Which are expected physiological change(s) in the respiratory system of an older adult? (Select all that apply)

Choice A reason: Impaired nutrition is generally unrelated to the immediate assessment of an irregular heart rhythm. While chronic heart failure can lead to cardiac cachexia, an irregular pulse is a hemodynamic issue that affects the delivery of nutrients, not the intake of nutrition itself, making it a secondary concern.

Choice B reason: While certain metabolic imbalances can cause arrhythmias, a risk for unstable blood glucose is a metabolic diagnosis. An irregular pulse is a direct cardiovascular finding. The primary concern with an arrhythmia is the heart's mechanical ability to pump blood, not the concentration of glucose in the bloodstream.

Choice C reason: An irregular pulse, such as that found in atrial fibrillation or premature contractions, often leads to a decrease in stroke volume and overall cardiac output. This happens because the heart cannot fill properly or contract synchronously, potentially leading to inadequate tissue perfusion and organ dysfunction.

Choice D reason: Altered body image is a psychosocial diagnosis related to how a person perceives their physical appearance. An irregular pulse is a physiological dysfunction of the cardiac conduction system. While the client may feel "palpitations," this does not inherently alter their perception of their physical body or self-image.

Choice A reason: Pain during chest expansion, often called pleuritic chest pain, is an abnormal finding. It may indicate pleurisy, where the pleural layers are inflamed and rub against each other. A healthy client should be able to take a deep breath comfortably without any stabbing or localized pain sensations during the maneuver.

Choice B reason: During the assessment of thoracic expansion, the nurse places their thumbs at the level of T9 or T10. As the client inhales deeply, the nurse's hands should move outward symmetrically. This indicates that both lungs are inflating equally and that the musculoskeletal structures of the chest wall are functioning uniformly on both sides.

Choice C reason: Asymmetrical rise and fall of the rib cage is a significant clinical abnormality. It suggests that one lung is not expanding fully, which can be seen in conditions such as massive atelectasis, pneumothorax, or pleural effusion on the affected side. This finding necessitates immediate further diagnostic investigation to determine the underlying cause of the restriction.

Choice D reason: A total lack of movement of the rib cage during a deep breath would indicate a profound respiratory failure, severe restrictive disease, or a neurological impairment of the diaphragm and intercostal muscles. In a living, breathing client, there should always be a palpable excursion of the thoracic cage during the inspiratory phase.