Respiratory Care for Older Adults: Strategies and Complications

1. Chapter 25Respiratory Conditions

2. 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  

3. 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.

4. 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

5. 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.

6. 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.

7. Symptoms of Chronic Bronchitis • Persistent, productive cough • Wheezing • Recurrent respiratory infections • Shortness of breath

8. 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

9. 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

10. 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

11. Measures to Treat Emphysema • Postural drainage • Bronchodilators • Avoidance of stressful situations • Breathing exercises • Stopping cigarette smoking

12. Factors Contributing to the Development of Lung Cancer • Chronic exposure to: • Cigarette smoke • Asbestos • Coal gas • Radioactive dusts • Chromates

13. Symptoms of Lung Cancer • Dyspnea • Coughing • Chest pain • Fatigue • Anorexia • Wheezing • Recurrent upper respiratory infections

14. Diagnosis and Treatment of Lung Cancer • Diagnosis: • Confirmed through chest roentgenogram, sputum cytology, bronchoscopy, and biopsy. • Treatment: • Surgery • Chemotherapy • Radiotherapy

15. Causes of Lung Abscess • Pneumonia • Tuberculosis • A malignancy • Trauma to the lung • Aspiration of foreign material

16. 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.

17. 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.

18. Nursing Observations • Respiratory rate and volume • Pulse • Blood pressure • Temperature • Neck veins • Patency of airway

19. Nursing Observations (cont.) • Coughing (frequency, depth, productiveness) • Quality of secretions • Mental status

20. 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

21. 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.

22. Source Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).