CH 16: Respiratory Changes

Question 1

respiratory effects of aging

Answer 1

-Connective tissue changes to the nose
-Reduced secretions in the submucosal gland
-Calcification of the trachea cartilage
-Reduction in size and weight of the lungs
–Decreased elastic recoil of the lungs during expiration
–Reduced elasticity of the alveoli
–Loss of skeletal muscle strength controlling the diaphragm
-Lose and brittle teeth may be aspirated
-Reduced cough and gag reflex
-Decreased gastric motility
-Immobility

Question 2

assessment of respiratory function

Answer 2

Skin color for face, ears, neck, fingers, toes, nose
Chest Structure and Posture
Breathing Pattern
Cough

Question 3

skin color respiratory assessment

Answer 3

-Pink and Ruddy – Emphysema and Hypoxia related to high carbon dioxide levels in the blood
-Bluish or Gray coloration due to from lack of oxygen binding to the hemoglobin

Question 4

chest structure and posture respiratory assessment

Answer 4

Anterior – Posterior diameter increase – barrel chest (COPD)
Kyphosis -hunchback - decreased diaphragm strength - diaphragm
Lordosis - sway back - an abnormal inward curvature of the lumbar spine -
Scoliosis - a sideways curvature of the spine - lung expansion

Question 5

breathing pattern respiratory assessment

Answer 5

Needing to sit in the tripod position to breathe
Use of accessory muscles to breathe
Pulse oximetry readings less than 92

Question 6

cough in respiratory assessment

Answer 6

Note the presence, frequency, and characteristics of any cough that you may observe

Question 7

respiratory health promotion

Answer 7

-influenza and pneumonia vaccines
-smoking cessation
-preventing immobility
-advised against treating respiratory problems themselves
-environmental factors
-oral health

Question 8

respiratory conditions

Answer 8

Chronic Obstructive Pulmonary Disease (COPD)
-Asthma
-Chronic bronchitis
-Emphysema
Pneumonia
Influenza
Lung Cancer
Lung Abscess

Question 9

factors of asthma

Answer 9

-can develop in older years
-high risk of complications of bronchiectasis, cardiac problems
-high rates of mortality
-assess for causative factors, triggers and education patient
-evaluate aerosol nebulizers use
-use of sympathomimetics can cause tachyarrythmias - use xopedex (no HR change)
-precaution: avoid adverse drug effects
-use of rescue inhaler

Question 10

Causes persistent, productive cough; wheezing; recurrent respiratory infections; shortness of breath

Answer 10

chronic bronchitis

Question 11

management of chronic bronchitis

Answer 11

-remove bronchial secretions - thick greenish color
-prevent obstruction of airway from inability to remove secretions
-maintain adequate fluid intake
-expectorate secretions
-if worsens - leads to emphysema

Question 12

causes of emphysema

Answer 12

cigarette smoking
chronic bronchitis
chronic irritation from air pollutants
morphologic changes in the lung – destruction of alveoli

Question 13

factors of emphysema

Answer 13

-increasing incidence in older adults
-cigarette smoking major role in development
-symptoms develop slowly, which can delay diagnosis and treatment

Question 14

symptoms of emphysema

Answer 14

gradual dyspnea
chronic cough
hypoxia
fatigue
anorexia
weight loss
weakness

Question 15

treatment of emphysema in older adults

Answer 15

Postural drainage, bronchodilators, avoid stress, and breathing exercises

Question 16

education, nutrition and support for emphysema

Answer 16

Small feedings and high-protein supplements
pace activities
avoid extremely cold weather - bronchospasms
recognizing symptoms of infection

Question 17

leading cause of death in older adults

Answer 17

pneumonia

Question 18

contributing factors for pneumonia

Answer 18

Poor chest expansion
Shallow breathing
High prevalence of respiratory diseases that increase mucus production and bronchial obstructions
Decreased resistance to infection
Aspiration
Reduced mobility and debilitation

Question 19

symptoms of pneumonia

Answer 19

Slight cough
fatigue
tachypnea
confusion
restlessness
pleuritic pain
minimal to no fever

**older adults may no have chest pain like younger populations

Question 20

treatment for pneumonia

Answer 20

pneumococcal vaccines

Question 21

Most frequent cause of serious illness and death in older adults

Answer 21

Influenza A

Question 22

Less severe, but can still produce serious problems for older adults

Answer 22

Influenza B

Question 23

symptoms of influenza

Answer 23

fever
myalgia
sore throat
nonproductive cough

Question 24

effects of influenza on older adults

Answer 24

Destroys ciliated epithelial cells of the respiratory tract
-depresses mucociliary clearance, and can lead to the development of secondary bacterial infections, myositis, pericarditis, encephalitis, and Guillain-Barre Syndrome

Question 25

preventative measures of influenza

Answer 25

Annual Flu Vaccines Reduced contact with individuals who are known or suspected to have the flu

Question 26

occurrence of lung cancer

Answer 26

most occur in patients older than 65 years

Question 27

is lung cancer more common in men or women

Answer 27

higher incidence in men african american smoking

Question 28

symptoms of lung cancer

Answer 28

dyspnea coughing chest pain fatigue anorexia wheezing respiratory infections

Question 29

treatment of lung cancer

Answer 29

surgery chemotherapy radiotherapy

Question 30

diagnosis of lung cancer

Answer 30

-xray -bronchoscopy

Question 31

causes of a lung abscess

Answer 31

pneumonia tuberculosis malignancy trauma aspiration of a foreign object

Question 32

symptoms of lung abscess

Answer 32

anorexia weight loss elevated temp chronic cough

Question 33

diagnosis of lung abscess

Answer 33

same as other age groups -bronchoscopy -chest xray

Question 34

treatment of lung abscess

Answer 34

postural drainage high-protein -high-calorie diet

Question 35

general Nursing Considerations for Respiratory Conditions

Answer 35

-prompt medical attention with signs of respiratory infection -atypical presentation --no chest pain***** --lower body temp -changes in character of sputum -nutritional needs-use of asccessory muscles uses a lot of calories

Question 36

preventing complications of respiratory conditions

Answer 36

Monitor closely to minimize disability and prevent mortality Assess to detect respiratory complications

Question 37

assessing for respiratory complications

Answer 37

Respiratory rate and volume, pulse, blood pressure, temperature, neck veins, patency of airway, cough, secretions, and mental status Look for signs of malnourishment, depression, social isolation Assess functional capacity and ability to perform ADL Allow frequent rest period to reoxygenate

Question 38

ensuring safe oxygen administration

Answer 38

prudent use of oxygen assessment of oxygen equipment home oxygen safety -make sure adequate supply evaluate home environment carbon dioxide narcosis - used to high CO2 and low O2 monitor blood gases

Question 39

characteristics of postural drainage to promote oxygenation

Answer 39

Used to remove bronchial secretions Aerosol medications used prior to procedure Consider positioning based on individual patient’s abilities --Instruct older adults to change positions slowly and to rest for a few minutes in between position changes Discontinue if dyspnea, palpitations, chest pain, diaphoresis, apprehension, or other signs of distress occur Oral hygiene and rest after procedure

Question 40

measures to promote productive cough

Answer 40

Hard candy increase secretions Breathing exercises Use of humidifier Expectorants Increase fluid intake

Question 41

complementary therapies for respiratory conditions

Answer 41

-some herbs affect respiratory health -aromatherapy may prove helpful -assess for interactions with other medications -hot, spicy foods open airways -avoid mucous-forming -nutrition assessment for cachexia -some vitamins are beneficial -acupuncture, acupressure, yoga, tai chi and massage

Question 42

promoting self-care in respiratory conditions

Answer 42

-assess patients ability to use nebulizer correctly -proper use and operation of supplemental oxygen, bi-pap, ventilators --attention to physical, emotional and social needs of ventilator-dependent patients and their caregivers

Question 43

why and how to provide encouragement for individuals with respiratory problems

Answer 43

Respiratory problems: frightening and produce anxiety Need for psychological support and reassurance, especially during periods of dyspnea Understanding of disease process and management Encouragement to meet demands of chronic disease Promptly seek medical attention if any changes in breathing, expectorant, or physical symptoms

Question 44

why should we add protein to the diet of older adults with respiratory disorders

Answer 44

coughing causes pt to lose protein each time