Chapter 15Respiration and Circulation

Chapter 15Respiration and Circulation

Factors That Can Alter Tissue PerfusionFactors That Can Alter Tissue Perfusion

• Cardiovascular Disease

– Arteriosclerotic heart disease, hypertension, congestive heart failure, varicosities

• Other Diseases

– Diabetes mellitus, cancer, renal failure

• Blood Dyscrasias

– Anemia, thrombus, transfusion reactions

Factors That Can Alter Tissue Perfusion (cont.)Factors That Can Alter Tissue Perfusion (cont.)

• Hypotension

– Anaphylactic shock, hypovolemia, hypoglycemia, hyperglycemia, orthostatic hypotension

• Medication Side Effects

– Antihypertensives, vasodilators, diuretics, antipsychotics

• Other Conditions

– Edema, inflammation, prolonged immobility, hypothermia, malnutrition

Assessing Tissue CirculationAssessing Tissue Circulation

• Review the individual’s health history.

• Evaluate vital signs.

• Inspect the tissues.

• Note signs or symptoms.

Indications of Ineffective Tissue PerfusionIndications of Ineffective Tissue Perfusion

• Hypotension

• Tachycardia; decreased pulse quality

• Claudication

• Edema

• Loss of hair on extremities

• Tissue necrosis; stasis ulcers

• Dyspnea; increased respirations

Indications of Ineffective Tissue Perfusion (cont.)Indications of Ineffective Tissue Perfusion (cont.)

• Pallor; coolness of skin

• Cyanosis

• Decreased urinary output

• Delirium (altered cognition and level of consciousness)

• Restlessness

• Memory disturbance

Interventions to Improve Tissue CirculationInterventions to Improve Tissue Circulation

• Maintain blood pressure within an acceptable range.

• Prevent and eliminate sources of pressure on the body.

• Remind or assist patients to change positions frequently.

• Prevent pooling of blood in the extremities.

• Encourage physical activity.

• Prevent hypothermia, maintaining body warmth.

Interventions to Improve Tissue Circulation (cont.)Interventions to Improve Tissue Circulation (cont.)

• Monitor drugs for the side effect of hypotension.

• Educate to reduce risks.

• Periodically evaluate physical and mental health to identify signs and symptoms of altered tissue perfusion.

Measures to Prevent Respiratory Infections in Older AdultsMeasures to Prevent Respiratory Infections in Older Adults

• Obtain vaccines.

• Avoid exposure to people with infections.

• Seek medical attention if signs of infection appear.

• Report changes in character of sputum.

Using Oxygen with the ElderlyUsing Oxygen with the Elderly

• Monitor blood gases.

• Observe the patient for symptoms of carbon dioxide narcosis:

– Confusion

– Muscle twitching

– Visual defects

– Profuse perspiration

Using Oxygen with the Elderly (cont.)Using Oxygen with the Elderly (cont.)

– Hypotension

– Progressive degrees of circulatory failure

– Cerebral depression

Interventions for Ineffective Breathing PatternsInterventions for Ineffective Breathing Patterns

• Instruct patient in breathing exercises.

• Control symptoms that could threaten effective respirations.

• Raise head of bed at least 30° when patient is lying down.

Interventions for Ineffective Breathing Patterns (cont.)Interventions for Ineffective Breathing Patterns (cont.)

• Instruct patient to turn, cough, and deep breathe at least once every 2 hours.

• Monitor rate, depth, and rhythm of respirations; coloring; coughing pattern; blood gases; and mental status.

SourceSource

• Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).