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Chapter 25
Respiratory Conditions
Effect of Aging on the Respiratory System
• Reduction in vital capacity and an increase in residual
volume
– Less air exchange and more air and secretions
remaining in the lungs.
• Drier mucous
• Lung abscesses, infections, and the aspiration of tooth
fragments.
• Relaxed sphincters and slower gastric motility
Measures to Improve Indoor Air
• Install air filters in heating and air conditioning systems.
• Vacuum regularly.
• Damp-dust furnishings.
• Discourage cigarette smoking.
• Open windows to air out rooms.
• Maintain green houseplants to help detoxify the air.
Facilitating Respiratory Health
• Include measures to prevent respiratory infections in
every care plan.
• Promote deep breathing exercises
• Avoid smoking
• Avoid immobility
• Advise older adults not to treat symptoms of respiratory
infection independently
Facilitating Respiratory Health (cont.)
• Discuss the impact of drugs on respiration
• Review environmental factors that can influence
respiratory health.
• Promote health of the oral cavity.
Asthma
• Can be a lifelong problem or develop in old age.
• Can create cardiac problems due to the extra stress it
places on the heart.
• Elders need to identify causative and contributing factors
and aid in their reduction.
• Risks with sympathomimetic bronchodilating nebulizers
should be explained to elders.
Symptoms of Chronic Bronchitis
• Persistent, productive cough
• Wheezing
• Recurrent respiratory infections
• Shortness of breath
Management of Chronic Bronchitis
• Remove bronchial secretions and prevent obstruction of
the airway
– Maintain good fluid intake and expectorate
secretions.
• Avoid chronic respiratory irritation
– E.g., smoking.
• Help older adults prevent respiratory infections
Factors Contributing to Emphysema
• Chronic bronchitis
• Chronic irritation from dusts or certain air pollutants
• Morphologic changes in the lungs
– Distention of the alveolar sacs, rupture of the
alveolar walls, and destruction of the alveolar
capillary bed
• Cigarette smoking
Symptoms of Emphysema
• Symptoms are slow in onset; may cause delayed
treatment.
– Increased dyspnea not relieved by sitting upright.
– Chronic cough
– Hypoxia, fatigue, anorexia, weight loss, and
weakness
– Recurrent respiratory infections
– Malnutrition, congestive heart failure, and cardiac
arrhythmias
Measures to Treat Emphysema
• Postural drainage
• Bronchodilators
• Avoidance of stressful situations
• Breathing exercises
• Stopping cigarette smoking
Factors Contributing to the Development
of Lung Cancer
• Chronic exposure to:
– Cigarette smoke
– Asbestos
– Coal gas
– Radioactive dusts
– Chromates
Symptoms of Lung Cancer
• Dyspnea
• Coughing
• Chest pain
• Fatigue
• Anorexia
• Wheezing
• Recurrent upper respiratory infections
Diagnosis and Treatment of Lung Cancer
• Diagnosis:
– Confirmed through chest roentgenogram, sputum
cytology, bronchoscopy, and biopsy.
• Treatment:
– Surgery
– Chemotherapy
– Radiotherapy
Causes of Lung Abscess
• Pneumonia
• Tuberculosis
• A malignancy
• Trauma to the lung
• Aspiration of foreign material
Symptoms of Lung Abscess
• Anorexia
• Weight loss
• Fatigue
• Temperature elevation
• Chronic cough
• Sputum production may occur, but this is not always
demonstrated in older persons.
Preventing Respiratory Complications
• Assess vital signs.
• Use oxygen safely.
– Keep flow at prescribed level.
– Prevent kinking or blockage of tube.
• Use modified procedure for postural drainage for older
adults.
• Use measures to promote removal of secretions.
Nursing Observations
• Respiratory rate and volume
• Pulse
• Blood pressure
• Temperature
• Neck veins
• Patency of airway
Nursing Observations (cont.)
• Coughing (frequency, depth, productiveness)
• Quality of secretions
• Mental status
Complimentary Therapies
• Herbs with mucus-secreting effects and expectorant
effects
• Aromatherapy with eucalyptus, pine, and lavender
• Hot, spicy foods to open air passages
• Dietary supplements including zinc, proteolytic enzymes,
and vitamins A, C, E, and B6
• Acupuncture and acupressure
• Yoga
Promoting Self-Care
• Assess patient’s ability to use nebulizers properly.
• Assess the ability of caregivers in other settings to
properly provide care.
• Encourage older adults to obtain pneumococcal and
influenza vaccines.
• Be aware of the psychosocial implications of respiratory
conditions.
Source
Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).