Gerontological Nursing, 4e (Tabloski) Chapter 16 The Respiratory System

Gerontological Nursing, 4e (Tabloski) Chapter 16 The Respiratory System 1) Which respiratory system assessment finding of an older client does the nurse determine is most concerning? 1. Coughing during the night while sleeping 2. Purposefully sitting up straighter to get a deep breath 3. Shortness of breath when crossing a large parking lot 4. Three episodes of diagnosed bronchitis in twelve months Answer: 1 Explanation: 1. Coughing during sleep can be a sign of asthma, heart failure, or other condition, but it is not normal and must be investigated. 2. Decreased muscle tone, increased abdominal girth, thoracic rigidity, and other issues can lead to incomplete chest expansion. The client who is aware of this may purposefully sit up straighter to take a deeper breath. 3. There is an increase in stiffness of the chest wall, decreased vital capacity, and increased residual volume occur with aging. Walking a significant distance can result in shortness of breath. If the client becomes short of breath when walking in the house, that is cause for concern. 4. Immune changes can cause increased frequency of respiratory infections. If infections occur more closely together or the client just never seems to get well, this is cause for increased concern. Page Ref: 385-390 Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nurs/Integ Conc.: Nursing Process: Assessment Learning Outcome: 1. Define normal changes of aging of the respiratory system. 1 Copyright © 2019 Pearson Education, Inc. 2) The nurse plans teaching for the older adult client about prevention of respiratory illnesses. What is the most important strategy for the client to use? 1. Obtain vaccinations as scheduled 2. Reduce use of inhaled tobacco 3. Wear a mask when mowing the lawn 4. Use hand sanitizer after shopping Answer: 1 Explanation: 1. Getting a flu vaccination annually and pneumonia vaccination beginning at the age of 65 are key to keeping the immune system healthy against diseases. Flu and pneumonia can result in death in the older adult client. 2. Elimination of smoking is recommended. This includes all smoking including tobacco, electronic cigarettes, and other inhaled, recreational substances. 3. If the client is allergic to substances found in the lawn, then this is advisable. The client should avoid allergens. airborne toxins, and air pollution. This is not a necessary precaution for many adults. 4. Washing hands frequently and avoiding others who are sick is ideal. While shopping, the client may have come into contact with many infectious sources. While using hand sanitizer after the trip is good, depending on the time of year, this may not be a strict enough strategy to prevent infection. Page Ref: 387 Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nurs/Integ Conc.: Nursing Process: Planning Learning Outcome: 1. Define normal changes of aging of the respiratory system. 2 Copyright © 2019 Pearson Education, Inc. 3) An older client is scheduled for diagnostic testing. What is the best indication for the client to undergo pulmonary function tests? 1. Chest x-ray demonstrating bilateral infiltrates 2. Abnormal arterial blood gas analysis results 3. The presence of hemoptysis and fatigue 4. Chronic wheezing with an undiagnosed cause Answer: 4 Explanation: 1. A chest x-ray will give information related to the pulmonary condition. Infiltrates often indicate pneumonia or similar process. If this information is not specific enough, a CT scan is the next diagnostic test the nurse anticipates. 2. An abnormal ABG is treated with medications or ventilation assistance. Further testing is not warranted until the imbalance is corrected. 3. Hemoptysis and fatigue are indications for a battery of respiratory tests, including CT or PET scan or bronchoscopy. A pulmonary function test may be included, but it is not the best indication for this test. 4. Pulmonary function tests are the most reliable way to diagnose asthma and differentiate it from other illness such as COPD. Measurement of air during expiration is used in the differential diagnosis. Page Ref: 413 Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nurs/Integ Conc.: Nursing Process: Planning Learning Outcome: 3. Discuss the nurse's role in caring for older adults with respiratory problems.