Managing Respiratory Problems

Lesson-6b

Let us pray: Make the sign of the cross…In the name of

the Father, and of the Son, and of the Holy spirit. Amen
Our Father…

FOCUS on the following

objectives:
To be able to provide interventions that increases the patient’s
safety, both real and perceived by:
1. Perform respiratory assessment frequently
2. Detect early changes in patient pulmonary function, thus
insuring prompt treatment.
 Lesson- 6b: Managing Respiratory
Problems
Check your knowledge:

DIRECTION: ALL ABOUT IDENTIFICATION; before you proceed

to the lesson proper, kindly answer first these 7 questions.
A. LET’S IDENTIFY THE FOLLOWING:
1. It is an acute infection of the lung parenchyma that commonly impairs gas exchange.
a. TB
b. COPD
c. Influenza
d. Pneumonia
2. True or False: Antitubercular therapy consists of INH, rifampin, pyrazinamide, &ofloxacin.
a. True
b. False
3. Also called airflow limitation disease. It is characterized by a reduced airway lumen from mucosal
thickening and increase airway compliance from the destruction of the lumen.
a. Influenza
b. Secondary Pneumonia
c. TB
d. COPD
4. Marked by an excessive production of tracheobronchial mucus sufficient to cause a cough for at least 3
months each year for 2 consecutive years.
a. Severe pneumonia
b. Bronchitis
c. Severe cough
d. Chronic bronchitis
5. Considered as the most common type of pneumonia found in older adults.
a. Severe Pneumonia
b. Primary Pneumonia
c. Viral Pneumonia
d. None of the above
6. True or false: The most common cause of bronchitis is cigarette smoking.
a. True
b. False
7. The most effective treatment of emphysema & chronic bronchitis is for the person to stop smoking and to
avoid pollutants.
a. True
b. False

Let’s move on..

 Time to Explore
Activity 1
Scenario: Your own lungs:
1. Do a breathing exercise. (do it 8 x) and see the effect.
Inhale through the nose deeply, hold it for a 5 second,
Then exhale…, release the air slowly through pursed lips breathing.
2. Do it as part of your morning exercise to help your lungs functionally healthy. (Just
inside your house) COVID-19 precautions.
3. Encourage other members of your family.

Essentials Questions? (don’t write)

1. What do the lungs do, and how do they function?
2. How that aging process affects the lungs structure and
function of the older adult?
3. What are we going to do with, or how are we going to
manage respiratory problems of the older adult?

Overview: Managing Respiratory Problems

The aging process slowly degrades the structure and function of the
respiratory system, putting older adults at greater risk for respiratory
disorders and diseases. Age-related anatomic changes that affects the
respiratory system include increased anteroposterior diameter of the chest
wall (reducing rib mobility and muscle contraction), and elevated ribs and
flattened diaphragm (causing decreased chest expansion). Also, because
of such factors as osteoporosis and vertebral collapse, kyphosis (spinal
curvature) advances with age. Mobility and physical activity also decline.
Stress, commonly well tolerated in the younger adult, causes fatigue and
dyspnea in an older person.
 Firming Up!
JUST a little DISCUSSION

Now! Let’s go down…

RESPIRATORY PROBLEMS
A. PNEUMONIA
 Is an acute infection of the lung parenchyma that commonly impairs gas
exchange.
 It can be classified in many ways;
 1. Based on microbiologic etiology
 Viral,
 Bacterial
 Fungal
 Protozoal
 Mycobacterial
 Mycoplasmal
 Rickettsial in origin.
 2. Based on location
 Bronchopneumonia – involves distal airways and alveoli
 Lobular pneumonia - part of the lobe
 or lobar pneumonia – entire lobe
 3. The infection can be classified as one of 3 types;
Primary pneumonia – results directly from inhalation or aspiration of a
pathogen, such as bacteria/ virus; it includes pneumococcal and viral
pneumonia.
Secondary pneumonia – follow initial lungs damage from a noxious
chemical or other insult (superinfection) or may result from
hematogenous spread of bacteria from a distant area.
Aspiration pneumonia – results from inhalation of foreign matter, such
as vomitus or food particles, into the bronchi.

Bacterial Pneumonia- is the most common type of pneumonia found in older

adults;
Viral Pneumonia - is the second most common type.

Aspiration Pneumonia – occurs in older adults from impaired swallowing ability and a
diminished gag reflex. (These changes can occur after a cerebrovascular accident or any
prolonged illness.
 Managing Respiratory Problems

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

o Also called chronic airflow limitation disease, COPD is characterized by a reduced airways
lumen from mucosal thickening and increased airway compliance from destruction of the lumen.
o In older adults, this disease most commonly takes 3 forms: emphysema, chronic bronchitis, and
asthma.
 Chronic Bronchitis
 is marked by excessive production of tracheobronchial mucus sufficient to cause
a cough for at least 3 months each year for 2 consecutive years.
 It results in hypertrophy and hyperplasia of the bronchial mucus glands,
increased goblet cells, ciliary damage, squamous metaplasia of the columnar
epithelium, and chronic leukocytic and lymphocytic infiltration of bronchial
walls.
 Widespread inflammation, airway narrowing, and mucus within the airways, all
producing resistance in the small airways and, in, turn, a sever ventilation-
perfusion mismatch.
 The severity of the disease is linked to the amount of cigarette smoke or other
pollutants inhaled and the duration of the inhalation.
 Emphysema
 Distends or ruptures the terminal alveoli, causing a loss of elasticity.
 These changes in lung tissue interfere with expiration.
 More prevalent in men than in women
 Many older adults have persistent productive cough, wheezing, recurrent
respiratory infections, and shortness of breath associated with chronic bronchitis.
 Symptoms usually develop gradually, and are commonly first noticed when the
patient has difficulty breathing in cold or damp weather.
 Older adults with a combination of chronic bronchitis and emphysema usually
have a long history of smoking.
 Asthma
 Is characterized by an increase in bronchial reactivity to a variety of stimuli,
which produces episodic bronchospasm and airway obstruction in conjunction
with airway inflammation.
 Some older patients have had asthma throughout their lives, and other first
develop it later in life.

Managing Respiratory Problems

TUBERCULOSIS (TB)
 o Is characterized by pulmonary infiltrates and by formation of granulomas with caseation, fibrosis,
and cavitation.
o 2x common in men than in women and 4x as common in nonwhites as in whites.
o Incidence is highest in people who live in crowded, poorly ventilated, unsanitary
Conditions, such those in some tenement houses and homeless shelters and those who live in
institutional settings.
o Diagnosis is commonly delayed in older adults because the typical presenting symptoms, fever
and night sweats, aren’t common seen.
o With age, diaphoresis decreases and alterations in body temperature commonly occur.

INFLUENZA
o Also called grippe or the flu, influenza is an acute, highly contagious infection of the respiratory
tract.
o It affects in all ages- but more serious in older people and people with chronic disease.

ACUTE RESPIRATORY DISTRESS SYNDROME

o A form of pulmonary edema that causes acute life-threatening respiratory failure,
o Is associated with various acute pulmonary injuries.
o It begins with increased permeability of the alveolocapillary membrane.
o Fluids accumulates in the lungs interstitium, alveolar spaces, and small airways, causing the lung
to stiffen. Ventilation becomes impaired, prohibiting adequate oxygenation of pulmonary
capillary blood.
o Severe ARDS can cause intractable and fatal hypoxemia; however, people who recover may have
little or no permanent lung damage.
o Older adults who have decreased lung elasticity and fewer functioning capillaries because of
aging, are more likely to develop ARDS after a pulmonary incident.
 Power Booster

Activity 2 (Kindly answer. Provide another sheet of paper)

Managing Respiratory Problem:
As a nurse what is your nursing intervention and plan of care to meet the goal of the following conditions/
problems:

Problems Etiology/ Assessment Diagnos- Treat- Compli- Nursing Patient

Causes Finding tic test ment cations Interven- Teaching
tions

Pneumonia

COPD

TB

Influenza

ARDS
 Time to Reflect
Read and Do

B. Assignment
Continue to read the following:
The most important function of the lungs is a. How to prevent pneumonia
to take oxygen from the environment and b. How to overcome SOB
transfer it to the bloodstream. c. How to perform chest
physio-therapy.

Read in advance the next topic

Let us pray: Make the sign of the cross…In the name of

the Father, and of the Son, and of the Holy spirit. Amen
Glory be to the Father…
Managing Neurologic Problems
Lesson-6c

Let us pray: Make the sign of the cross…In the name of

the Father, and of the Son, and of the Holy spirit. Amen
Our Father…

FOCUS on the following

objectives:
To be able to provide interventions that increases the patient’s
safety by;
1. Perform neurological assessment frequently
2. Recognize neurological disorder, thus insuring prompt
treatment.
3. Help the elderly patients reach their highest level of
functioning and independence.

Managing Neurologic Problems

Lesson-6c
 Check your knowledge:

DIRECTION: MULTIPLE CHOICE:, before you proceed to the lesson

proper, kindly answer first, these 5 questions.
A. MAKE YOUR BEST CHOICE:
1. It is a progressive degenerative disorder of the cerebral cortex causes gradual loss of memory with loss of
at least one other cognitive function, such as language, abstraction, or spatial orientation.
a. Dementia
b. Alzheimer’s disease
c. Parkinson’s disease
d. CVA
2. True or False: Herpes zoster is caused by the reactivation of latent varicella virus called chickenpox.
a. True
b. False
3. Transient Ischemic Attacks are sudden, brief episodes of neurologic deficit caused by focal cerebral
ischemia
a. True
b. False
c. None of the above
4. Transient Ischemic Attacks (TIAs) significantly increase a person’s risk of CVA.
a. True
b. False
c. None of the above
5. This results from impaired circulation in one or more blood vessels of the brain, usually due to thrombosis,
embolism, or hemorrhage.
a. TIAs
b. CVA
c. None of the above

and Thank you for being honest!

Let’s move on..

Time to Explore
Activity 1
Try to see or look at the anatomy of the brain, explore the different parts and its
functions.

Essentials Questions?

1. How are memories stored and retrieved? ...

2. What is intelligence? ...
3. How do specialized parts of the brain integrate with one another?

Overview: Managing Neurologic

Problems
The neurologic system is the body’s communications network. It
regulates every mental and physical function during a person’s lifetime,
from birth to death. This dynamic control system coordinates and
organizes all body systems. For this reason, a change in the neurologic
system affects every body system.

As the body ages, the neurologic system changes. The number of

 Firming Up!
JUST a little DISCUSSION

Now! Let’s go down…

Common Neurologic Problems

1. HERPES ZOSTER
 Also known as shingles. It is a virus that causes acute inflammation of
the nerves of the skin, eye, and ears.
 As each nerve emanates from the spine, it bands and branches around the
body to innervate a skin called dermatome.
 Produces vesicular skin lesions in a particular dermatome.
 The rash erupts along the course of the affected nerve fibers, covering
the skin in one or several of the dermatomes.
 The thoracic and lumbar dermatomes are the most commonly affected,
but others, such as those covering the cervical and sacral areas can also
be affected. Affected dermatomes can vary and overlap.
 The infection found primarily in adults over age 50, seldom recurs.
Weakening of the immune system, which comes with age, is believed to
contribute to the increased incidence of herpes zoster in older people.
 Other factors that compromise the immune system, such as
chemotherapy and radiation can activate the HZ.
 This HZV is more severe in the immune compromised patient but is
seldom fatal.

2. ALZHEIMER’S DISEASE
 Is a chronic condition characterized by declining intellectual capacity,
and is the most common form of dementia.
 This progressive degenerative disorder of the cerebral cortex (frontal
lobe) causes gradual loss of memory with loss of at least one other
cognitive function, such as language, abstraction, or spatial orientation.

Let’s go further… Alzheimer’s

 One in ten people over age 65and almost half of the people over age 85
have Alzheimer’s disease. Because this is primary progressive dementia,
the prognosis for a person with AD is poor.
 Typically, patient’s die of debilitating brain disease 2 to 15 years after
the onset of symptoms. The average duration of the illness before death
is 8 years.
 3. PARKINSON’S DISEASE
 One of the most common disabling diseases. PD is a slowly progressive,
chronic, degenerative condition.
 It characteristically causes progressive muscle rigidity, postural
instability, bradykinesia, and resting tremors.
 As the person loses mobility, he may experience injury from falls and
skin breakdown. Deterioration progresses for an average of 10 years,
culminating death, which usually results from aspiration pneumonia or
another infection.
 PD occurs throughout the world in all racial and ethnic groups. It strikes
1in very 100 people over age 60- men more than women.

Power Booster
Activity 2 (Kindly answer. Provide another sheet of paper)
Managing Respiratory Problem:
As a nurse what is your nursing intervention and plan of care to meet the goal of the following conditions/
problems:

Problems Etiology/ Assessment Diagnos- Treat- Compli- Nursing Patient

Causes Finding tic test ment cations Interven- Teaching
tions

ALZHEIMERS
DISEASE

PARKINSON’S
DISEASE

Problems Etiology/ Assessment Diagnos- Treat- Compli- Nursing Patient

Causes Finding tic test ment cations Interven- Teaching
tions

HERPES
ZOSTER
 Time to Reflect
Read and Do

1. The human brain is still very much a mystery to science.

The average human brain has about 90 billion neurons that make 100
trillion connections or synapses. Scientists believe this staggering
number of neurons is responsible for the traits that make us uniquely
human: our thoughts, memories and emotions.

Recent technological advances in functional magnetic resonance

imaging, optogenetics and whole-brain imaging have made the brain accessible in ways that previous
generations of neuroscientists could only dream of. Yet, many pieces are still missing from the puzzle.
There are still unsolved questions in neuroscience. – regarding the power of the brain. (eg. How is
information encoded in the neurons?)

2. Assignment: Continue reading the following topics;

a. Herpes Zoster
b. CVA
c. Transient Ischemic Attack
3. They are included in the quizzes and examinations.

Let’s Pray: Make the sign of the Cross.. Glory Be

Managing Musculoskeletal
Problems

Let us pray: Make the sign of the cross…In the name of

 Managing Musculoskeletal
Problems

Check your knowledge:

DIRECTION: MAKE YOUR BEST CHOICE: Select what is the right answer of the
following musculoskeletal problems.

1. A metabolic bone disorder, the rate of bone resorption accelerates while the rate of bone
formation decreases.
a. Arthritis
b. Osteoarthritis
c. Osteoporosis
2. True or False: Falls are the common cause of hip fracture in older adults.
a. True
b. False
3. A shortened leg and outward rotation are the classic signs of a fractured hip.
a. True
b. False
4. The cause of primary osteoporosis is unknown. But other contributing factors may
include except:
a. Inadequate calcium intake
b. Sedentary lifestyle
c. Liver disease
d. Estrogen deficiency
5. This cause the deterioration of joint cartilage and formation of new bone at the margins
and subchondral areas of the joints.
a. Arthritis
b. Osteoarthritis
c. Rheumatism
d. Osteoporosis

Let’s move on..

Time to Explore
Activity 1

Let’s have fun by simply recalling the parts of the human skeleton. Can you identify the
parts?

Essentials Questions?
1. Did you know how many bones the adult human has?
2. Which human bone is the biggest and smallest?
3. What makes my bones fragile?

Overview: Managing
Musculoskeletal Problems

The aging process creates profound changes in the musculoskeletal system. The number
Managing Musculoskeletal Problems
Lesson-6d

Firming Up!
JUST a little DISCUSSION

Ok ! Are you ready!

Musculoskeletal Problems
1. OSTEOARTHRITIS
 The most common arthritis- causes deterioration of joint cartilage and formation of
new bone at the margins and subchondral areas of the joints.
 The chronic degeneration of osteoarthritis results from a breakdown of
chondrocytes.
 It occurs most common in weight-baring joints, especially in the hips and knees.
 It occurs equally in both sexes.
 More than half of all people over age 30 have some features of primary
osteoarthritis.
 It affects 83-87% of people between age 55 and 64.

2. OSTEOPOROSIS
 A metabolic bone disorder, the rate of bone resorption accelerates while the rate of
bone formation decelerates – result in decrease bone mass.
 The bones lose calcium and phosphate, becoming porous, brittle, and abnormally
vulnerable to fracture. The immobility that follows a fracture can exacerbate
osteoporosis.
 Let’s go further……
OSTEOPOROSIS
 It may be primary or secondary to an underlying disease.
 Primary osteoporosis classification:
a. IDIOPATHIC
b. TYPE I
c. TYPE II
 IDIOPATHATIC OSTEOPOROSIS – affects children and adults.
 TYPE I OSTEOPOROSIS – (post-menopausal) usually affects women
ages 51- 75. Its related to the loss of estrogen’s protective effect on
bone and result in trabecular bone loss and some cortical bone loss.
Vertebral and wrist fractures are common with this type.
 TYPE II OSTEOPOROSIS - (Senile) occurs most commonly between
ages 70 and 85. It causes trabecular and cortical bone loss, typically
leading to fractures of the proximal humerus, proximal tibia, femoral
neck, and pelvis.

4. HIP FRACTURE
 The most frequent fall-related injuries resulting in hospitalization- are a leading cause
of disability among older adults.
 They occur in over 200,000 people each year ad, by the age of 80, one in 5 women
will suffer a hip fracture.
 Are one of many events that may permanently change your patient’s level of
functioning and independence.
 Fractures in an older person are related to falls, cancer metastasis, osteoporosis, and
other skeletal disease.
 The most common fracture site is the head of the femur, with women having a higher
incidence than men.
 Older adults’ bones fracture more easily because they’re more brittle. They also heal
more slowly, increasing he risk of immobility complications.

5. HIP REPLACEMENT
 Also known as arthroplasty, involves the surgical removal of diseased parts of
the hip and replacement with a synthetic prothesis.
 It restores mobility and stability and relieves pain.
 Other benefits- include improved, pain-free mobility, and an increased sense
of independence and self-worth.

Power Booster

Activity 2 (Kindly answer. Provide another sheet of paper)

Managing Musculoskeletal Problem:
As a nurse what is your nursing intervention and plan of care to meet the goal of the following
conditions/ problems:

Problems Etiology/ Assessment Diagnos- Treat- Compli- Nursing Patient

Causes Finding tic test ment cations Interven- Teaching
tions

OSTEOPOROSIS

OSTEOARTHRIT
IS

HIP FRACTURE

Time to Reflect
Read and Do
 1. Bones...
The skeleton acts like a shield for our vital organs, such as our brain and heart. The skull protects
the brain, the ribcage protects the lungs and heart, and the backbone wraps all the way around the
spinal cord.

Our bones play a vital function in our body. So, we must take good care of it. If there is fracture,
it takes 1-2 months for a broken bone to heal.

2. Assignment: Continue reading the following topics;

a. Isometric Exercises
b. Hip Replacement
c. And the rest of the topics.
3. All these are included in the quizzes and examinations.

L t us pray: Make the sign of the cross…In the name of

the Father, and of the Son, and of the Holy spirit. Amen
Glory be to the Father…