11.1. INTRODUCTION TO APPLY KNOWLEDGE OF BODY SYSTEMS TO CLIENT CARE

In this chapter you will learn the basic structure and functions of body systems and apply this knowledge to the individuals for whom you provide care. Age-related changes and common chronic conditions in each body system are outlined with related nursing assistant interventions to promote optimal patient outcomes. Observations related to each condition are discussed, as well as what should be immediately reported to the nurse.

11.2. CARDIOVASCULAR SYSTEM

The cardiovascular system consists of the heart, blood, and blood vessels. (See Figure 11.1.[1]) The heart pumps the blood through the blood vessels. Blood can be viewed as the transportation fluid that transports nutrients to cells and carries wastes away from cells.[2]

Figure 11.1

The Cardiovascular System

The transportation route to all tissues is an intricate blood vessel network composed of arteries, veins, and capillaries. See Figure 11.2[3] for an illustration of the blood vessel network. The transportation of nutrients begins in the small intestine where they are absorbed and then transported to the liver through the hepatic portal vein. From the liver, nutrients travel in the blood up to the inferior vena cava blood vessel to the heart. The heart pumps the nutrient-rich blood to the lungs to pick up oxygen. The oxygenated blood returns to the heart, where it is pumped out to tissues in the body through the aorta and the arteries. Arteries become smaller and smaller on their way to cells, so that by the time blood reaches a cell, the vessel’s diameter is extremely small, and it is now called a capillary. This reduced diameter of capillaries slows the speed of blood flow and gives cells time to harvest the nutrients and oxygen in the blood and return metabolic wastes to the capillary to be eliminated. Deoxygenated blood containing metabolic wastes is transported back to the heart via veins, and wastes are filtered out by the kidneys and liver.[4]

Figure 11.2

Transportation of Nutrients and Elimination of Wastes

As the body ages, the strength and elasticity of the heart and blood vessels decrease, resulting in a decreased ability to regulate blood pressure, distribute oxygen, and remove wastes from the body. These changes can lead to dizziness (and a higher fall risk), fluid retention, edema, fatigue, and decreased stamina to complete daily functions.

In addition to these age-related changes, a diet high in saturated fats causes plaque to be deposited on the walls of the blood vessels, causing further narrowing and decreased blood flow. This decrease in circulation increases the risk for blood clots, heart attacks, and strokes.

Because the cardiovascular system is vital for health, any symptoms related to chest pain, shortness of breath, or lack of oxygenation should be immediately reported to the nurse. Cyanosis is a common cardiovascular symptom that refers to bluish discoloration around the mouth and in the extremities (i.e., feet and hands). It occurs when there is decreased oxygenated blood flow to the tissues and should be immediately reported to the nurse. Common nursing assistant interventions for all cardiovascular conditions include encouraging activity as tolerated; promoting a low fat, low cholesterol diet; motivating individuals to quit smoking; and helping individuals make healthy food choices to maintain a healthy weight. Table 11.2 describes symptoms of common cardiovascular diagnoses and related nursing assistant interventions.

11.3. DIGESTIVE SYSTEM

There are four steps in the digestive process. The first step is ingestion, the intake of food into the digestive tract. Ingestion may seem a simple process, but it includes smelling food as it is prepared and served, thinking about food and making food choices, and the involuntary release of saliva in the mouth to prepare for food entry. After food enters the mouth, the next steps of mechanical and chemical digestion of food begin. Mechanical digestion starts with chewing when teeth crush and grind large food particles into smaller pieces that are easy to swallow. Chemical digestion of food involves enzymes found in saliva that break down particles into smaller components.[1]

In the mouth, saliva provides lubrication and enables food to move downward through the esophagus (a muscular tube that goes from the mouth to the stomach). This slippery mass of partially broken-down food is called a bolus that moves down the digestive tract after it is swallowed. Swallowing is initially voluntary because it requires conscious effort to push the food with the tongue back towards the throat, but then it proceeds involuntarily through the gastrointestinal tract, meaning it proceeds without conscious control.

As the bolus is swallowed, it is pushed from the mouth through the pharynx (i.e., throat) and into the esophagus. As the bolus travels through the pharynx, a small flap called the epiglottis closes to keep food from going into the trachea and down into the lungs. Peristaltic contractions in the esophagus (referred to as peristalsis) propel the bolus down to the stomach. At the junction between the esophagus and stomach, there is a sphincter that remains closed until the food bolus approaches. The pressure of the food bolus stimulates the lower esophageal sphincter to relax and open, causing the food to move from the esophagus into the stomach. The mechanical digestion of food continues by the muscular contractions of the stomach and small intestine that mash, mix, and continue to propel the bolus down the digestive tract.[2]

In the small intestine, nutrients are absorbed from the bolus and then transported throughout the body by the cardiovascular system. The small intestine is typically 25 to 30 feet in length with a smaller diameter than the large intestine. After passing through the small intestine, the bolus enters the large intestine. The large intestine is about 8 to 10 feet in length with a larger diameter than the small intestine. Water is absorbed from the bolus in the large intestine, making it solid and formed. It eventually reaches the anus and is expelled as feces.[3] See Figure 11.3[4] for an illustration of digestion.

Figure 11.3

The Digestive System

View the following Khan Academy video for an overview of the digestive process[5]: The Digestive System.

As people age, many age-related changes occur in the digestive system. The condition of one’s teeth (referred to as dentition) often declines during the aging process, resulting in the decreased ability to chew foods with a dense or tough consistency (such as meat and fibrous vegetables). Production of saliva also decreases, increasing the risk for choking. Additionally, many medications cause a side effect of dry mouth that further contributes to the risk of choking. The epiglottis may weaken and allow food or fluids to enter the lungs that can cause aspiration pneumonia. Absorption of nutrients in the small intestine is less efficient, which can cause malnutrition even though food intake may be sufficient. Lastly, the slowing of peristalsis allows the bolus to remain in the large intestine for longer periods of time. As water continues to be absorbed, the fecal matter becomes drier and more difficult to expel, resulting in constipation and possible bowel obstruction.

A bowel obstruction stops the bolus and other digestive contents from reaching the part of the intestine beyond the blockage. The lack of peristalsis that occurs during a bowel obstruction can cause the large intestine to twist upon itself, cutting off circulation and causing tissue death. The area of the intestine experiencing tissue death may require surgical removal. Sometimes the remaining parts of the healthy intestine can be reattached to regain normal bowel function. However, if reattachment is not possible, an opening (called a stoma) is surgically created in the abdominal wall where the healthy part of the intestine is attached. (This type of surgery to create a stoma in the colon is referred to as a colostomy.) Fecal matter is collected in a drainage bag that attaches to the stoma via a device commonly called a wafer. In this manner, elimination occurs through the stoma into a pouch rather than through the rectum. Bowel obstructions, as well as other gastrointestinal conditions such as colon cancer, severe infection, fistulas, or colon injuries, can lead to the placement of a stoma. See Figure 11.4 for an image of a stoma, Figure 11.5[6] for an image of the wafer to which the drainage bag attaches, and Figure 11.6[7] for an image of an attached drainage bag.

Figure 11.4

Stoma

Figure 11.5

Stoma With a Wafer Placed to Attach the Drainage Bag

Figure 11.6

Drainage Bag Attached to a Wafer

The most effective interventions for improving digestive function are to encourage intake of fiber, water, and other fluids, as well as promoting activity as tolerated. Fiber adds bulk to the bolus to keep it moving through the large intestine. Fiber is found in plants, so any food that originates from growing in the ground contains fiber. Examples of high-fiber foods include grains in bread and cereal, rice, barley, quinoa, fruits, and vegetables. Whole grains are preferred because they contain more fiber than processed grains. Water and other fluids aid in peristaltic movement, and activity increases circulation to improve digestive function. See Table 11.3 for common digestive system diagnoses, associated symptoms to report to the nurse, and specific interventions the nursing assistant can implement to promote digestive function. Refer to section Chapter 5.7, “Assisting With Nutrition and Fluid Needs” for additional review of digestive interventions.

11.4. ENDOCRINE SYSTEM

Endocrine glands secrete hormones that affect the functioning of other organs throughout the body and are transported by the circulatory system. The glands in the endocrine system are the pituitary, thyroid, parathyroid, adrenals, thymus, pineal, pancreas, ovaries, and testes, as seen in Figure 11.7.[1]

Figure 11.7

The Endocrine System

The functions of the endocrine system are connected to an individual’s nutrition. The endocrine system is responsible for regulating appetite, nutrient absorption, nutrient storage, and nutrient usage, as well as contributing to other body functions such as reproduction. The most notable connection between nutrition and the functions of the endocrine system is how unhealthy dietary patterns are linked to obesity and the development of diabetes.[2]

The pancreas is an endocrine gland that makes insulin, the hormone that allows cells to use glucose for energy. Insulin is released after an individual eats a meal based on the amount of calories they consumed. The function of the pancreas is affected by a medical condition called diabetes. The Centers for Disease Control and Prevention (CDC) estimates that 11 percent of the U.S. population has diabetes, and 49 percent of adults over age 65 have prediabetes.[3]

See maps of diabetes and obesity by county at CDC’s Diabetes and Obesity Maps web page.

In type 1 diabetes, the pancreas becomes unable to make insulin. In type 2 diabetes, obesity causes changes in muscle, fat, and liver cells that leads to their diminished response to insulin, referred to as “insulin-resistance.” When cells are resistant to insulin, they do not take in enough glucose to make energy, resulting in high levels of glucose in the blood. Chronically elevated blood glucose damages other tissues over time, increasing the individual’s risk for cardiovascular disease, kidney disease, nerve damage, and eye disease. The nerve damage causes pain and numbness in the feet and lower legs that can increase risk for falls.[4]

Individuals with diabetes must frequently measure their blood glucose level to keep it in normal range with medications prescribed by their health care provider. Blood glucose levels are typically checked in individuals with diabetes from one to four times per day. This measurement is typically performed by the nurse, but some states allow nursing assistants to receive additional training to complete this procedure.

People with diabetes are typically prescribed oral medications or injectable insulin to keep their blood glucose in a healthy range. Too much or not enough insulin can cause life-threatening reactions so it must be administered cautiously. In hospitals and long-term care centers, insulin is administered by a nurse.

Too much insulin or not enough carbohydrate intake results in very low blood sugar (referred to as hypoglycemia) that can cause a coma if it is not quickly addressed. Nursing assistants must observe for signs of low blood sugar in clients with diabetes and immediately report them to the nurse for follow-up. Signs of low blood sugar include confusion, irritability, shakiness, cold and clammy skin, sweating, hunger, and anxiety.[5]

When not enough insulin or other diabetic medications are administered for the amount of carbohydrates an individual consumes, blood glucose levels become elevated (i.e., hyperglycemia). Symptoms of elevated blood glucose include increased urination; increased thirst and hunger; a fruity breath odor; warm, dry skin; and fast, deep breathing. These symptoms should be immediately reported to the nurse.[6]

Because nutritional intake affects an individual’s blood glucose, nursing assistants play a helpful role in encouraging healthy diet choices for individuals with diabetes. Encourage clients to avoid eating refined sugar and highly processed foods and increase their intake of whole grains and non-starchy vegetables such as broccoli, spinach, and green beans. Encouraging residents to be as active as possible can also help manage their blood glucose levels.[7]

If neuropathy occurs, the individual’s skin should be diligently inspected daily, especially on the bottoms of their feet and in between their toes. Well-fitted shoes should be worn, and socks should be carefully placed so the seams do not cause irritation. Individuals with neuropathy do not feel skin irritations or open areas, and they can become infected quickly. If left untreated, severe infection can lead to amputation. Due to these risks, nursing assistants should not trim the nails of diabetic patients.

11.5. INTEGUMENTARY SYSTEM

Review information about the integumentary system in Chapter 5.5, “Skin Care” and Chapter 8.2, “Moving and Positioning Clients.” These sections can be reviewed for age-related changes and interventions to promote skin integrity.

11.6. MUSCULOSKELETAL SYSTEM

The musculoskeletal system includes muscles, bones, and connective tissues. The human skeleton consists of 206 bones and other connective tissues called ligaments, tendons, and cartilage. See Figure 11.8[1] for an illustration of the major bones of the body. Ligaments connect bones to other bones, tendons connect bones to muscles, and cartilage provides bones with flexibility and acts as a cushion in the joints between bones.

Figure 11.8

Major Bones of the Body

The skeleton’s bones and connective tissues work together with muscles to provide a variety of functions and multiple types of movements. Gross motor skills are large movements controlled by the legs and trunk of the body. Fine motor skills are small movements such as those by the wrists and hands. The skeleton also provides structural support and protection for all the other organ systems in the body. The skull, or cranium, is like a helmet and protects the eyes, ears, and brain. The ribs form a cage that surrounds and protects the lungs and heart.[2]

In addition to producing movement, protecting organs, and providing structural support, the bones have several other functions. Bone marrow synthesizes red blood cells, white blood cells, and platelets, and bones store minerals such as calcium, phosphorus, and magnesium. Although bone tissue may look inactive at first glance, bones are continuously breaking down and reforming at the microscopic level. Bones also contain a complex network of canals, blood vessels, and nerves that allow for nutrient transport and communication with other organ systems.[3]

There are three types of muscle tissue, including skeletal muscle, cardiac muscle, and smooth muscle. Skeletal muscle produces movement, assists in maintaining posture, protects internal organs, and generates body heat. Skeletal muscles are voluntary, meaning a person is able to consciously control them, but they also depend on signals from the nervous system to work properly. See Figure 11.9[4] for an illustration of skeletal muscle. To move the skeleton, the tension created by the contraction of the skeletal muscles is transferred to the tendons, strong bands of dense, regular connective tissue that connect muscles to bones.[5]

Figure 11.9

Major Muscles of the Body

Other types of muscles are involuntary and are controlled by the autonomic nervous system. Involuntary muscle includes the smooth muscle within the digestive system and respiratory system, as well as cardiac muscle in the heart that pumps blood throughout the body.[6]

Review sections Chapter 8.3, “Promoting Joint Mobility and Activity,” Chapter 9.4, “Complications of Immobility,” and Chapter 9.6, “Promoting Independence During ADLs” regarding problems that may occur in the musculoskeletal system, as well as how to assist clients in keeping the musculoskeletal system healthy. Remember that clients maintain range of motion, flexibility, and bone health by being as active as possible, especially with weight-bearing activity. Nursing assistants should promote ambulation as tolerated and encourage clients to move about independently as much as possible. Nursing assistants can also encourage protein diet choices to assist with tissue growth and repair and calcium to assist with bone health. Lean protein, such as low-fat meats and dairy products, are examples of healthy protein choices. Dairy products, soy milk, almond milk, and coconut milk are good sources of calcium, as well as green leafy vegetables like spinach, kale, and romaine.[7]

A common condition in the musculoskeletal system is osteoarthritis, a medical diagnosis that refers to inflammation of joints due to wear and tear throughout one’s life. Interventions that nursing assistants can perform to help alleviate discomfort associated with osteoarthritis are discussed in section Chapter 6.4, “Comfort Measures” and include measures such as ice, heat, topical medications, repositioning, and massage. Effectiveness of measures will vary by individual, so it is important to allow each individual to choose what is most helpful to alleviate their arthritis.

11.7. URINARY SYSTEM

The urinary system includes the kidneys, ureters, bladder, and urethra. It has many functions including filtering the blood and eliminating wastes, regulating blood and urine pH levels, and working in collaboration with the cardiovascular system to regulate blood pressure. The urinary system also provides reproductive functions in the prostate for males. The kidneys also release a hormone that stimulates red blood cell production and synthesizes vitamin D to assist in bone health. Each of these functions is vital to well-being and survival.[1] See Figure 11.10[2] for an illustration of the structures of the urinary system.

Figure 11.10

The Urinary System

Blood is filtered through the kidneys, and the filtrate is transformed into urine at a relatively constant rate throughout the day. The urine travels from the kidneys through the ureters to the bladder. The bladder stores urine and signals the brain when full (around 300 mL). It stores urine until a convenient time for elimination or voiding, and then the brain allows the urethra to release the urine.[3]

Urine is a fluid of variable composition. Urine characteristics change depending on influences such as water intake, exercise, environmental temperature, nutrient intake, and other factors. Characteristics such as color and odor provide a rough estimate of a person’s state of hydration. For example, after exercising or working outside on a hot day and sweating heavily, urine will become darker with a slight odor.[4] See Figure 11.11[5] for ranges of urinary color related to hydration status. Review the subsection “Observation and Documentation of Urinary Output” in Chapter 5.8 for other characteristics that nursing assistants should document when assisting clients to void.

Figure 11.11

Urine Color Related to Hydration Status

Urine volume varies considerably. The normal range of urine output for an adult is one to two liters per day. The kidneys must produce a minimum urine volume of about 500 mL/day to adequately eliminate wastes from the body. Output below this level can be caused by severe dehydration or kidney disease.[6]

The effects of failure of various parts of the urinary system can range from incontinence to kidney disease with a life-threatening loss of the ability to eliminate wastes. When the kidneys begin to fail, several symptoms may occur such as weakness, shortness of breath, widespread edema (swelling), rising potassium levels, and heart arrhythmias.[7]

Failure of voluntary control of urination is called incontinence. Incontinence may occur if the connection between the brain and the urethra is disrupted or there is loss of muscle tone in the urinary system. There are several types of incontinence. Incontinence in small amounts (i.e., leaking or dribbling) can occur from coughing, laughing, or moving when the bladder is full. Some people feel an urge to void and then must go immediately or incontinence may occur if they are not near a restroom. Some people have total loss of control of urination, resulting in the entire contents of their bladder being released involuntarily.[8] Refer to section Chapter 5.8, “Assisting With Toileting” to review appropriate interventions to help prevent incontinence.

The prostate gland encompasses the urethra in males. As males age, the prostate gland grows, known as benign prostate enlargement (BPE). Because prostate enlargement puts pressure on the urethra, the urine may become blocked. Older men may experience difficulty starting the stream of urine or become unable to completely empty their bladder. If the blockage becomes significant, it can cause infection when urine remains in the bladder for long periods of time. In these cases, a urinary catheter may be placed to reduce the retention of urine, or a surgical procedure may be completed to reopen the urethra.

See Table 11.7 for common chronic conditions, symptoms to report, and interventions nursing assistants can provide to promote urinary health.

11.8. NEUROLOGICAL SYSTEM

The central nervous system consists of the brain, spinal cord, and other nerves in the body as seen in Figure 11.12.[1] The main function of the central nervous system is to utilize the senses of sight, touch, hearing, taste, and smell to detect changes in the external environment and create a reaction to them. For instance, if your finger comes into contact with a thorn on a rose bush, a sensory neuron transmits a signal from your finger up through the spinal cord and into the brain. Another neuron in the brain sends a signal that travels back to the muscles in your hand and stimulates muscles to contract so that you jerk your finger away. All this happens within a tenth of a second. Nerves communicate with each other via chemicals built from amino acids called neurotransmitters. Eating adequate protein from a variety of sources will ensure the body gets all the different amino acids that are important for central nervous system function.[2]

Figure 11.12

The Central Nervous System

The brain’s cognitive functions include language processing, learning, perceiving, and thinking. The brain’s main fuel for these functions is glucose. Too high or too low levels of blood glucose can cause sudden changes in cognitive functioning, and chronically elevated blood-glucose levels can damage brain cells as previously discussed in the “Endocrine System” section of this chapter.

As people age, the transmission of neurons slows, causing slower reactions to environmental stimuli. This longer reaction time can increase their risk for falls and other safety concerns. Functioning of the senses also declines, as previously discussed in section Chapter 9.7, “Assisting With Sensory Deficits.” Nursing assistants can assist with this general decline and improve safety by ensuring residents have their glasses, hearing aids, and other adaptive aids in place. Healthy nutritional choices such as foods rich in omega-3 fatty acids and antioxidants can be encouraged to keep the neurosensory system healthy, and activity can be promoted. Having conversations with residents and promoting social interaction whenever possible is one of the easiest ways to encourage word recall and stimulate thinking. Assisting residents to attend activity department offerings, such as board, card, and word games, or looking at memorabilia can help clients maintain their neurological health.[3]

Common conditions related to the neurosensory system include strokes, seizures, and dementia. Refer to section Chapter 3.2, “Emergency Situations” to review the appropriate responses for individuals suspected of having a stroke or seizure. Refer to section Chapter 10.5, “Caring for Clients With Dementia” to review interventions for individuals with dementia. See Table 11.8 regarding two common chronic conditions of the neurosensory system and related nursing assistant interventions. Keep in mind that a difficult aspect of these neurological diagnoses is knowing that symptoms will continue to worsen, so individuals with these diagnoses and their loved ones should be supported emotionally and monitored for signs of depression.

11.9. IMMUNE SYSTEM

See Figure 11.13[1] to review the various structures of the immune system. The immune system provides specific and nonspecific defense mechanisms to protect the body from infection. Examples of a specific defense are white blood cells that circulate in the blood and lymph. The function of these cells is to identify and destroy pathogens such as bacteria and viruses. Examples of nonspecific defenses are the skin and mucous membranes. These parts of the system act as barriers to block entrance of pathogens. For more information, refer to the “Defenses Against Transmission of Infection” section in Chapter 4.

Figure 11.13

Structures of the Immune System

Immune system function and decreasing the risk for infection depends on healthy nutrition. In fact, malnutrition is the leading cause of immune system deficiency worldwide. When immune system functions are inadequate, there is a marked increase in the chance of getting an infection. Children in many poor, developing countries who lack good sources of protein and carbohydrates often die from infections that their bodies would have normally fought off with proper nutritional intake. Because their protein and/or energy intake is so low, the immune system cannot perform its functions.[2]

Other nutrients, such as iron, zinc, selenium, copper, folate, and vitamins A, B6, C, D, and E, benefit immune system function. It is best to obtain minerals and vitamins from eating a variety of healthy foods. Deficiencies in these nutrients can cause an increased risk for infection and even death. Zinc deficiency results in suppression of the immune system’s skin barrier functions and is also associated with a decrease in the number of circulating white blood cells. Taking zinc supplements has been found to be therapeutically beneficial for the treatment of leprosy, tuberculosis, pneumonia, and the common cold.[3]

Just as undernutrition compromises immune system health, so can overnutrition that causes obesity. People who are obese are at increased risk for developing diabetes, cardiovascular, and immune system disorders. High intake of saturated and trans fats negatively affects the immune system, whereas increasing intake of omega-3 fatty acids (found in salmon and other oily fish) reduces the risk of developing certain autoimmune disorders, such as rheumatoid arthritis. Rheumatoid arthritis affects the joints but is more severe in terms of pain and swelling than osteoarthritis. It can begin as early as age 18. Nursing assistant interventions for osteoarthritis also can be used to help manage the discomfort of rheumatoid arthritis.[4]

Autoimmune disorders cause the body to view parts of itself as foreign, mistake those parts as pathogens, and launch an attack against those parts. It can affect certain parts of the body like skin, joints, or a specific organ, or it can affect the entire body. In the digestive system, it can cause food intolerances, celiac disease, or irritable bowel syndrome. Refer to the Chapter 6.2 subsection on “Modified Diets” for management. See Table 11.9 for common chronic conditions and the interventions nursing assistants can provide to assist with immune disorders. Review section Chapter 4.7, “Signs and Symptoms of Infection” for observations related to the immune system that should be reported to the nurse.

11.10. RESPIRATORY SYSTEM

Most humans cannot survive without breathing for more than three minutes. If you experiment by trying to hold your breath longer, your autonomic nervous system will take over and resume a normal breathing pattern. This is because cells need to maintain a delicate balance of using oxygen for functioning and releasing carbon dioxide as a waste product.[1]

Although oxygen is critically needed for cell functioning, it is the accumulation of carbon dioxide that primarily drives the need to breathe. The major organs of the respiratory system function to provide oxygen to body tissues for cellular respiration, remove the waste product carbon dioxide, and help maintain an acid-base balance. Portions of the respiratory system are also used for nonvital functions, such as sensing odors, producing speech, and for straining, such as during childbirth or coughing. The respiratory system includes muscles that move air into and out of the lungs, the passageways through which air moves, and alveoli. Alveoli are microscopic gas exchange surfaces covered by capillaries. See Figure 11.14[2] for an image of the anatomy of the respiratory system.[3]

Figure 11.14

Anatomy of the Respiratory System

Capillaries carry deoxygenated blood to the alveoli, where carbon dioxide is released and oxygen is picked up by hemoglobin. The cardiovascular system transports oxygenated blood from the lungs to the tissues throughout the body where it picks up carbon dioxide and carries it back to the alveoli.[4]

A variety of diseases can affect the respiratory system, such as asthma, chronic obstructive pulmonary disorder (COPD), pneumonia, and lung cancer. These conditions affect the gas exchange process and can result in decreased oxygen saturation levels, increased respiratory rates, labored breathing, and other respiratory difficulties.[5]

Anatomy of the Lungs

The lungs are pyramid-shaped, paired organs that are connected to the trachea by the right and left bronchi. Below the lungs is the diaphragm, a flat, dome-shaped muscle located at the base of the lungs. Each lung is composed of smaller units called lobes. The right lung consists of three lobes and the left lung consists of two lobes to accommodate the positioning of the heart. As discussed previously, the respiratory system works in conjunction with the cardiovascular system to transport oxygen and nutrients to cells and remove waste from cells and out of the body during exhalation. See Figure 11.15[6] for an image of the anatomy of the lungs.[7]

Figure 11.15

Anatomy of the Lungs

As the body ages, chest muscles lose their strength, and the smaller airways of the respiratory system, called the bronchioles, lose their elasticity and can collapse. These age-related changes decrease the ability of an older adult to inhale oxygen, resulting in fatigue and increased difficulty completing activities of daily living. Although some respiratory function can be maintained or restored through exercise, the aging respiratory system leaves older adults more susceptible to acute respiratory illnesses such as influenza, pneumonia, and COVID-19.[8]

Because the respiratory system is necessary for life, if a nursing assistant notices any issues with breathing or a blocked airway, these concerns should be reported immediately to the nurse. See the section “Choking and Airway Clearance” in Chapter 3 for a review of interventions for a blocked airway.

Because the cardiovascular system transports oxygenated blood, some symptoms of respiratory distress are similar to cardiovascular complications such as cyanosis, fatigue, dizziness, and shortness of breath. Exercising and avoiding smoking are vital for maintaining or improving respiratory function. Table 11.10 outlines common respiratory diagnoses in the aging population, symptoms to report, and associated interventions provided by nursing assistants.

Table 11.10

Common Respiratory Conditions and Related Nursing Assistant Interventions[9]

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Condition	Definition	Symptoms to Report	Nursing Assistant Interventions
Bronchitis	Acute or chronic inflammation of the bronchioles (i.e., small airways)	Cough that produces mucus, fatigue, shortness of breath, and chest discomfort	Encourage fluids to thin the mucous, segment ADLs, and position the patient for breathing comfort.
Asthma	A chronic condition in which irritants cause inflammation and narrowing of the respiratory tract	Coughing, wheezing, chest tightness, difficulty breathing, and shortness of breath	Avoid exposure to known triggers (such as smoke, pet dander, pollen, mold, etc.). During an asthma attack, try to keep the patient calm and immediately report breathing difficulties.
Emphysema	A chronic condition in which alveoli hyperinflate, causing reduced air exchange and resulting in a lower amount of oxygenated blood in circulation	Shortness of breath that becomes increasingly more difficult as the disease progresses	Encourage healthy weight and activity as tolerated, segment ADLs, and encourage the use of supplemental oxygen if it is prescribed.
Chronic Obstructive Pulmonary Disease (COPD)	Chronic inflammation of the lungs, often caused by smoking, chronic bronchitis, asthma, or emphysema	Shortness of breath, labored breathing, dizziness, disorientation, and cyanosis	Encourage healthy weight, activity as tolerated, and smoking cessation.
Lung Cancer	Cancer in the lungs	Chronic cough, coughing up blood, shortness of breath, and chest pain	Encourage smoking cessation, healthy weight and activity as tolerated; segment ADLs; and position the patient for breathing comfort.
Bacterial Pneumonia	Bacterial infection of the lungs	Fever; chills; shortness of breath; productive cough with green, yellow, or bloody mucous; sharp chest pain; fatigue; and confusion or disorientation	Encourage healthy diet, activity as tolerated, rest, and taking antibiotics as prescribed.

View the following YouTube video[10] to learn more about the respiratory system: Respiratory System, Part 1: Crash Course Anatomy & Physiology #31.

11.11. REPRODUCTIVE SYSTEM

Reproduction is the process by which organisms make more organisms like themselves. Although the reproductive system is essential to keeping a species alive, unlike other body systems, it’s not essential to keeping an individual alive. Because the endocrine system controls the hormone levels throughout the body, it has a large role in the functioning of the reproductive system. Hormone levels affect growth and development, appetite, mood, body temperature, and stress, along with sexual function and reproductive health. Both the male and female reproductive systems are necessary to reproduce. The organs that are part of both reproductive systems are referred to as genitals.[1]

Female Reproductive System

The external part of the female reproductive organs is called the vulva, which covers the opening to the vagina and other internal reproductive organs. Two pairs of skin flaps called the labia surround the vaginal opening. The clitoris, a small sensory organ, is located toward the front of the vulva where the folds of the labia join. Between the labia are openings to the urethra and vagina. When girls become sexually mature, called puberty, the outer labia and the mons pubis are covered by pubic hair. A female’s internal reproductive organs are the vagina, uterus, Fallopian tubes, and ovaries. See Figure 11.16[2] for an illustration of the organs of the female reproductive system.

Figure 11.16

The Female Reproductive System

Toward the end of puberty, girls begin to release eggs as part of a monthly period called the menstrual cycle. About once a month, during ovulation, an ovary sends an egg into one of the Fallopian tubes. Unless the egg is fertilized by a male’s sperm while in the Fallopian tube, the egg leaves the body about two weeks later through the uterus in a process called menstruation. During menstruation, blood and tissues from the inner lining of the uterus combine to form the menstrual flow, which in most women lasts from three to five days.[3]

The menstrual cycle continues until menopause, when levels of estrogen decline and the woman no longer releases eggs. This usually occurs sometime around the late forties to early fifties. As estrogen levels decrease, women may experience irregular periods, hot flashes, night sweats, mood swings, and changes in metabolism.[4]

Male Reproductive System

The external male genitals are the penis and scrotum. The urethra runs from the bladder through the penis to expel urine externally. Internally, the male reproductive system includes the testes, the duct system made up of the epididymis and the vas deferens, and the accessory glands that include the seminal vesicles and prostate gland. Testosterone is a hormone that increases during puberty and is produced in the testes. Testosterone is responsible for causing boys to develop deeper voices, larger muscles, and body and facial hair. It also stimulates the production of sperm that fertilizes the egg of a female.[5] See Figure 11.17[6] for an illustration of the male reproductive system.

Figure 11.17

The Male Reproductive System

All males are born with a foreskin, a fold of skin at the end of the penis. Some boys are circumcised, which means that a doctor or a clergy member cuts away the foreskin. Circumcision is typically performed during a baby’s first few days of life based on parental religious beliefs, concerns about hygiene, or cultural or social reasons. There is no medical necessity for circumcision.

As men age, their prostate enlarges. Because the prostate surrounds the urethra, its enlargement often causes urinary issues such as the decreased ability to dispel urine, frequent urination, an intermittent stream of urine, and retention of urine in the bladder. Urinary retention and incomplete emptying of urine from the bladder increase the male resident’s risk of urinary tract infections, so signs of infection should be monitored by nursing assistants.

11.12. LEARNING ACTIVITIES

XI. GLOSSARY

Bolus

A slippery mass of partially broken-down food that moves down the digestive tract as you swallow.

Chemical digestion

Digestion of food by enzymes found in saliva that break down food particles into smaller components.

Colostomy

Surgery to create a stoma in the colon.

Cyanosis

Blue coloration around the mouth and in the extremities (i.e., feet and hands) that occurs when there is decreased oxygenated blood flow to the tissues.

Epiglottis

A small flap that closes over the trachea when swallowing to prevent food and fluids from going into the lungs.

Esophagus

The muscular tube from the mouth to the stomach.

Fine motor skills

Small movements such as those in the wrists and hands.

Gross motor skills

Large movements controlled by the legs and trunk of the body.

Incontinence

Failure of voluntary control of urination.

Involuntary muscle

Muscles controlled by the autonomic nervous system, including smooth muscle within the digestive system and respiratory system and the cardiac muscle in the heart that pumps blood throughout the body.

Large intestine

The long, tube-like organ that is connected to the small intestine at one end and the anus at the other.

Mechanical digestion

Digestion that begins with chewing when teeth crush and grind large food particles into smaller pieces that are easy to swallow.

Neurotransmitters

Chemicals in the body used for nerve communication.

Osteoarthritis

A medical diagnosis that refers to inflammation of joints due to wear and tear throughout one’s life.

Peristalsis

Contractions that move the bolus through the esophagus, stomach, small intestine, and large intestine.

Pharynx

The hollow tube that starts behind the nose and ends at the trachea and esophagus.

Skeletal muscle

Muscle that produces movement, assists in maintaining posture, protects internal organs, and generates body heat.

Small intestine

A long tube-like organ that connects the stomach and the large intestine where nutrients are absorbed from a food bolus.

Stoma

A surgically created opening in the abdominal wall where a healthy part of the intestine is attached.

Tendons

Strong bands of dense, regular connective tissue that connect muscles to bones.

Trachea

The hollow tube, otherwise known as the windpipe, that leads to the lungs.

Voluntary muscle

Muscle that a person is able to consciously control.