1. Chapter 15 Respiration and Circulation

2. Factors 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

3. 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

4. Assessing Tissue Circulation Review the individual’s health history. Evaluate vital signs. Inspect the tissues. Note signs or symptoms.

5. Indications of Ineffective Tissue Perfusion Hypotension Tachycardia; decreased pulse quality Claudication Edema Loss of hair on extremities Tissue necrosis; stasis ulcers Dyspnea; increased respirations

6. Indications of Ineffective Tissue Perfusion (cont.) Pallor; coolness of skin Cyanosis Decreased urinary output Delirium (altered cognition and level of consciousness) Restlessness Memory disturbance

7. Interventions 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.

8. 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.

9. Measures 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.

10. Using Oxygen with the Elderly Monitor blood gases. Observe the patient for symptoms of carbon dioxide narcosis: –Confusion –Muscle twitching –Visual defects –Profuse perspiration

11. Using Oxygen with the Elderly (cont.) –Hypotension –Progressive degrees of circulatory failure –Cerebral depression

12. Interventions 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.

13. 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.

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