2. Sign: Chest Wall Stiffness (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Now let's start from the outside and work our way in.

    00:04 So the second one is the chest wall stiffens and the thoracic compliance decreases.

    00:09 So this is what makes breathing more difficult.

    00:12 Think what has to happen for you to be able to breathe, right? You need that chest wall to be compliant, you need to be able to expand and contract.

    00:19 As you age, it becomes stiffer.

    00:22 So that's why breathing is more difficult.

    00:25 Now remember those intercostal muscles, they're really important in breathing.

    00:30 Just for fun.

    00:31 What are the three main muscles we talked about that you need for breathing? See if you can pause and recall those in your notes.

    00:41 Should be what the diaphragm, those intercostal muscles and abdominal muscles.

    00:48 Good job.

    00:49 Now if you didn't get it, don't worry about it.

    00:51 Just the actual act of stopping, asking yourself a question and thinking trying to recall it from your brain is powerful when you're trying to study.

    01:01 So it's much better than reading and rereading and rereading your notes.

    01:05 So keep that in mind as you're moving through all the video series.

    01:09 So we know that chest wall gets stiffer, we also know those intercostal muscles are weaker, and they're smaller, they kind of start to shrink.

    01:17 Calcification is also a problem.

    01:20 See in your 30s, you're going to have calcification of about 6%.

    01:25 Now it's 45% once a client reaches their 90's.

    01:28 So things that are calcified, don't move as well, right, they're not as compliant.

    01:34 That ribcage is what calcifies since we're talking about the respiratory system.

    01:39 So know that one of the changes as we age, we have increased calcification, and in the case of the ribcage as part of what makes that chest wall so stiff.

    01:49 Now the ribcage may also become a little smaller, enclosed in a little bit on the lungs.

    01:54 Well what's gonna happen if my ribcage is smaller and kind of compressing my lungs? Right, I'm not going to be able to take such a deep breath.

    02:05 So my breath will be relatively shallower than when I was younger.

    02:11 That's what another reason why breathing becomes more difficult.

    02:15 Now let's take a look at young Enrique.

    02:18 Remember, Enrique and Jose started at the same level of health when they were young men.

    02:24 But I want to talk about what happens as you're aging and still experiencing chronic illness.

    02:30 See old Enrique, his chest wall has really become stiff.

    02:34 Now part of the rationale for that is that on top of normal aging, Enrique was not very active.

    02:41 So keep this in mind when you're working with any client, activity benefits just about every part of your body.

    02:48 So the more you exercise, the less stiffness you'll experience that Enrique is.

    02:54 Because since he was not active, he's incredibly stiff.

    02:59 He's much more significantly stiff than Jose would be.

    03:02 And this is something we can easily address.

    03:04 We just need to help people stay active and moving.

    03:08 Now another problem that Enrique develop that often happens with elderly clients is he suffered from osteoporosis since he turned 65.

    03:17 So for the last 20 years, his bones have really been struggling.

    03:21 Enrique also didn't help matters because he didn't take vitamins and his diet was not one that was a healthy balanced diet.

    03:30 Now young Jose on the other hand, he took his vitamins, he exercise, he made healthy choices.

    03:36 Now he will also have that calcification and stiffness, but it's not going to be as severe as Enrique.

    03:42 So keep moving, eat healthy and your whole body benefits from that.

    03:48 Old Jose's chest wall won't have near the changes that Enrique's did.

    About the Lecture

    The lecture 2. Sign: Chest Wall Stiffness (Nursing) by Rhonda Lawes, PhD, RN is from the course Assessment of the Geriatric Patient: Respiratory System (Nursing).

    Included Quiz Questions

    1. The rib cage becomes larger and flares out from the lungs.
    2. The intercostal muscles weaken and shrink.
    3. The rib cage calcifies.
    4. Respirations become shallower.
    1. 45%
    2. 6%
    3. 90%
    4. 78%

    Author of lecture 2. Sign: Chest Wall Stiffness (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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