COMMUNITY HEALTH NURSING

DEPARTMENT

Aged Related Changes

The walls of alveoli: thinner

The number of capillaries: decline
The alveoli duct: stretched
Causing: the alveoli enlarge or tear
Costal cartilage: rigid and stiff
Increasing the need to use the accessory
muscle
The intercostals muscle: atrophy and weaker
Increasing the work of breathing
Respiratory muscle strength: weaker
The anteroposterior chest diameter increases

Aged related changes

Lung

volumes: do not inflate well,

exhales incompletely, residual volume
increase, decrease vital capacity, the
blood coming into the lung poorly O2
The action chemoreceptor: less
responsive changes in O2 and pH level,
more vulnerable to disease affecting the
respiratory system, pneumonia and
emphysema
The ciliary action decreases: the difficulty
raising secretion

Problems: COPD

Disorder: Chronic bronchitis and

emphysema or both
Risk factors: smoking, air polution,
exposure to irritants through job-related
activities, genetic
Symptoms: dyspnea on exertion, easy
fatigue, persistent cough

COPDmanagement

Medication: bronchodilator
(lower dosage)
O2 therapy: low concentration
(< 1-2 L/mnt)): higher O2
inhibit respiratory action
Prevention of infection:
corticosteroid to control
inflammation and antibiotic to
treat bacterial infection

COPD: Emphysema

Irreversible change in the structure of

alveoli
The walls of alveoli: damages and break
down, large air space, disturbance on
gas exchange
The lung elasticity lose: difficulty in
inspiration, expiration becomes
prolonged and difficult, resulting in an
expiratory wheeze

EmphysemaSign and
symptom

Dyspnea
Fatigue (after any activity)
Persistent productive cough
Prolonged expiration with distention of
the neck vein
Use the accessory muscle when
breathing
Increase in pulse and RR

Emphysema: diagnostic
findings

Chest radiography: hyper inflation of the

lung fields
Pulmonary function study: difficulty with
expiration
Arterial blood gases: high CO2 and low
O2 levels

COPD: Chronic Bronchitis

Persistent

inflammation on the lining of the

bronchial tubes
Caused by exposure to an irritant (cigarette
smoking), infection, allergens, airborne
irritant (chemicals)
The inflammation responses: an increased
secretion of mucus: the airway becomes
smaller
The cilia function decrease: coughing less
effective, mucus stagnates in the airway:
increases the incidence of bacterial infection

Bronchitis chronicsigns and

symptoms

The expectoration of thick, white mucus

A cough after a cold or minor upper
respiratory infection
Coughing in the morning after arising
and in the evening
The sputum becomes yellow, thick, and
purulent

Nursing Process of COPD

Assessment:

dyspnea at rest or activity,

fatigue, difficulty sleeping, poor appetite,
anxious, confuse, irritable
A history of illness: the amount of cigarette
smoked, how long smoked, still smoking,
consider other irritants
The presence of cough and quality of
sputum
Pulse (rapid) and RR (prolonged and
shallow)
The use of accessory muscle
Skin color: pale or cyanosis on nail and lips

NP of COPDDiagnosis

Impaired gas exchange

Ineffective airway clearance
Altered nutrition
Risk for infection
Ineffective breathing pattern
Ineffective individual coping
others

NP of COPDplanning

Pulsed-lip breathing: taking a slow, deep

inspiration at least 3 second through the
nose followed by prolonged expiration
through pursed lips at least 6 second)
Diaphragmatic breathing: moving the
abdomen outward while taking a deep
inspiration, slowly contraction the
abdominal muscle when expiration
At least twice each day

NP of COPDplanning
An

upright position using 2 or more pillows

Increase fluid intake (if condition permits); 6-8
glasses per day
Postural drainage and percussion in the morning
and the afternoon to help loosen and bring up
secretion
Frequent feeding
Relaxation technique
Monitoring sign of infection: RR 26 to 48 (indicator
for bacterial pneumonia); Odorous, yellow and
green sputum indicates respiratory infection

NP of COPDEvaluation

Less dypnea
Tolerates greater activity
Appetite improved: Progressive weight
gain
Incorporates interventions to life style to
decrease risk for infection

Problem: Asthma

Intermittent obstructive airway,

characterized spasmodic constriction of
bronchi and inflammation
Causes: allergy or non allergic (bacterial
or viral respiratory infection, emotional,
or non-specific irritants)

Problem: Pneumonia

An infection or inflammation of the lung

The alveoli fill with pus and exudates
The most common type of pneumonia
affecting older adult is bacterial
pneumonia
Elderly at risk: bed rest, frail elderly,
depressed cough reflex, taking
sedatives or opioids

PneumoniaAssessment

Vital signs (RR, pulse rate, painful

cough
Sputum (amount, color, consistency)
Breathing status (breath sound,
wheezing, crackles, or gurgle)
Cyanosis: nail. Lip, mucosa
Activity tolerance
Confuse

Pneumonia: caring

Influenza vaccination
Semi-Fowler position
Frequent change position (every 2
hours)
O2 therapy
Monitor mental status, restlessness,
confusion (a decreased O2 supply to the
brain)
Monitor respiratory function (rate, depth,
easy)

Pneumonia: caring

If not contraindicated, a high fluid intake:

6-8 glasses
Humidified air or a high humidity mask
Breathe deeply every 1-2 hours
Chest physiotherapy (percussion or
postural drainage)
Plan activities with frequent rest periods

Problemsleep apnea

The absence for breathing of 10

seconds or longer during sleep
A neurological irregularity
The primary symptom is omission of
breathing for 10 second to 2 minutes (in
extreme cases)
Caused by an obstruction in the air way

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