Age-related changes that affect respiratory function:
Upper Respiratory Structures
- degenerative structural changes in the nose
- diminished blood flow to the nose
- thicker mucus in the nasopharynx. due to degenerative changes in the submucusal glands
- stiffening of the trachea d/t calcification of cartiladge
- blunted cough and laryngeal reflexes
- atrophy of the nerve endings
Age-related changes that affect resp. function:
Chet wall and musculoskeletal structures
- ribs and vertebrae become osteoporotic so higher chance of rib fractures
- intercostal cartilage calcifies and the respiratoy muscles weaken
- kyphosis (increased curvature of the spine)
- chest wall expansion is compromised and older adults ned to expend more energy to achieve respiratory efficiency
Age-related changes:
lung structure and function
- lungs become smaller and more fatty
- Ductectasia: alveoli enlarge and their walls become thinner, resulting in gradual increase in the amount of anatomic dead space
- pulmonary artery becomes wider, thicker, and less elastic
- the number of capillaries diminishes
- the capillary blood volume decreases
- the mucosal bed where diffusion occurs thickens
Age-related changes:
gas exchange
- gas exchange is compromised in the lower lung regions and inspired air is preferentially distributed in the upper regions
- normally, compensatory changes in resp rate are made under conditions of hypercapnia (high CO2) or hypoxia (low O2)
- age related changes reduce the ventilatory response to both hypercapnia and hypoxia
- changes to T-cells (the component of immunity most responsible for protecting against infections and malignancy) are a major factor in contributing to increased prevalence of lung disease
A summary of age-related changes to the respiratory system:
- increased stiffness of chest wall
- enlarged aveoli
- weaker resp muscles
- decreased response to hypercapnia and hypoxia
Risk Factors that affect resp function
- tobacco smoking
- environmental pollutants
- occupational exposure to resp toxins (ex. asbestos)
- obesity or chronic illness that interfere with the ability to obtain adequate physical activity
- kyphosis
- medications (ex. anticholegeric meds causes drying of upper airway-> ACE inhibitors can cause persistent cough
Functional Consequences affecting respiratory wellness
- increased suseptibily to lower resp infections
- pneumonia & influenza (the 8th leading cause of death among 64-84 yr olds, 6th leading cause for 85+)
- frailty, dysphagia, and reduced functional status contribute
- poor oral care is a contributing factor is hospitals and residential care
- increased suseptiblity to TB d/t weaker immune systems, TB infection rate higher in Aboriginal/foreign-born/certain racial minorities, higher incidence in LTC likely r/t virulence and more subtle disease manifestation in older adults
- dyspnea & fatigue (resp systems are less efficient in gas exchange)
- aspiration pneumonia (most commonly related to dysphagia, which affects 25% of healthy adults and more than 50% of nursing home residents)
3 Pathologic conditions affecting resp function:
Pneumonia
TB
COPD
Pneumonia
def
def: an infection in one or both lungs which causes the alveoli to fill with fluid or pus, making breathing difficult
Pneumonia
risk factors
- age
- recent upper resp illness
- asthma/COPD/CHF/other chronic diseases
- smoking
- weakened/suppressed immune system
- tube feeding, malnutrition, dehydration, decreased LOC, decreased cough reflex, reduced salivary flow
Pneumonia
symptoms
normal adult:
- cough
- fever
- purulent sputum
- SOB
- fatigue
- chest tightness/pain
older adults:
- acute delirium/ confusion
- dizziness
- lower than normal body temperature
- temp= can either have cold or warm sepsis with T<36C)
Pneumonia
treatment
- antipyretics for fever (acetaminophen or ibuprofen)
- antibiotics (bacterial or viral)
- bronchodilators if wheezes present
- oxygen therapy if needed
- deep breathing and coughing
Tuberculosis
def
a bacterial infection (caused by the Mycobacterium Tuberculosis) that most commonly affects the lungs
Is TB curable and preventable?
Yes
How is TB spread?
person-to-person through aerosolized droplets / saliva droplets expelled when coughing
- need minimal exposure to become infected
- often occurs in Northern American older adults d/t reactivation of dormant disease, therefore, nurses need to know their older adults’ past medical history
- TB can be latent or active. Body detects invasion and sends macrophages to neutralize them into latent TB.
- latent TB can become active months or years later and spread to other body systems. The immune system can become overwhelmed and become infected.
- 1/3 of the world is infected
TB
risk factors
- people who have been recently exposed to someone with active TB
- people who have come from a country where TB is an epidemic
- people with weakened immune systems related to chronic disease or high-risk behaviour: ex - HIV+, malnourished, cancer pts, homeless and IV drug users, those on immunosuppressive drugs
- TB rate is higher in Aboriginal, foreign-born, and certain racial minorities
- higher incidence of TB in LTC residences likely r/t virulence and altered/more subtle disease manifestation in older adults
TB
symptoms
- persistent coughing that lasts three or more weeks
- chest pain with breathing and coughing
- fatigue
- fever
- night sweats
- chills
unintentional weight loss
TB
treatment
-2-4 daily PO meds x6-12 months depending on whether or not TB is a drug-resistant strain
-meds: Isoniazid Rifampin (Rifadin, Rimactane) Ethambutol (Myambutol) Pyranzinamide
-2 week isolation on droplet precautions after start of adequate therapy and until 3 negative sputum test for AFB (Acid-fast bacilli)
COPD
def of 2 types
2 types:
- Chronic bronchitis (affecting bronchi)
- Emphysema (chronic progressive lung disease caused by SOB from over-inflated alveoli / damaged lung tissue involved in gas exchange of O2/COO2)
- characterized by chronic airflow obstruction that interferes with normal breathing
- 4th leading cause of death in Canada in older adults with 80-90% of those deaths caused by smoking
COPD
risk factors for developing COPD
- smoking (primary cause)
- exposure to secondhand smoke and other air pollutants
- increased age
- genetic predispositions
- low socioeconomic status
- history of significant childhood respiratory disease
COPD
symptoms
- chronic productive cough worsening dyspnea, especially with exertion
- wheezing and chronic sputum production
- barrel-chest over time d/t trapped air in the lungs
- chest tightness
- fatigue
- cyanosis of the fingernail bed and lips
- women reported most severe symptoms than men, but men’s mortality rates r/t COPD are higher
- disease is progressive and cumulative (it gets worse over time)
COPD
treatment
- bronchodilators (nebulized, meter-dosed inhalers (MDI’s))
- inhaled steroids (nebulized or MDI)
- combination inhalers
- pulse-dosed oral steroids (in exacerbations of COPD only)
- Continuous or intermittent O2 therapy (in later stages)
Nursing Assessment of Resp function in older adults
Objective data: chest auscultation, RR, SPO2 (with or without oxygen), cough (productive or nonproductive) and sputum appearance, medications
-subjective data: chest pain, medical hx, SOB (with or without exertion)
Opportunities for health promotion:
(x6)
*pic to finish
- Immunizations
- 1.1 Pneumococcal: *
- 1.2 Influenza: annual, with 2-3 week delay after admin before immunity achieved, duration of effectiveness approx 6 months, free for seniors over 65 yrs - Preventing Resp Infections
- 1 proper handwashing, avoid hand-to-mouth or hand-to-eye contact, avoid inhaling air that has been contaminated with particles from an infected person
- Smoking cessation programs
- Avoiding second-hand smoke, dust, other environmental irritants
- Ensuring both compliance and proper use of inhaled medications
- Advocating for home O2 therapy in appropriate cases
