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PREP FOR SUCCESS- RESPIRATORY
(is the least affected by age related changes, most are caused by lifestyle and environmental factors) What are the functions of respiration? The primary functions of respiration are to supply O2 and to remove CO2 from the blood Summarize the main point regarding Cumulative effects regarding the respiratory system and older adults :
Cumulative effects regarding the respiratory system and older adults: As with other
physiologic functions, it is difficult to distinguish the effects of age-related changes
from those caused by disease processes and external influences, such as environmental
factors. Although these influences occur throughout the life span, their cumulative
effects become more pronounced in older adults, especially when combined with risk
factors. Age-related changes of the respiratory system are summarized in this section
and effects of these changes are discussed in the section on Functional Consequences.
A&P Reminder: UPPER RESPIRATORY SYSTEM Nose, pharynx and larynx AGE-RELATED changes
- degenerative changes in connective tissue causing the nose to have a retracted columella (the lower edge of the septum) and a poorly supported, downwardly rotated tip
- Diminished blood flow to the nose, causing the nasal turbinates to become smaller
- Thicker mucus in nasopharynx due to degenerative changes in submucosal glands
- Stiffening of trachea due to calcification of cartilage
- Blunted cough and laryngeal reflexes Atrophy of the laryngeal nerve endings FUNCTIONAL CONSEQENCES: The nose and other upper respiratory structures are affect by age-related changes that can affect comfort and function. A&P Reminder: CHEST WALL/Musculoskeletal _____________________________
AGE-RELATED changes
- The rib cage and the vertebral musculoskeletal structures are affected by the same kind of age-related changes that affect other musculoskeletal tissue: the ribs and vertebrae become osteoporotic
- The costal cartilage calcifies,
- and the respiratory muscles weaken.
- Because of these age-related processes, the following structural changes occur: kyphosis (i.e., an increased curvature of the thoracic spine), shortened thorax, chest wall stiffness, and increased anteroposterior diameter of the chest. respiratory efficiency. FUNCTIONAL CONSEQENCES Overall, these age-related changes compromise chest wall expansion, and older adults need to expend more energy to achieve A&P Reminder: LUNGS _________________________________________________
Define Elastic Recoil: Elastic recoil is the characteristic that keeps the airway open during inspiration by resisting expansion and maintaining a positive pressure across the
Susceptibility of pneumonia, respiratory infections, and COVID-19. TOBACCO USE Tobacco smoking causes detrimental effects through multiple heat and chemicals action on the respiratory system and other organs. Harmful Physiological Effects:
- Bronchoconstriction
- Impaired air flow
- Inflammation of the mucosa throughout the respiratory tract
- Inhibited ciliary action
- Leading to increased coughing and
- Mucous secretions
- Most serious consequences are tobacco is significantly increased risk of developing cancer, Diseases of the lungs, Cardiovascular system, and many other systems How many years of life are lost from smoking? Male 12 years and women 11 years Consequences of smokeless tobacco: Smokeless tobacco has been linked to all the following serious consequences: lung injury and respiratory disease; cancers of the mouth, pancreas, pharynx, and esophagus; and increased risk of stroke, diabetes, and heart disease Which organ is effected from nicotine-drug interactions? Liver or kidney (p. 448) Name 3 occupations that can jeopardize respiratory function: Firefighters, miners, traffic controllers, shipyard workers, rubber workers, aluminum workers, iron and steel foundry workers, tunnel and street repair workers, asbestos workers, quarry workers, farmers, agricultural workers, grain handlers, construction workers, paper mill workers, (workers exposed to the following: dust, fumes, gases, nickel, arsenic, beryllium, chromium, or radiation)
RISK FACTORS for Impaired Respiratory function OR Pneumonia : frailty, dehydration,
malnutrition, substance abuse, impaired functioning, or compromised immunity.
1. Decreased immune function.
2. Cumulative effects of exposure to pollution.
3. Age related changes in the respiratory tract.
4. Diminished physiologic reserve.
5. The immune system
Name 3 types of Pneumonia : Pneumonia is an infectious disease of the lower respiratory system with a wide range of manifestations and causative organisms. Older age increases the risk for increased incidence of and mortality from pneumonia, Dysphagia is a major risk for aspiration pneumonia and commonly occurs in older adults with conditions such as stroke, dementia, Parkinson disease, and postsurgical care. Three types of Pneumonia and their manifestations include:
1. Bacteria pneumonia.: Tachypnea, delirium, failure to thrive, malaise and falls.
2. Viral pneumonia: Bronchospasm and recent onset dyspnea.
3. Aspiration pneumonia: Gradual course and low course fever.
Summarize the OVERALL effects (functional consequences) regarding the respiratory system: (Table 22-1 on p. 448) COPD Back to your book: CONSEQUENCES of COPD:
- Shorter life expectancy
- Longer and more frequent hospitalizations
- Increased risk for being discharged to nursing facilities
- And impaired health related quality of life What is the 6th^ vital sign for patients with COPD? Dyspnea is the 6th^ vital sign in people w/ COPD COPD is a term that refers to a progressive and heterogenous syndrome that is characterized by persistent airflow obstruction and breathing-related problems.
Rather than presenting with w/ a cough, elevated temp. and purulent sputum, older adults may have subtler and non-specific disease manifestation Instead, list what may (or may not) be seen during assessment:
- Even initial chest radiography may not provide accurate diagnostic information
- In addition, a mental status or another alteration in functional status,
- such as falls
- or incontinence, may be a major clue to pneumonia and collect info. NORMAL ASSESSMENT What might you find on physical assessment of a normal older adult’s respiratory status compared to a younger person? (p. 452)
- slight increase in the normal respiratory rate which ranges from 16 to 24 respirations per min
- increased anteroposterior diameter
- forward-leaning posture b/c of kyphosis
- increased resonance on percussion
- diminished lung sounds
- increased presence of adventitious sounds in the lower lungs RESPIRATORY HOSPICE CRITERIA (Prognostic Indicators) What screening tool works for the respiratory system? Palliative performance scale Define Dyspnea Shortness of breath What else is used to qualify a patient for the hospice benefit? (see video)
- Disabling dyspnea at rest (how they feel no matter how they look)
- Poor response to bronchodilator’s or steroids
- Affects quality of life: ADL’s disabled
- Increasing visits to ED/Clinic or hospitalizations for pulmonary infections or respiratory failure (3 visits in one year) Summarize history assessment questions for overall respiratory function (Box 22-3)
Immunosenescence, defined as the age-related alterations in the immune system, affects
respiratory function, even in healthy older adults. Evidence-based examples of the
serious risks and detrimental effects of smoking include the following:
Half of all smokers who continue to smoke will die from smoking-related diseases.
In the United States, tobacco use is responsible for nearly 20% of deaths overall, 30%
of all cancer deaths, and 80% of lung cancer deaths.
Men and women who smoke will shorten their lives by about 12 and 11 years,
respectively.
About two out of three people diagnosed with lung cancer are 65 or older, with the
average age at time of diagnosis being 70 years.
Smoking increases the risk for developing all the following types of cancers: oral
cavity, larynx, pharynx, esophagus, lung, liver, kidney, urinary bladder, stomach,
