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Chronic obstructive pulmonary disease (COPD): group of diseases including asthma, chronic bronchitis, and emphysema Kyphosis: curvature of the spine Elastic recoil: lungs’ ability to expand and contract Total lung capacity: maximum volume that lungs can expand during fullest inspiration Vital capacity: maximum amount of air that can be expelled following maximum inspiration Respiratory health vital for physically, mentally, and socially active life Lifetime of insults to respiratory system takes its toll during older age Respiratory diseases leading to cause of disability; fourth leading cause of death Positive health practices promote effective breathing Respiratory problems develop easily; difficult to manage Changes occur in upper airway paths, nose, and trachea Reduce cough Lungs reduce in size and weight Decreased elastic recoil Alveoli less elastic Reduction in vital capacity; increase residual volume Loose or brittle teeth can be aspired Is the following statement True or False? Loose teeth that are infected can break or dislodge, leading to lung abscesses, infections, and aspirated tooth fragments. True Often overlooked in the prevention of respiratory problems is the significance of a healthy oral cavity as infections of the oral cavity can lead to respiratory infections. Prevention of infection Influenza and pneumonia vaccines important Avoiding exposure to people with respiratory infections Deep-breathing exercises Smoking cessation Immobility major threat Caution with self-treatment of respiratory issues Review of medications Consider environmental factors Chronic obstructive pulmonary disease: group of diseases; higher in women and smokers ◦ Asthma ◦ Chronic bronchitis ◦ Emphysema ◦ Lung cancer ◦ Lung abscess Can develop in older years High risk of complications of bronchiectasis, cardiac problems High rates of mortality Assess for causative factors and educate patient Evaluate aerosol nebulizers’ use Precaution: avoid adverse drug effects Older adults who have asthma should be aware of which potential side effect of sympathomimetic bronchodilating nebulized drugs? a. Respiratory infection b. Cardiac arrhythmias c. Elevated serum potassium d. Peptic ulcer b. Cardiac arrhythmias Overuse of sympathomimetic bronchodilating nebulizers creates a risk of cardiac arrhythmias leading to sudden death. Causes persistent, productive cough; wheezing; recurrent respiratory infections; shortness of breath Management of chronic bronchitis ◦ Remove bronchial secretions ◦ Prevent obstruction of airway ◦ Maintain adequate fluid intake ◦ Expectorate secretions Increasing incidence in older adults Causes: chronic bronchitis, chronic irritation, and morphologic changes in the lung Cigarette smoking major role in development Symptoms develop slowly; may resemble agerelated changes; can delay diagnosis, treatment Treatment ◦ Postural drainage, bronchodilators, avoid stress, and breathing exercises ◦ Smoking cessation Education and support Increasing incidence in 65 years and older Higher incidence in men than in women Incidence and mortality rate varies in ethnic groups Incidence in smokers twice as nonsmokers Symptoms: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, and respiratory infections Diagnosis: CT scan, bronchoscopy, sputum cytology, and biopsy Treatment: surgery, chemotherapy, and radiotherapy Causes: pneumonia, tuberculosis, malignancy, trauma, and aspiration Symptoms: anorexia, weight loss, elevated temperature, and chronic cough Diagnosis: same as other age groups Treatment: postural drainage; high-protein, high-calorie diet Which of the following potential age-related changes may result in a lung abscess from aspiration of foreign material? a. Decreased elastic recoil of the lungs b. Increase in residual volume of the lung c. Decreased pharyngeal reflexes d. Increased elasticity of the alveoli c. Decreased pharyngeal reflexes Lung abscess may result from pneumonia, tuberculosis, malignancy, or trauma to the lung. In addition, aspiration of foreign material can also cause a lung abscess, which is a risk to older adults who have decreased pharyngeal reflexes. Recognizing symptoms Prompt medical attention with signs of respiratory infection Atypical presentation ◦ No chest pain ◦ Lower body temperature Changes in character of sputum Monitor closely to minimize disability and prevent mortality Assess to detect respiratory complications ◦ Respiratory rate and volume; pulse; blood pressure; temperature; neck veins; patency of airway; cough; secretions; mental status Prudent use of oxygen ◦ Carbon dioxide narcosis ◦ Monitor blood gases Assessment of oxygen equipment: gauge at prescribed level, oxygen flow Home oxygen safety Evaluate home environment Used to remove bronchial secretions Aerosol medications used prior to procedure Consider positioning based on individual patient’s abilities Discontinue if dyspnea, palpitations, chest pain, apprehension, or other signs of distress occur Oral hygiene and rest after procedure Coughing is important in removal of secretions Nonproductive coughing is useless and stressful Measures to promote productive cough ◦ Hard candy to increase secretions ◦ Breathing exercises ◦ Use of humidifier ◦ Expectorants ◦ Increase fluid intake Good handwashing and oral hygiene essential Some herbs affect respiratory health Aromatherapy may prove helpful Assess for interactions with other medications Hot, spicy foods open airways Avoid mucus-forming foods Some vitamins beneficial Acupuncture, acupressure, yoga, Rolfing, and massage Yoga, as a complementary therapy in the treatment of respiratory conditions, acts to a. Relax the diaphragm and promote breathing b. Increase deep breathing and tissue oxygenation c. Decrease the potential for apnea d. Improve elastic recoil in the lung b. Increase deep breathing and tissue oxygenation The practice of yoga can promote deep breathing and good oxygenation of tissues. Assess patient’s ability to use nebulizers correctly Proper use and operation of ventilators ◦ Attention to physical, emotional, and social needs of ventilator-dependent patients Respiratory problems: frightening and produce anxiety Need for psychological support and reassurance Understanding of disease process and management Encouragement to meet demands of chronic disease