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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).