9. Respiratory

Question 1

Age-related changes

Answer 1

Upper resp. structures:

• diminished blood flow to nose
• thicker mucus in the nasopharynx dt degenerative changes in the submucosal glands
• stiffening of trachea dt calcification of cartilage
• blunted cough and laryngeal reflexes
• atrophy of the nerve endings

Chest wall:

• ribs and vertebrae become osteoporotic= risk of fracture
• intercostal cartilage calcifies and resp. muscles weaken
• kyphosis - increased curvature of spine
• chest wall expansion is compromised and older adults need to expend more energy to achieve resp. efficiency

Lung structure and function:

• lungs get smaller and fatty
• Ductectasia(alveoli enlarge and their walls become thinner= increase in the amount of anatomic dead space)
• pulmonary artery becomes wider, thicker, less elastic
• number of capillaries decreases
• capillary blood volume decreases
• mucosal bed, where diffusion occurs, thickens
• gas exchange is compromised in lower lung and inspired air is preferentially distributed in the upper lungs
• normal ventilatory responses to conditions like hypercapnia (high CO2) or hypoxia (low O2) are reduced
• changes to T-cells are a major factor contributing to increased prevalence of lung disease (t-cells protect against infections)

Question 2

Risk factors

Answer 2

• Smoking/pollutants
• obesity or chronic illness that interfere with ability to obtain adequate PA (which is necessary to optimize resp. function)
• medications ex anticholigeric that cause drying of upper airway; ACE inhibitors can cause persistent cough

Question 3

Functional consequences

affecting resp. wellness

Answer 3

• susceptibility to lower resp. infections
• pneumonia and influenza= most common cause of death
• aspiration pneumonia
• frailty, dysphagia, serious illness and reduced functional status
• poor oral care
• susceptibility to TB

Question 4

3 Pathologic conditions

affecting resp. function

Answer 4

1. Pneumonia
   -alveoli fill with fluid and make breathing difficult
   Risk factors:
   -age,
   -recent upper resp. illness,
   -asthma, COPD, CHF,
   -smoking,
   -weakened immune system
   Symptoms:
   -cough,
   -fever (warm or cold sepsis)
   -purluent sputum,
   -SOB,
   -fatigue,
   -chest tightness/pain,
   -acute delirium,
   -dizziness,
   -lower than normal body temp
   Treatment:
   -antibiotics
   or
   -antipyretics- for fever ex acetaminophen, ibuprofen
   -bronchodilators if wheezes
   -oxygen therapy prn
   -deep breathing and coughing
2. TB
   -bacterial infection
   -curable and preventable
   -spread person-person through aerosolized droplets
   -often occurs in North American older adults dt reactivation of dormant TB
   -body detects invasion and sends macrophages to neutralize them = latent TB
   Risk Factors:
   -recent exposure to active TB
   -from a country where TB is an epidemic
   -weakened immune systems rt chronic disease ex:
   -HIV+
   -malnourished
   -cancer pt
   -homeless and IV drug user
   -on immunosuppressive drugs
   Symptoms:
   -persistent cough 3+ weeks
   -coughing up blood
   -chest pain with coughing
   -unintentional weight loss
   -fatigue
   -fever
   -night sweats
   -chills
   Treatment:
   -2-4 daily PO meds 6-12 months
   -isolation on droplet precautions 2 weeks until 3 negative sputum for Acid Fast Bacilli tests
3. COPD
   -chronic (affecting bronchi)
   or
   -emphysema (chronic progressive lung disease causing SOB from over-inflated alveoli/damaged lung tissue involved of gas exchange)
   -characterized by chronic airflow obstruction that interferes with normal breathing
   -progressive= gets worse over time
   Risk Factors:
   -smoking/airpollutants
   -age
   -genetic predisposition
   -low socioeconomic status
   -hx of childhood resp. disease
   Symptoms:
   -chronic productive cough
   -wheezing
   -barrel-chest over time dt trapped air in lungs
   -chest tightness
   -fatigue
   cyanosis of fingernal bed and lips
   -women report more severe symptoms but men’s mortality rate is higher
   Treatment:
   -bronchodilators (nebulized, meter-dosed inhalers)
   -inhsled steroids (nebulized or MDI)
   -combination inhalers
   -pulse-dosed oral steriods(in exacerbations of COPD only)
   -continuous or intermittent O2 therapy (in later stages)

Question 5

Assessment

of resp. function

Answer 5

Objective data:

• chest auscultation
• RR
• SpO2
• cough-productive or not
• sputum characteristics
• medications

Subjective:

• chest pain
• medical hx
• hx of exposure to smoking or environmental toxins
• SOB with or without exertion

note: focus on health promotion, smoking behavior, and detecting lower resp. tract infections

Question 6

Health Promotion

Answer 6

Immunizations:

• pneumococcal
• influenza

Preventing resp. infections:

• hand washing
• avoid hand-mouth/eye
• avoid inhaling air from an infected person

Smoking cessation/2nd hand/air pollutants

Ensure proper use of inhaled meds

Advocate for home O2 therapy when appropriate