Page 84 Complete Your CE Test Online - Click Here Here are some recommendations for patients to help them avoid or reduce the risk for lung disease [12,13]. ● ● Stop smoking! ● ● Avoid contact with others who are sick or ill including family members and friends as well as infants. ● ● Practice good hand hygiene. Wash hands frequently. Carry antibacterial hand wash and use it especially when in public settings. ● ● Receive the pneumonia vaccine if not contraindicated. ● ● Receive the influenza vaccine annually. ● ● Drink plenty of fluids to maintain hydration and keep lung secretions moist. ● ● Take ten deep breaths every hour to expand lungs and loosen secretions. ● ● Take antibiotics or antiviral medications as prescribed and take all of the medication as prescribed. Report adverse side effects promptly. Nursing consideration: Smoking contributes to all forms of lung disease. Help patients to quit smoking. Be aware of smoking cessation programs that patients can access. The following are some common lung diseases that are often found in older adults and treatment issues impacted by age. Pneumonia Pneumonia, an acute infection of the lungs, is the sixth leading cause of death in the United States [13]. Prognosis is usually good for persons with normal lung function. However, age-related changes in the respiratory system can make it difficult for older adults to recover. Unfortunately, mortality rates from pneumonia have not decreased significantly since the 1950’s [9]. Therefore, it is imperative that eligible persons receive the pneumococcal vaccine. Nursing consideration: The pneumococcal vaccine is recommended for all individuals aged 65 and older, and for all adults who are dealing with chronic illnesses or have suppressed immune systems. Currently, only about 25% of older patients with risk factors receive the pneumococcal vaccine. Nurses should provide information about immunization to all patients, especially for those who are 65 and older and those at high risk. The vaccine is about 80% effective, but effectiveness decreases over time [9]. Risk factors believed to increase older adults’ susceptibility to respiratory infections include the following issues [9]: ● ● Alcoholism. ● ● Antibiotic therapy in the past month. ● ● Aspiration. ● ● Diagnosed lung disease. ● ● Heart failure. ● ● History of nosocomial pneumonia in the past six months to one year. ● ● Hyperglycemia. ● ● Nasogastric tube feeding. ● ● Nursing home residence. ● ● Recent hospitalization. ● ● Smoking. ● ● Use of medications that dry secretions or increase gastric pH. ● ● Use of oxygen therapy. Nursing consideration: Pneumonia is treated with antibiotic therapy. However, drug-resistant pneumonia is becoming a concern as with many infections. Nurses must do everything they can to help decrease drug resistance and to discourage inappropriate antibiotic use. Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is chronic airway obstruction that is the result of emphysema, chronic bronchitis, asthma, or any combination of these diseases [13]. Smoking is probably responsible for more than 90% of diagnosed cases of COPD [9]. Other contributing factors include chronic respiratory infections, air pollution, and inflamed lung tissues [13]. COPD also compromises cardiac function, placing strain on the right ventricle, which is responsible for pumping blood into the lungs. Older patients are particularly vulnerable to compromised cardiac function as a result of COPD [9]. The earliest clue to the presence of COPD is an early morning cough that produces clear sputum. Periods of wheezing may occur if the patient has a “cold.” As the disease progresses, shortness of breath develops and becomes progressively worse [9,13]. The usual progression of COPD looks resembles the following [9,13]: ● ● There are usually no symptoms in the first ten years after the patient starts to smoke. ● ● At about ten years after starting to smoke, the patient develops a chronic cough that produces clear sputum. ● ● At the age of 40 or 50 the patient begins to exhibit dyspnea. ● ● At about the age of 50, patients begin to be vulnerable to respiratory infections with progressively longer recovery times. ● ● As COPD progresses, shortness of breath occurs with minor activities, such as making a bed. EBP alert! Older adult patients who suffer from COPD often have calluses on their elbows. This is the result of leaning over tables to stretch out their upper body so that more air can enter and leave the lungs during respiration [9,13]. Be alert for this sign. Also, watch for signs that your patients are attempting to stretch out their torsos to facilitate breathing. There is no cure for COPD. Treatment focuses on [9,13]: ● ● Careful assessment, evaluation, and monitoring of the patient. ● ● Reducing risk factors such as smoking and presence in locations that contain cigarette smoke or other lung pollutants. ● ● Managing stress and mental health problems. ● ● Mucolytic therapy. Lung cancer Shelby is 22 years old and recently began smoking cigarettes because she believes this will help her to lose weight. During a visit with her 75-year-old grandmother, Shelby lights a cigarette. Shelby’s grandmother reacts angrily and tells her to “put out that cigarette right now!” Shelby’s grandfather was a heavy smoker for 20 years and died from lung cancer at the age of 45. Lung cancer is the most common cause of cancer deaths in men and women. Research shows that lung cancer is responsible for more deaths than breast cancer, prostate cancer, and colon cancer combined [9,13]. Previously more predominant in men, lung cancer rates in women are rapidly increasing as the incidence of female smokers increases. Smoking is the biggest risk factor for developing lung cancer as the pollutants in tobacco smoke cause progressive lung cell degeneration. Lung cancer is about ten times more common in smokers than non- smokers, and 90% of patients with lung cancer are, or have been, smokers [9,13]. Symptoms of lung cancer mimic symptoms of other lung diseases. Chronic cough, shortness of breath, coughing up blood, fatigue, weight loss, and frequent lung infections are common symptoms [9,13]. Older patients may undergo surgical removal of the tumor, part of the lung, or the entire lung, depending on the extent of the tumor and the patient’s general condition. Radiation and chemotherapy may also be necessary [9,13]. Pulmonary embolism (PE) Pulmonary embolism (PE) is a complication of bedrest. Pulmonary embolism results in about 100,000 deaths every year and is the third leading cause of death in the U.S. [9]. Diagnosis of PE remains difficult and is often overlooked in older adults due to nonspecific and atypical presentations. Symptoms of PE include rapid respirations (tachypnea), dyspnea, chest pain, tachycardia, decreased cardiac output, and, possibly, shock [9,13]. Risk factors for pulmonary embolism include immobility, surgery, obesity, clotting disorders, dehydration, atherosclerotic changes in the older adult person’s circulatory system, and atrial fibrillation [9,13]. Many of these risk factors are found in older adults as part of normal aging changes. Educate patients how to avoid these complications, especially if you know they are facing upcoming surgery: ● ● Demonstrate and facilitate active range of motion exercises. ● ● If the patient is unable to perform active range of motion, teach caregivers how to perform passive range of motion exercises.