The respiratory system
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16. Lecture Note PowerPoint Presentation. The Respiratory System. LEARNING OUTCOME 1. Identify normal changes of aging of the respiratory system. Respiratory System Components . Lungs Airways leading to the lungs Blood vessels serving the lungs Chest wall.

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The Respiratory System

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16

Lecture Note PowerPoint Presentation

The Respiratory System


LEARNING OUTCOME 1

Identify normal changes of aging of the respiratory system.


Respiratory System Components

  • Lungs

  • Airways leading to the lungs

  • Blood vessels serving the lungs

  • Chest wall


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


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


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


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


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


Immune Function Changes That Can Affect Pulmonary Function

  • Decreased production of antibodies after immunization

  • Use of medications that can suppress immune function


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


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.


Changes That Can Affect Pulmonary Function

  • Use of medications that can cause

    • Fatigue

    • Depression of the cough reflex

    • Insomnia

    • Dehydration

    • Bronchospasm


LEARNING OUTCOME 2

Describe appropriate health promotion and disease prevention guidelines relating to the respiratory system.


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


Teach Patients to Minimize or Avoid Asthma Attacks

  • Avoid allergens and triggers for attacks

    • Colds and infections

    • Exercise

    • Weather

    • Pollens

    • Molds


Monitor Medications Prescribed for Respiratory Problems

  • Therapeutic and side effects

  • Monitor for interactions with other medications


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.


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


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


Vaccinations

  • Pneumococcal vaccine

  • Influenza (yearly)


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


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


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


LEARNING OUTCOME 3

Discuss the nurse’s role in caring for older persons with respiratory problems.


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


Medications Used to Treat Asthma

  • Inhaled corticosteroid therapy

  • Oral corticosteroids

  • Cromolyn sodium

  • Inhaled beta2-agonists

  • Methylxanthine (theophylline)

  • Ipratropium bromide


Medications Contraindicated in Patients with Asthma

  • Beta-blockers

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Diuretics

  • Antihistamines

  • Angiotensin-converting enzyme (ACE) inhibitors

  • Antidepressants


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


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


COPD Education

  • Additional methods used to help loosen and remove secretions

    • Postural drainage

    • Chest percussion

    • Controlled coughing

    • Tracheal suctioning

  • Smoking cessation


Physical Assessment of the Patient with COPD

  • The same as for the patient with asthma


Diagnosis of TB

  • Purified protein derivative (PPD) skin test

    • Given subdermally

    • Area should be measured and recorded in 72 hours


Educate the Patient with Tuberculosis (TB)

  • Take their medications at the same time daily

  • Prevents the development of resistant Mycobacterium


LEARNING OUTCOME 4

Describe common diseases of the respiratory system.


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


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


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


Asthma Diagnosis in an Older Person

  • Results of pulmonary function tests

  • Chest radiography

  • Electrocardiography

  • Complete blood count with differential


Four Categories of Asthma Classification

  • Intermittent

  • Mild persistent

  • Moderate persistent

  • Severe

  • Criteria

    • Duration of symptoms

    • Presence and severity of nocturnal symptoms

    • Results of spirometry


Asthma Treatment Goals

  • Reduce the frequency and severity of symptoms

  • Improve results of spirometry testing


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


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


Emphysema

  • Risk factors

    • Smoking

    • Family history


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


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


COPD Symptoms

  • Early

    • Early morning cough with clear sputum

    • Periods of wheezing during or after colds

    • Shortness of breath on exertion


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


COPD Diagnosis

  • Spirometry preferred

  • Arterial blood gases (ABGs)

    • Can be difficult to obtain


COPD Treatment

  • Oxygen

  • Medications

    • Bronchodilators

    • Corticosteroids

    • Antibiotics

      • First sign of infection

      • Yellow or green sputum


COPD Treatment

  • Medications

    • Other drugs to treat associated symptoms

      • Diuretics

      • Analgesics

      • Cough suppressants

      • Anxiolytics


COPD Treatment

  • Other treatments

    • Bullectomy or lung reduction

    • Pulmonary rehabilitation

      • Exercise

      • Oxygen

      • Nutritional support

    • Intermittent mechanical ventilator support

      • CPAP


COPD Treatment

  • Other treatments

    • Relaxation techniques

      • Breathing techniques

    • Clearing airway passages

      • Postural drainage

      • Chest percussion

      • Controlled coughing

      • Tracheal suctioning


Tuberculosis (TB) Overview

  • Airborne disease

  • Spread by droplets when an infected person coughs, sneezes, speaks, sings, or laughs

  • Adequate ventilation is the most important measure to prevent transmission


TB in Older Persons

  • Can be a reactivation of old disease

  • Can be a new infection due to exposure to an infected individual


TB Risk Factors

  • Living in an institution

  • Diabetes mellitus

  • Use of immunosuppressive drugs

  • Malignancy

  • Malnutrition

  • Renal failure


TB Diagnosis

  • Skin test (PPD)

  • Chest X-ray


TB Treatment

  • Several antibiotics that are prescribed for 6 to 12 months

  • Patients must take their medication at the same time every day to prevent resistance


Lung Cancer

  • Responsible for almost one third of all cancer deaths in the United States


Lung Cancer

  • At least 12 different types of tumors are included in the broad heading of lung cancer

    • Squamous cell

    • Adenocarcinomas

    • Large cell carcinomas

    • Small cell carcinomas (“oat cell”)

    • Growth rate and metastasis rate vary by tumor type


Lung Cancer Symptoms

  • Vague and mimic the symptoms of other pulmonary illnesses

  • Chronic cough

  • Hemoptysis

  • Chest pain

  • Shortness of breath

  • Fatigue, weight loss

  • Frequent lung infections


Lung Cancer Diagnosis

  • CT scan

  • MRI scan

  • Pulmonary function tests

  • Bronchoscopy with collection of lung tissue, cells, or fluids for analysis


Lung Cancer Treatment

  • Surgical removal of the tumor or lung

  • Chemotherapy

  • Radiation

  • Palliative care


Respiratory Infections

  • Older adults may not cough, exhibit an elevated temperature, or show other classic signs of a respiratory infection

  • Atypical symptoms include lethargy, falling, exhibiting loss of cognitive or physical function, or simply not eating or drinking


Upper Respiratory Infections

  • Most require no treatment


Sinusitis

  • Inflammation of the mucosal lining of the paranasal sinuses that can lead to mucous stasis, obstruction, and subsequent infection

  • Treatment

    • Nasal decongestants

    • Saline spray

    • Acetaminophen

    • Humidified air


Pneumonia

  • Most common type of infectious disease of the lung


Pneumonia Risk Factors

  • History of nosocomial pneumonia within the last 6 to 12 months

  • Diagnosed lung disease (COPD)

  • Recent hospitalization

  • Nursing home residence

  • Smoking

  • Alcoholism

  • Neurologic disease


Pneumonia Risk Factors

  • Immunosuppression

  • Use of oxygen therapy

  • Severe protein-calorie malnutrition

  • Heart failure

  • Antibiotic therapy during the previous month

  • Eating dependency

  • Enteral feeding by nasogastric tube.


Pneumonia Pathogens

  • Streptococcus pneumonia

  • Haemophilus influenza

  • Staphylococcus aureus

  • Enterobacteriaceae


Pneumonia Symptoms

  • Cough

  • Fever

  • Sputum production

  • Fever may be absent in the older person

  • Changes in function, appetite, continence, and other subtle symptoms may be the first signs of the onset of illness in the older adult


Pneumonia Assessment

  • Assess vital signs

  • Inspect the thorax

  • Auscultate the lungs

  • Assess the skin for cyanosis


Pneumonia Diagnostic Tests

  • Chest X-ray

  • Blood culture

  • Sputum specimen

  • Pulse oximetry

  • Blood chemistry analysis


Pneumonia Treatment

  • Antibiotic therapy

  • Chest percussion

  • Inhaled beta-adrenergic agonists

  • Oxygen

  • Rehydration


Pneumococcal Vaccination

  • Recommended for older persons over age 65, at-risk persons, and those with unknown immunization status

  • 25% of older patients with risk factors have received the vaccine

  • 80% effective

  • Associated with reduction in pneumonia-related hospitalizations


Acute Bronchitis

  • An acute inflammation of the bronchi

  • Usually a self-limiting viral illness

  • Signs and symptoms similar to those of pneumonia

    • Productive cough

    • Chills, lethargy

    • Low-grade fever


Acute Bronchitis

  • Treatment

    • Rest

    • Air humidification

    • Use of cough suppressant

    • Acetaminophen


Pulmonary Embolism

  • An occlusion of a portion of the pulmonary vascular bed by an embolus consisting of a thrombus, an air bubble, or a fragment of tissue or lipids

  • Result is shortness of breath, heart failure, or death


Pulmonary Embolism Risk Factors

  • Clotting disorders

  • Immobility

  • Dehydration

  • Recent surgery

  • Atherosclerotic changes in the circulatory system

  • Obesity


Pulmonary Embolism Treatment

  • Intravenous administration of heparin

  • Other anticoagulant therapy

  • Warfarin therapy may be continued 3 to 6 months after discharge to prevent the formation of another pulmonary embolus


LEARNING OUTCOME 5

Identify the nursing assessment process and formulation of nursing diagnoses relating to the respiratory system.


Nursing Diagnoses for the Older Person with Asthma

  • Activity Intolerance for those persons with exercise induced asthma

  • Ineffective Airway Clearance for those with chronic cough with mucous production

  • Ineffective Breathing Patterns for those with tachypnea and wheezing with poorly controlled asthma


Nursing Diagnoses for the Older Person with Asthma

  • Altered Tissue Perfusion: Respiratory for those with hypoxemia

  • Ineffective Management of Therapeutic Regimen, Individual for those who are unable or unwilling to monitor the peak flow recordings and adjust medications to prevent asthma attacks and exacerbations


Nursing Diagnoses for the Older Person with COPD

  • Activity Intolerance for those persons with fatigue and air hunger

  • Ineffective Airway Clearance for those with chronic cough with mucous production

  • Ineffective Breathing Pattern for those with tachypnea and wheezing with advanced COPD


Nursing Diagnoses for the Older Person with COPD

  • Altered Tissue Perfusion: Respiratory for those with hypoxemia

  • Ineffective Management of Therapeutic Regimen, Individual for those who are unable or unwilling to refrain from cigarette smoking and adjust medications to prevent exacerbations


Nursing Diagnoses for Pneumonia

  • Risk for Infection based on advanced age or immunosuppression

  • Altered Health Maintenance, based on poor nutrition, or tobacco or alcohol use

  • Noncompliance, based on inability or unwillingness to take medications as prescribed


Nursing Diagnoses for Pneumonia

  • Ineffective Airway Clearance, based on altered cough reflex and excessive secretions

  • Risk for Aspiration, based on diagnosis with neurological disease such as CVA or dementia

  • Ineffective Tissue Perfusion, based on the presence of hypoxia


Nursing Diagnoses for Pulmonary Embolism

  • Ineffective Breathing Patterns, Risk for Suffocation

  • Activity Intolerance


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