary dysfunction.


Changes in Neurologic, Neuromuscular, and Sensory Functions

• Aging results in neuron loss in the brain and central nervous system

• Changes that can affect pulmonary function



• Loss of muscle tone, exacerbated by deconditioning, obesity, and sedentary lifestyle

• Increased thoracic rigidity and osteoporotic changes to the spine (kyphosis)



• Use of medications that can cause fatigue, depression of the cough reflex, insomnia, dehydration, and bronchospasm such as opioids, diuretics, and beta-blockers

• Diagnosis of neurologic disease or impairment (dementia, Parkinson’s disease, stroke/ cerebrovascular accident)


Common Respiratory Diseases

• Asthma• Chronic Obstructive Pulmonary Disease

(COPD)• Tuberculosis• Lung cancer


Types of Respiratory Infections

• Pneumonia• Acute bronchitis• Pulmonary embolism• Sinusitis• Rhinitis• Severe Acute Respiratory Syndrome

(SARS)• Influenza


Asthma

• The gerontological nurse can greatly improve the asthma management plan by teaching the older patient and family members about the peak flow meter and diary so that asthma attacks can be minimized or avoided.


Chronic Obstructive Pulmonary Disease

• The nurse should investigate community resources and availability of smoking cessation support groups.



• Managing patients with COPD focuses on the following broad goals:–Careful assessment and monitoring of

the treatment of the disease–Reducing risk factors (cigarette smoking

and environmental pollutants)–Managing stable COPD and preventing

disease progression



• Managing patients with COPD focuses on the following broad goals:–Assessing and managing anxiety and

depression–Mucolytic therapy–Rehabilitation–Managing exacerbations


Respiratory Infections

• Infections are a major cause of respiratory illness.

• The gerontological nurse must be cognizant of the atypical presentation of respiratory infection in the older person.



• Infections of the lower respiratory tract are the sixth leading cause of death in the United States and the fourth leading cause of death in Americans over the age of 65.


Lung Cancer

• The symptoms of lung cancer are vague and mimic the symptoms of other pulmonary illness, making diagnosis difficult.


Lung Cancer

• Chronic cough, chest pain, shortness of breath, fatigue, weight loss, and frequent lung infections such as pneumonia and bronchitis that do not resolve with antibiotic treatment could all be warning signs that indicate the older person should be referred to the primary care provider for further testing.


Changes in Immune Function

• For older people, the overall decline in immune function results in increased susceptibility to tuberculosis, pneumonia, and influenza.



• When the gerontological nurse suspects pneumonia, health assessment should include checking vital signs, inspecting the thorax, and auscultating the lungs.

• The primary care provider probably will request a chest X-ray.


Pulmonary Embolism

• Risk factors for formation of pulmonary embolus include clotting disorders, immobility, dehydration, recent surgery, atherosclerotic changes in the circulatory system, atrial fibrillation, and obesity.

• Patients with leg swelling and duskiness are at risk for pulmonary embolus.


Pulmonary Embolism

• Hypoxemia and hyperventilation are suggestive of the diagnosis of pulmonary embolus.

• The gerontological nurse can play a vital role in the prevention of pulmonary embolus by identifying persons at risk and reducing risk factors.

Tabloski ch16 lecture

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