Week 9: Respiratory Function

Question 1

Age-related changes that affect respiratory function:

Upper Respiratory Structures

Answer 1

• degenerative structural changes in the nose
• diminished blood flow to the nose
• thicker mucus in the nasopharynx. due to degenerative changes in the submucusal glands
• stiffening of the trachea d/t calcification of cartiladge
• blunted cough and laryngeal reflexes
• atrophy of the nerve endings

Question 2

Age-related changes that affect resp. function:

Chet wall and musculoskeletal structures

Answer 2

• ribs and vertebrae become osteoporotic so higher chance of rib fractures
• intercostal cartilage calcifies and the respiratoy muscles weaken
• kyphosis (increased curvature of the spine)
• chest wall expansion is compromised and older adults ned to expend more energy to achieve respiratory efficiency

Question 3

Age-related changes:

lung structure and function

Answer 3

• lungs become smaller and more fatty
• Ductectasia: alveoli enlarge and their walls become thinner, resulting in gradual increase in the amount of anatomic dead space
• pulmonary artery becomes wider, thicker, and less elastic
• the number of capillaries diminishes
• the capillary blood volume decreases
• the mucosal bed where diffusion occurs thickens

Question 4

Age-related changes:

gas exchange

Answer 4

• gas exchange is compromised in the lower lung regions and inspired air is preferentially distributed in the upper regions
• normally, compensatory changes in resp rate are made under conditions of hypercapnia (high CO2) or hypoxia (low O2)
• age related changes reduce the ventilatory response to both hypercapnia and hypoxia
• changes to T-cells (the component of immunity most responsible for protecting against infections and malignancy) are a major factor in contributing to increased prevalence of lung disease

Question 5

A summary of age-related changes to the respiratory system:

Answer 5

• increased stiffness of chest wall
• enlarged aveoli
• weaker resp muscles
• decreased response to hypercapnia and hypoxia

Question 6

Risk Factors that affect resp function

Answer 6

• tobacco smoking
• environmental pollutants
• occupational exposure to resp toxins (ex. asbestos)
• obesity or chronic illness that interfere with the ability to obtain adequate physical activity
• kyphosis
• medications (ex. anticholegeric meds causes drying of upper airway-> ACE inhibitors can cause persistent cough

Question 7

Functional Consequences affecting respiratory wellness

Answer 7

• increased suseptibily to lower resp infections
• pneumonia & influenza (the 8th leading cause of death among 64-84 yr olds, 6th leading cause for 85+)
• frailty, dysphagia, and reduced functional status contribute
• poor oral care is a contributing factor is hospitals and residential care
• increased suseptiblity to TB d/t weaker immune systems, TB infection rate higher in Aboriginal/foreign-born/certain racial minorities, higher incidence in LTC likely r/t virulence and more subtle disease manifestation in older adults
• dyspnea & fatigue (resp systems are less efficient in gas exchange)
• aspiration pneumonia (most commonly related to dysphagia, which affects 25% of healthy adults and more than 50% of nursing home residents)

Question 8

3 Pathologic conditions affecting resp function:

Answer 8

Pneumonia

TB

COPD

Question 9

Pneumonia

def

Answer 9

def: an infection in one or both lungs which causes the alveoli to fill with fluid or pus, making breathing difficult

Question 10

Pneumonia

risk factors

Answer 10

• age
• recent upper resp illness
• asthma/COPD/CHF/other chronic diseases
• smoking
• weakened/suppressed immune system
• tube feeding, malnutrition, dehydration, decreased LOC, decreased cough reflex, reduced salivary flow

Question 11

Pneumonia

symptoms

Answer 11

normal adult:

• cough
• fever
• purulent sputum
• SOB
• fatigue
• chest tightness/pain

older adults:

• acute delirium/ confusion
• dizziness
• lower than normal body temperature
• temp= can either have cold or warm sepsis with T<36C)

Question 12

Pneumonia

treatment

Answer 12

• antipyretics for fever (acetaminophen or ibuprofen)
• antibiotics (bacterial or viral)
• bronchodilators if wheezes present
• oxygen therapy if needed
• deep breathing and coughing

Question 13

Tuberculosis

def

Answer 13

a bacterial infection (caused by the Mycobacterium Tuberculosis) that most commonly affects the lungs

Question 14

Is TB curable and preventable?

Answer 14

Yes

Question 15

How is TB spread?

Answer 15

person-to-person through aerosolized droplets / saliva droplets expelled when coughing

• need minimal exposure to become infected
• often occurs in Northern American older adults d/t reactivation of dormant disease, therefore, nurses need to know their older adults’ past medical history
• TB can be latent or active. Body detects invasion and sends macrophages to neutralize them into latent TB.
• latent TB can become active months or years later and spread to other body systems. The immune system can become overwhelmed and become infected.
• 1/3 of the world is infected

Question 16

TB

risk factors

Answer 16

• people who have been recently exposed to someone with active TB
• people who have come from a country where TB is an epidemic
• people with weakened immune systems related to chronic disease or high-risk behaviour: ex - HIV+, malnourished, cancer pts, homeless and IV drug users, those on immunosuppressive drugs
• TB rate is higher in Aboriginal, foreign-born, and certain racial minorities
• higher incidence of TB in LTC residences likely r/t virulence and altered/more subtle disease manifestation in older adults

Question 17

TB

symptoms

Answer 17

• persistent coughing that lasts three or more weeks
• chest pain with breathing and coughing
• fatigue
• fever
• night sweats
• chills

unintentional weight loss

Question 18

TB

treatment

Answer 18

-2-4 daily PO meds x6-12 months depending on whether or not TB is a drug-resistant strain

-meds: 
Isoniazid
Rifampin (Rifadin, Rimactane)
Ethambutol (Myambutol)
Pyranzinamide

-2 week isolation on droplet precautions after start of adequate therapy and until 3 negative sputum test for AFB (Acid-fast bacilli)

Question 19

COPD

def of 2 types

Answer 19

2 types:

• Chronic bronchitis (affecting bronchi)
• Emphysema (chronic progressive lung disease caused by SOB from over-inflated alveoli / damaged lung tissue involved in gas exchange of O2/COO2)
• characterized by chronic airflow obstruction that interferes with normal breathing
• 4th leading cause of death in Canada in older adults with 80-90% of those deaths caused by smoking

Question 20

COPD

risk factors for developing COPD

Answer 20

• smoking (primary cause)
• exposure to secondhand smoke and other air pollutants
• increased age
• genetic predispositions
• low socioeconomic status
• history of significant childhood respiratory disease

Question 21

COPD

symptoms

Answer 21

• chronic productive cough worsening dyspnea, especially with exertion
• wheezing and chronic sputum production
• barrel-chest over time d/t trapped air in the lungs
• chest tightness
• fatigue
• cyanosis of the fingernail bed and lips
• women reported most severe symptoms than men, but men’s mortality rates r/t COPD are higher
• disease is progressive and cumulative (it gets worse over time)

Question 22

COPD

treatment

Answer 22

• bronchodilators (nebulized, meter-dosed inhalers (MDI’s))
• inhaled steroids (nebulized or MDI)
• combination inhalers
• pulse-dosed oral steroids (in exacerbations of COPD only)
• Continuous or intermittent O2 therapy (in later stages)

Question 23

Nursing Assessment of Resp function in older adults

Answer 23

Objective data: chest auscultation, RR, SPO2 (with or without oxygen), cough (productive or nonproductive) and sputum appearance, medications

-subjective data: chest pain, medical hx, SOB (with or without exertion)

Question 24

Opportunities for health promotion:

(x6)

*pic to finish

Answer 24

1. Immunizations
   - 1.1 Pneumococcal: *
   - 1.2 Influenza: annual, with 2-3 week delay after admin before immunity achieved, duration of effectiveness approx 6 months, free for seniors over 65 yrs
2. Preventing Resp Infections
3. 1 proper handwashing, avoid hand-to-mouth or hand-to-eye contact, avoid inhaling air that has been contaminated with particles from an infected person
4. Smoking cessation programs
5. Avoiding second-hand smoke, dust, other environmental irritants
6. Ensuring both compliance and proper use of inhaled medications
7. Advocating for home O2 therapy in appropriate cases

Question 25

Nursing Interventions:

Answer 25

*pic