103. CCA Study Notes: Respiratory System Disorders and Supporting Clients

The Big Picture

The respiratory system includes the lungs and the airways leading to them. It brings oxygen into the lungs and removes carbon dioxide from the body.

Respiratory disorders interfere with this process. Some make breathing difficult. Others involve infections that affect the lungs or airways and sometimes spread to other people.

When supporting someone with a respiratory disorder, the CCA needs to notice breathing problems, follow infection precautions and the care plan, and know when concerns need immediate action.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

What the Respiratory System Does

The respiratory system consists of the lungs and their airways.

The airways allow the body to:

• bring oxygen into the lungs
• remove carbon dioxide from the body

Respiratory disorders interfere with these functions and can become life-threatening.

Asthma

Asthma is a respiratory disorder that causes recurring episodes of breathing difficulty.

A person with asthma may experience:

• intermittent spasms of shortness of breath, called paroxysmal dyspnea
• wheezing while breathing in, breathing out, or both
• narrowing of the bronchi
• coughing
• thick mucus in the airways
• a rapid pulse
• perspiration ⓘ
• cyanosis

Cyanosis means the skin has a blue tinge.

Wheezing and shortness of breath can be frightening for the client.

Common Causes of Asthma Attacks

Asthma attacks may be caused by:

• allergies
• exercise
• cold air
• outdoor activity during hot, humid weather
• smog
• emotional stress

Clients with asthma may use medications to manage the disorder. Severe attacks may require treatment in an emergency department.

CCA action: You must call emergency services as soon as you see a client with asthma in distress ⓘ.

Clients and their families also need teaching about preventing attacks because repeated asthma attacks can damage the respiratory system.

Pneumonia

Pneumonia is an infection of lung tissue.

The lungs contain tiny air sacs called alveoli. With pneumonia, alveoli in the affected area fill with pus, mucus, and other fluid.

This prevents normal exchange of oxygen and carbon dioxide and causes too little oxygen in the blood.

Causes and Risks

Both bacteria and viruses can cause pneumonia.

Bacterial pneumonia can be life-threatening for clients who:

• are immobile ⓘ
• are older
• have a decreased cough reflex

Viral pneumonia can cause serious breathing complications. Some people require hospitalization, and pneumonia can cause death.

Pneumonia is identified as the eighth leading cause of death in Canada.

Influenza can also lead to pneumonia, especially in older people and clients with challenged immune systems.

Signs and Symptoms

Pneumonia may begin gradually or suddenly.

Signs and symptoms include:

• shaking
• chills
• severe chest pain
• coughing
• rust-coloured or greenish sputum
• high temperature
• rapid breathing
• rapid pulse
• cyanosis
• confusion

Sputum is phlegm or mucus that is coughed up.

Supporting a Client With Pneumonia

Follow Standard Practices while providing care.

A physician may order Transmission-Based Practices to prevent pneumonia from spreading to other people. These precautions are especially important in facilities where frail clients with compromised immune systems are vulnerable to infection.

Support workers need to know the required precautions and strictly follow isolation procedures.

Immunizations against pneumonia are available for clients at high risk.

Acute Bronchitis

Acute bronchitis is inflammation of the bronchi. The bronchi are the large airways that enter the lungs.

Bacteria or viruses can cause acute bronchitis. It may last several days or weeks.

A client with acute bronchitis usually has a cough that produces sputum.

Green mucus may indicate a bacterial infection, but only a laboratory test confirms whether the infection is bacterial or viral and determines the treatment the physician will prescribe.

Other symptoms may include:

• fever
• fatigue ⓘ
• shortness of breath
• chest pain

Bacterial bronchitis is treated with antibiotics. Viral bronchitis usually disappears on its own.

Report: If you observe blood-tinged sputum while supporting a client, report it immediately to your supervisor.

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a persistent lung disorder that blocks the airways and makes breathing difficult.

COPD refers to:

• chronic bronchitis
• emphysema

These conditions often occur together.

COPD gradually becomes worse over time.

It is identified as the fourth leading cause of death worldwide and was expected to move to third place by 2030. Among Canadian women, COPD causes more deaths than breast cancer.

Causes of COPD

Smoking is the most common cause of COPD.

Another cause is long-term exposure to:

• chemical fumes
• certain dusts

Managing COPD

COPD cannot be cured, but it can be controlled.

Management may include:

• quitting smoking
• avoiding secondhand smoke
• medications that open the airways
• metered-dose inhalers, also called MDIs or puffers
• breathing exercises
• oxygen therapy
• increased fluid intake to make secretions ⓘ less thick
• efforts to prevent respiratory tract infections

If a respiratory tract infection develops, prompt treatment is necessary.

Chronic Bronchitis

Chronic bronchitis is persistent inflammation of the bronchi.

Large amounts of mucus form inside the bronchi, and the bronchial walls become swollen.

The mucus is thick and difficult to cough up. When it cannot be completely cleared, it blocks the airways and makes it harder for air to move into and out of the lungs.

As a result, the body cannot receive normal amounts of oxygen.

The extra mucus also provides a place for pathogens to grow, which increases the risk of infection.

Symptoms of Chronic Bronchitis

Coughing is the first and most common symptom.

The client may also:

• have difficulty breathing
• tire easily
• eventually have difficulty breathing even while resting

Emphysema

Emphysema damages the walls of the alveoli.

The damaged alveoli become less elastic. They no longer expand and shrink normally during breathing.

When the client breathes out, some air remains trapped inside the alveoli instead of leaving the lungs.

As emphysema progresses:

1. More alveoli become affected.
2. More air becomes trapped.
3. Normal oxygen and carbon dioxide exchange becomes harder.
4. The lungs become overinflated as they attempt to absorb more oxygen.
5. Over time, the rib cage may remain pushed outward.

This permanently rounded shape of the rib cage is called a barrel chest.

Effects of Emphysema

Breathing can become extremely difficult.

Some clients lose weight because eating becomes difficult when they are short of breath.

Clients often prefer to sit upright and lean slightly forward because this position makes breathing easier.

Treatment

Treatment may include:

• antibiotics to fight infection
• medications for chest pain, coughing, and fever
• proper diet
• proper fluid intake and hydration
• Fowler’s or semi-Fowler’s position to make breathing easier
• oxygen therapy

Influenza

Influenza (“the flu”) is a communicable infection of the respiratory tract caused by a virus.

In Canada, flu season lasts from November or December through April or May.

Millions of people develop influenza each year.

How Influenza Spreads

Influenza is highly contagious.

It spreads when an infected person coughs or sneezes.

It can also spread through indirect contact. For example, a person may touch a doorknob or telephone that an infected person recently touched.

Signs and Symptoms

Influenza usually begins suddenly.

Early symptoms include:

• headache
• chills
• cough

These may be followed by:

• fever
• loss of appetite
• muscle aches
• tiredness
• runny nose
• sneezing
• watery eyes
• throat irritation

Nausea, vomiting, or diarrhea may also occur, especially in children.

Recovery is usually complete within 1 to 2 weeks.

Some people develop serious or life-threatening complications, including pneumonia.

H1N1, COVID-19, and Later Viral Variants

H1N1 influenza and COVID-19 are described as extremely contagious illnesses that mainly affect the respiratory system in most people.

Germs associated with these illnesses can remain on hard surfaces such as counters and doorknobs. A person may get germs on their hands and transfer them to the respiratory system by touching the mouth, nose, or both.

H1N1

H1N1 emerged in North America in the spring of 2009 and primarily affected young people.

Its main symptoms are:

• fever
• cough

People had little or no natural immunity to the new virus, which contributed to serious and widespread illness.

Later variations of the virus also appeared.

Although H1N1 was originally called “swine flu,” people do not get it by:

• eating pork
• eating pork products
• receiving blood transfusions

COVID-19

The first recognized symptoms of COVID-19 were thought to resemble H1N1 symptoms. The recognized symptom list later expanded as more information became available.

Preventing Influenza and Similar Respiratory Infections

Good hygiene and Standard Practices are essential during supportive care.

Important practices include:

• washing your hands before and after client contact
• frequently using waterless hand sanitizer after touching surfaces the client has touched
• following required infection-prevention practices

The flu vaccine is identified as the most effective method of influenza prevention.

People at high risk need the vaccine yearly.

High-risk groups include:

• people 65 years of age and older
• residents of long-term care facilities
• people with chronic diseases
• caregivers and people who live with someone in a high-risk group

An employer may request or require a yearly flu vaccination because it protects both workers and clients.

Tuberculosis

Tuberculosis (TB) is a persistent bacterial infection generally transmitted by inhaling or ingesting infected droplets. It usually affects the lungs, although it can involve several organ systems.

TB was a major cause of death during the early 1900s. After TB medications became available in the 1940s, the number of cases decreased dramatically.

How TB Spreads

The bacteria that cause TB are called Mycobacterium tuberculosis.

The bacteria spread through airborne droplets when a person with TB:

• coughs
• sneezes
• speaks

Other people may inhale these bacteria.

People who have close, frequent contact with an infected person are at risk.

TB is more likely in crowded living conditions, including:

• inner-city neighbourhoods
• group homes
• prisons
• long-term care facilities

It is also more common in developing countries that lack adequate health care.

People with immune disorders, including HIV infection, are also at increased risk.

If TB remains untreated, it can spread to several organ systems.

Latent and Active TB

Sometimes TB bacteria remain in a person’s body for many years without causing an infection. This is called latent TB.

Clients with active TB may have no symptoms at first. TB may first be identified during a routine chest X-ray or TB skin test.

Early signs and symptoms include:

• tiredness
• loss of appetite
• weight loss
• fever
• night sweats

As TB progresses:

• coughing develops and becomes more frequent
• sputum production increases
• chest pain may occur

Care and Precautions for TB

Clients with active TB may require hospital treatment.

After returning home, they must continue taking TB medications every day for several months.

Clients with TB need to cover their nose and mouth with tissues when coughing or sneezing and then flush the tissues down the toilet.

In health care facilities, used tissues from clients with TB go into a biohazard bag and are disposed of according to facility policy.

Safety: Standard Practices and Airborne Precautions must be followed while caring for a client with TB.

TB Numbers to Remember

TB remains a global health concern.

Since the late 1980s, the number of TB cases in Canada has remained the same.

In 2017:

• active TB occurred at a rate of 4.9 per 100,000 people in Canada
• the rate among Canadian-born Indigenous people was 21.5 per 100,000 people
• about 10 million people worldwide became ill with TB

The Canadian government monitors new and re-treatment cases of active TB using data voluntarily submitted by provincial and territorial public health authorities.

Supporting a Client With a Respiratory System Disorder

Difficulty breathing can frighten a client. Respiratory conditions may also cause significant discomfort.

The CCA has several supported responsibilities when providing care.

Protect Yourself and Others From Infection

Follow Standard Practices at all times.

When the client has a contagious illness such as influenza:

• wear the proper PPE recommended in the client’s care plan
• follow Standard Practices
• change out of your uniform before leaving the agency or the client’s home to reduce the risk of spreading pathogens

Help the Client Stay Comfortable

Use supported comfort measures that help with breathing.

Ensure that the client:

• has good body alignment
• sits or lies on a clean, dry, wrinkle-free base

Report and Record Breathing Problems

Report: Report any shortness of breath the client experiences.

Document: Record the shortness of breath.

These steps help make sure the client remains comfortable and receives medication according to the care plan.

Communicate With Respect

Listen to the client and use empathy ⓘ when speaking with them.

This shows respect for the client.

Protect Confidentiality

Always follow confidentiality rules.

Never discuss the client or information about the client with anyone who is not involved in the client’s care.