2. Learning Objectives
1. Define normal changes of aging of the
respiratory system.
2. Describe appropriate health promotion
and disease prevention guidelines
relating to the respiratory system.
3. Discuss the nurse’s role in caring for
older persons with respiratory
problems.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
3. Learning Objectives
4. Classify common diseases of the
respiratory system.
5. Identify the nursing assessment
process and formulation of nursing
diagnoses relating to the respiratory
system.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
4. Introduction
• During a normal day, the average
person takes 25,000 breaths and
inhales more than 10,000 liters of air.
• The lungs have a series of built-in
barriers and defenses to protect
function and life; however, with aging
and disease, damage to the lungs can
occur.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
5. Anatomy and Physiology
• The respiratory system is composed of
the lungs, the airways leading to the
lungs, the blood vessels serving the
lungs, and the chest wall.
• The right lung has three lobes (upper,
middle, and lower). To leave space for
the heart, the left lung has two lobes
(upper and lower).
Gerontological Nursing, Third Edition
Patricia A. Tabloski
6. Anatomy and Physiology
• This coordinated system enables the
lung to perform its primary function of
rapidly exchanging oxygen from inhaled
air with the carbon dioxide in the blood.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
7. Normal Changes of Aging
• The following changes occur in lung
structure and function with normal
aging:
–Stiffening of elastin and the collagen
connective tissue supporting the lungs
–Altered alveolar shape resulting in
increased alveolar diameter
Gerontological Nursing, Third Edition
Patricia A. Tabloski
8. Normal Changes of Aging
• The following changes occur in lung
structure and function with normal
aging:
–Decreased alveolar surface area
available for gas exchange
– Increased chest wall stiffness
–Stiffening of the diaphragm
Gerontological Nursing, Third Edition
Patricia A. Tabloski
9. Respiratory Diseases Common in
Older People
• Age-related changes in the lungs, years
of exposure to air pollutants and
cigarette smoke, and presence of
comorbidities may predispose the older
person to respiratory diseases and
pulmonary dysfunction.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
10. Changes in Neurologic, Neuromuscular,
and Sensory Functions
• Aging results in neuron loss in the brain
and central nervous system
• Changes that can affect pulmonary
function
Gerontological Nursing, Third Edition
Patricia A. Tabloski
11. Changes in Neurologic, Neuromuscular,
and Sensory Functions
• Loss of muscle tone, exacerbated by
deconditioning, obesity, and sedentary
lifestyle
• Increased thoracic rigidity and
osteoporotic changes to the spine
(kyphosis)
Gerontological Nursing, Third Edition
Patricia A. Tabloski
12. Changes in Neurologic, Neuromuscular,
and Sensory Functions
• Use of medications that can cause
fatigue, depression of the cough reflex,
insomnia, dehydration, and
bronchospasm such as opioids,
diuretics, and beta-blockers
• Diagnosis of neurologic disease or
impairment (dementia, Parkinson’s
disease, stroke/ cerebrovascular
accident)
Gerontological Nursing, Third Edition
Patricia A. Tabloski
13. Common Respiratory Diseases
• Asthma
• Chronic Obstructive Pulmonary Disease
(COPD)
• Tuberculosis
• Lung cancer
Gerontological Nursing, Third Edition
Patricia A. Tabloski
14. Types of Respiratory Infections
• Pneumonia
• Acute bronchitis
• Pulmonary embolism
• Sinusitis
• Rhinitis
• Severe Acute Respiratory Syndrome
(SARS)
• Influenza
Gerontological Nursing, Third Edition
Patricia A. Tabloski
15. Asthma
• The gerontological nurse can greatly
improve the asthma management plan
by teaching the older patient and family
members about the peak flow meter
and diary so that asthma attacks can
be minimized or avoided.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
16. Chronic Obstructive Pulmonary
Disease
• The nurse should investigate
community resources and availability of
smoking cessation support groups.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
17. Chronic Obstructive Pulmonary
Disease
• Managing patients with COPD focuses
on the following broad goals:
–Careful assessment and monitoring of
the treatment of the disease
–Reducing risk factors (cigarette smoking
and environmental pollutants)
–Managing stable COPD and preventing
disease progression
Gerontological Nursing, Third Edition
Patricia A. Tabloski
18. Chronic Obstructive Pulmonary
Disease
• Managing patients with COPD focuses
on the following broad goals:
–Assessing and managing anxiety and
depression
–Mucolytic therapy
–Rehabilitation
–Managing exacerbations
Gerontological Nursing, Third Edition
Patricia A. Tabloski
19. Respiratory Infections
• Infections are a major cause of
respiratory illness.
• The gerontological nurse must be
cognizant of the atypical presentation
of respiratory infection in the older
person.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
20. Respiratory Infections
• Infections of the lower respiratory tract
are the sixth leading cause of death in
the United States and the fourth
leading cause of death in Americans
over the age of 65.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
21. Lung Cancer
• The symptoms of lung cancer are
vague and mimic the symptoms of
other pulmonary illness, making
diagnosis difficult.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
22. Lung Cancer
• Chronic cough, chest pain, shortness of
breath, fatigue, weight loss, and
frequent lung infections such as
pneumonia and bronchitis that do not
resolve with antibiotic treatment could
all be warning signs that indicate the
older person should be referred to the
primary care provider for further
testing.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
23. Changes in Immune Function
• For older people, the overall decline in
immune function results in increased
susceptibility to tuberculosis,
pneumonia, and influenza.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
24. Respiratory Infections
• When the gerontological nurse suspects
pneumonia, health assessment should
include checking vital signs, inspecting
the thorax, and auscultating the lungs.
• The primary care provider probably will
request a chest X-ray.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
25. Pulmonary Embolism
• Risk factors for formation of pulmonary
embolus include clotting disorders,
immobility, dehydration, recent
surgery, atherosclerotic changes in the
circulatory system, atrial fibrillation,
and obesity.
• Patients with leg swelling and duskiness
are at risk for pulmonary embolus.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
26. Pulmonary Embolism
• Hypoxemia and hyperventilation are
suggestive of the diagnosis of
pulmonary embolus.
• The gerontological nurse can play a
vital role in the prevention of
pulmonary embolus by identifying
persons at risk and reducing risk
factors.
Gerontological Nursing, Third Edition
Patricia A. Tabloski