The respiratory system undergoes several changes as individuals age. It's essential for healthcare professionals to understand these changes to provide appropriate care. Let's look at some key aspects related to respiratory care, particularly in the context of conditions like COPD and Parkinson's disease.
Normal Changes in the Respiratory System in Older Adults
One of the normal changes associated with aging is the weakening of the respiratory muscles, leading to reduced respiratory capacity. This is an important consideration when caring for older adults with respiratory conditions.
Case Study: Senior Adult with Parkinson's Disease and COPD Exacerbation
Consider a senior adult client with Parkinson's disease and an exacerbation of COPD. Let's analyze some assessment findings and nursing interventions.
Assessment Findings
- 0715: Client sitting up in bed with oxygen 2.1 per nasal cannula (NC) on. Clear pink skin and warm and dry lungs with scattered wheezes throughout. The client complains of shortness of breath and states, "I feel so much better than I did a couple of days ago." Mild tremors were noted.
- 1140: Client is still in bed with oxygen 2.1 per NC on, scattered wheezes throughout, and coarse rhonchi, which are clear with coughing. Cough is productive of yellow phlegm. Skin cool and dry.
Key Considerations
Change in mental status, confusion, and agitation are symptoms of deterioration, and assessment findings indicate the client is having increased respiratory difficulty and pain.
Indicators of Improved Hemodynamic Status
Several vital signs and lab values can indicate an improvement in a client's hemodynamic status. Here are a few examples:
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- An increase in blood pressure (BP) from 112/68 mm Hg to 122/80 mm Hg indicates an improvement in hemodynamic status, as it shows that the client's blood vessels are constricting to maintain BP and tissue perfusion.
- An increase in urine output from 18 mL/hour to 45 mL/hour indicates an improvement in renal function and fluid balance, which is important for maintaining hemodynamic stability.
However, it's important to note that not all changes indicate improvement. For instance, a decrease in serum sodium levels can be concerning.
- Serum sodium decreased from 146 mEq/L (146 mmol/L) to 138 mEq/L (138 mmol/L) is not a finding that indicates improvement in hemodynamic status. Hyponatremia or low serum sodium levels can cause fluid shifts in the body leading to altered mental status, seizures, and cerebral edema, among other complications.
Assessing Respirations - Health Assessment for Nursing Students | @LevelUpRN
Advance Directives and End-of-Life Care
An advance directive details the client's preferences for end-of-life care, as well as the identification of a health care proxy. This ensures that the client's wishes are respected, whether they are receiving care at home, in a hospital, or another setting.
Additional Considerations
Other factors that may influence respiratory health and care include:
- Current pain medication.
- Dry mucosa.
- The presence of white sputum.
Table: Key Indicators and Considerations in Respiratory Care
| Indicator/Consideration | Significance |
|---|---|
| Weakening of respiratory muscles | Reduced respiratory capacity in older adults. |
| Increased blood pressure | Indicates improved hemodynamic status. |
| Increased urine output | Indicates improved renal function and fluid balance. |
| Hyponatremia | May cause fluid shifts, altered mental status, seizures and cerebral edema. |
| Advance directives | Details client's preferences for end-of-life care. |
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