The Respiratory System

1. 16 Lecture Note PowerPoint Presentation The Respiratory System

2. LEARNING OUTCOME 1 Identify normal changes of aging of the respiratory system.

3. Respiratory System Components • Lungs • Airways leading to the lungs • Blood vessels serving the lungs • Chest wall

4. Figure 16-1Normal anatomy of the lungs and airways.

5. Normal Age-Related Changes in Lung Structure and Function • Stiffening of elastin and the collagen connective tissue supporting the lungs • Altered alveolar shape resulting in increased alveolar diameter • Decreased alveolar surfaces available for gas exchange • Increased chest wall stiffness • Stiffening of the diaphragm

6. Figure 16-2Normal changes of aging in the respiratory system.

7. Cardiovascular Function Changes That Can Also Affect the Pulmonary System • Increased stiffness of the heart and blood vessels, rendering these vessels less compliant to increased blood flow demands • Diastolic dysfunction due to impaired diastolic filling • Systolic dysfunction due to increased left ventricular afterload • Decreased cardiac output with rest and with exercise

8. Immune Function Changes That Can Affect Pulmonary Function • A decrease in the nature and quantity of antibodies produced • A decrease in effectiveness of the protective cilia of the respiratory tract in removing debris (remains) from the airways, allowing more foreign bodies to travel to the lungs

9. Immune Function Changes That Can Affect Pulmonary Function • Decreased production of antibodies after immunization • Use of medications that can suppress immune function

10. Aging-Related Neuron Loss • Increases reaction time • Decreases the ability to respond to multiple complex stimuli • May impair the ability to adapt and interact with the environment

11. Changes That Can Affect Pulmonary Function • Loss of muscle tone • Exacerbated by deconditioning • Obesity • Sedentary lifestyle • Increased thoracic rigidity and osteoporotic changes to the spine (kyphosis) • Deconditioning can be defined as the multiple, potentially reversible changes in body systems brought about by physical inactivity and disuse.

12. Changes That Can Affect Pulmonary Function • Use of medications that can cause • Fatigue • Depression of the cough reflex • Insomnia • Dehydration • Bronchospasm

13. LEARNING OUTCOME 2 Describe appropriate health promotion and disease prevention guidelines relating to the respiratory system.

14. Teach Patients to Minimize or Avoid Asthma Attacks • Peak flow meter use • Avoid allergens and triggers for attacks • Dust • Animals • Cockroaches • Tobacco smoke • Wood smoke • Strong odors and sprays

15. Teach Patients to Minimize or Avoid Asthma Attacks • Avoid allergens and triggers for attacks • Colds and infections • Exercise • Weather • Pollens • Molds

16. Monitor Medications Prescribed for Respiratory Problems • Therapeutic and side effects • Monitor for interactions with other medications

17. Be Persistent in Educating and Urging Older Patients to Quit Smoking • Investigate community resources • Availability of smoking cessation support groups • Nicotine patches and gum • Bupropion (Zyban) : is an atypical antidepressant and smoking cessation aid.

18. Additional Education for Patients with COPD • Avoid exposure to dust and fumes • Avoid air pollution, including secondhand smoke • Refrain from close contact with people who have colds or the flu

19. Additional Education for Patients with COPD • Avoid excessive heat, cold, and high attitudes • Drink lots of fluids • Maintain good lifestyle habits • Have spirometry done routinely and understand the numbers

20. Vaccinations • Pneumococcal vaccine • Influenza (yearly)

21. Education for Patients with Pneumonia • Stop smoking • Take 10 deep breaths an hour to aerate lungs and loosen secretions • Drink plenty of fluids to keep secretions moist • Take antibiotics or antivirals as prescribed and finish all medications • Report any adverse reactions

22. Education for Patients with Pneumonia • Avoid coughing in public and practice good handwashing • Avoid contact with other who are ill, infants, and frail older persons • Receive the pneumococcal vaccine as soon as possible after recovery and get a flu shot yearly

23. Pulmonary Embolus Prevention • Minimize venous stasis by leg elevation • Urge passive and active range of motion in the immobile older person • Encourage early postoperative ambulation • Place elastic compression stockings and pneumatic calf compression boots on the postoperative patient

24. LEARNING OUTCOME 3 Discuss the nurse’s role in caring for older persons with respiratory problems.

25. Asthma Care • Assist the patient with spirometry testing • Educate the patient regarding proper Use • Metered-dose inhaler • Nebulizer use • Spacer use • Peak flow meter • Care of the respiratory equipment

26. Medications Used to Treat Asthma • Inhaled corticosteroid therapy • Oral corticosteroids • Cromolyn sodium • Inhaled beta2-agonists • Methylxanthine (theophylline) • Ipratropium bromide

27. Medications Contraindicated in Patients with Asthma • Beta-blockers • Nonsteroidal anti-inflammatory drugs (NSAIDs) • Diuretics • Antihistamines • Angiotensin-converting enzyme (ACE) inhibitors • Antidepressants

28. Physical Assessment of the Patient with Asthma • Observation of the overall shape and movement of the thorax during respiration • Auscultation of the lungs, noting the presence of any crackles, wheezes, rhonchi, or pleural rubs • Chest excursion • Tactile and vocal fremitus • Chestexcursion was operationally defined as the difference in chest girth between tidal inspiration and tidal expiration at two separate sites

29. Medications Used to Treat COPD • Are similar to those used to treat asthma • Bronchodilators • Inhaled corticosteroids • Antibiotics • Influenza and pneumococcal vaccines • Expectorants • Other drugs to treat associated symptoms such as diuretics, analgesics, cough suppressants, and anxiolytics

30. COPD Education • Additional methods used to help loosen and remove secretions • Postural drainage • Chest percussion • Controlled coughing • Tracheal suctioning • Smoking cessation

31. Physical Assessment of the Patient with COPD • The same as for the patient with asthma

32. Diagnosis of TB • Purified protein derivative (PPD) skin test • Given subdermally • Area should be measured and recorded in 72 hours

33. Educate the Patient with Tuberculosis (TB) • Take their medications at the same time daily • Prevents the development of resistant Mycobacterium

34. LEARNING OUTCOME 4 Describe common diseases of the respiratory system.

35. Factors Causing Predisposition to Respiratory Diseases • Age-related changes in the lungs • Years of exposure to air pollutants and cigarette smoke • The presence of comorbidities

36. Asthma • Reversible airflow inflammation • Increased mucous production • Increased airway responsiveness to a variety of stimuli • Often ignored in the older person • Can present as a newly diagnosed disease or as a chronic disease that the older person has lived with for many years

37. Common Symptoms of an Asthma Attack • Coughing: may be worse at night • Wheezing: usually high-pitched whistling sounds on expiration • Shortness of breath • Chest tightness

38. Asthma Diagnosis in an Older Person • Results of pulmonary function tests • Chest radiography • Electrocardiography • Complete blood count with differential

39. Four Categories of Asthma Classification • Intermittent • Mild persistent • Moderate persistent • Severe • Criteria • Duration of symptoms • Presence and severity of nocturnal symptoms • Results of spirometry

40. Asthma Treatment Goals • Reduce the frequency and severity of symptoms • Improve results of spirometry testing

41. COPD related Term • Used for two closely related diseases of the respiratory system, chronic bronchitis and emphysema • Chronic bronchitis • Narrowing of the large and small airways, making it more difficult to move air in and out of the lungs

42. COPD Terminology • Emphysema • Permanent destruction of the alveoli because of irreversible destruction of elastin, a protein in the lung that is important for maintaining the strength of the alveolar walls

43. Emphysema • Risk factors • Smoking • Family history

44. COPD Pathophysiology • Walls of the small airways and alveoli lose their elasticity and thicken • Closes off some of the smaller air passages and narrows the larger ones • Air can enter the alveoli but becomes trapped due to the collapsed airways • Affects gas exchange and pathological changes occur

45. COPD Pathophysiology • Blood is poorly oxygenated and tissue perfusion is less efficient • Carbon dioxide may accumulate to critical levels • Respiratory acidosis • Respiratory failure • Strains the heart • Right ventricle can enlarge and thicken • Abnormal rhythms called cor pulmonale

46. COPD Symptoms • Early • Early morning cough with clear sputum • Periods of wheezing during or after colds • Shortness of breath on exertion

47. COPD Symptoms • Late • Mouth breathing • Puffing • Use of accessory muscles of breathing • Inability to finish sentence without catching one’s breath • Sleep in semi-sitting position

48. COPD Diagnosis • Spirometry preferred • Arterial blood gases (ABGs) • Can be difficult to obtain

49. COPD Treatment • Oxygen • Medications • Bronchodilators • Corticosteroids • Antibiotics • First sign of infection • Yellow or green sputum

50. COPD Treatment • Medications • Other drugs to treat associated symptoms • Diuretics • Analgesics • Cough suppressants • Anxiolytics