GERIA-RESPI (1).pptx

Respiratory System Geriatric Nursing Presented by: Megan Bombales Kristine Damonsong  Objectives 1.Differentiate the from normal respiratory system to older adult respiratory system, and know its cha...

Respiratory System Geriatric Nursing Presented by: Megan Bombales Kristine Damonsong  Objectives 1.Differentiate the from normal respiratory system to older adult respiratory system, and know its changes in structure and function in older adults. 2.Recognize the factors affecting the lung functions in older adults 3.Learn the common diseases or infections in older adults, its diagnosis, treatment and nursing management  The respiratory system is a complex biological system responsible for the exchange of gases— primarily oxygen and carbon dioxide—between an organism and its environment  The respiratory system in older adults undergoes various physiological, anatomical, and immunological changes that can significantly impact its function Changes in Structure and Function in Older Adults Lung function decline o Lung tissue loses elasticity, which impairs the ability of the lungs to expand and contract effectively. o The number of alveoli decreases, this reduction in surface area limits the amount of oxygen that can be absorbed into the bloodstream and the removal of carbon dioxide. o Decreased immune function - making older adults more susceptible to respiratory infections and reducing their ability to recover from illnesses that can further impair lung function. Respiratory muscle strength o Muscles weaken with aging. o Inspiratory and expiratory forces are decreased because of less forceful contractions. Older adults require increased effort to breathe. o Breathing is less efficient due to the increased stiffness of the chest wall and decreased muscle strength o There is a notable decline in the strength of respiratory muscles, which can impair effective coughing and airway clearance. Ventilatory response o Breathing patterns of older adults are more dependent on intraabdominal pressure changes. o Positioning and increased abdominal pressure can greatly affect their breathing pattern. o Respiratory rates are generally higher in older adults (16-25 breaths per min as a normal rate). o Shallow breathing patterns of Older adults may result to hypoxia and hypercapnia due to the base of the lung is underventilated. o Results in decrease ventilation/perfusion in the area and ineffective alveolar gas exchange. Factors Affecting Lung Function  Exercise and Immobility Increased oxygen demands during exercise periods may exceed the abilities of older adult. Activity intolerance is a major concern for px with COPD Increased immobility and breathlessness when an activity is attempted  Smoking Smoking interferes with gas exchange because CO byproduct competes with oxygen for the Hgb molecule It has been long known to damage the lungs Prolonged exposure to secondhand smoke Cillias are paralyzed by the nicotine, unable to clean the lung  Smoking Tobacco smoke increases the goblet cells production of mucus Cigarette smoke causes bronchoconstriction, increased airway resistance and closing volumes Smoking cessation – it is imperative. Five components of smoking cessation consists; ask, advise, assess, assist and arrange  Five components of smoking cessation Asked about tobacco use. This gives the nurse the opportunity to advise and discuss health benefits and promote smoking cessation. The nurse must use strong, clear and personalized language. Assess the older adults willingness to give up smoking and determine how soon they start the process. Assists older adults with smoking cessation by encouraging them to set quit date, recommending nicotine replacement therapy , providing advice on successful quitting. Arranges for follow up.  Obesity This results to chest wall compliance and reduction in pulmonary functions which increases breathlessness Ventilation at the bases of the lungs may be diminished because of clients inability to take a deep breath Older client who is immobile has a risk of developing atelectasis and increased URTI & LRTI  Sleep Increased sleep time of older adults increases the risk of aspiration and O2 desaturation during sleep Diminished ventilatory drive and loss of upper airway tone that predisposes them to apnea, hypopnea, and nocturnal 02 desaturation Diminished cough and arousal reflexes increases likelihood of aspiration during sleep  Anesthesia and Surgery Older client undergoing surgery has increased risk of aspiration as a result of loss of laryngeal reflexes Emergency surgery, risk is increased due to delayed gastric emptying and potential for a full stomach Incisions, pain and decreased post-op deep breathing has a chance of developing post-op atelectasis  Anesthesia and Surgery Subsequent immobility decreases ventilation and effective airway clearance Hypovolemia contributes to thickened secretions since older clients has less effective cough reflex Pain incision further contributes to ineffective airway clearance MGT: Promotion of deep breathing, adequate hydration, frequent position changes, and early mobility. Common Diseases in Older Adults  Asthma Chronic inflammatory disease that affects the airways in the lungs. It causes the airways to become inflamed and swollen, making it difficult for air to flow in and out of the lungs. Asthma attack is precipitated by: Exposure to allergens or irritants – weather, odors or stress Associated with viral respiratory infection Chronic bronchitis Clinical syndrome characterized by excessive mucus production with chronic or recurrent cough on most days for a minimum of 3 month for atleast 2 years. There is hypertrophy of the bronchial mucus gland, increase in number of goblet cells, and a decrease in the effectiveness of mucociliary escalator  Risk factors Cigarette smoking exacerbates chronic bronchitis It also associated with RHF, polycythemia, hypoxemia, and respiratory insufficiency  Emphysema It is characterized by progressive destruction of alveoli and their supporting structures Usually occurs between ages 60 and 70 The alveoli distal to the terminal bronchioles becomes enlarged. Associated with older client who has history of smoking Barrel chest with the use of accessory muscles  COPD It is characterized by airway obstruction and decrease expiratory flow rate. Often caused by long-term exposure to harmful substances 2 reversible components of COPD; Airway diameter and expiratory flow rate. Emphysema, chronic bronchitis , asthma and bronchiectasis often referred to as COPD  Risk factors of COPD Age Male Reduced lung function Air pollution Exposure to secondhand smoke Familial allergies Poor nutrition and alcohol intake It is also a comorbid factor in deaths from pneumonia and influenza Restrictive Pulmonary Disease  Lung Carcinoma Lung cancer is the leading cause of cancer deaths Rare in