RESPIRATION

RESPIRATION

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Respiration monitoring is an involuntary process of inspiration (inhalation), expiration (exhalation) in a patient

Respiration is the act of breathing in and breathing out. It includes inspiration and expiration. The exchange of gases between the blood and lungs is called external or pulmonary respiration. The exchange of gases between the blood and cell is called internal respiration

Respiration is the act of breathing. It includes the intake of oxygen and the amount of carbon dioxide, i.e. respiration consists of inspiration and expiration

Purpose

• To determine the respiratory status of the patient
• To determine number of respiration occurring per minute
• To gather information about rhythm and depth
• To assess response of patient to any related therapy/medication

Types of Respiration

• External respiration: the exchange of gases between the blood and the air in the lungs is called as external or pulmonary respiration
• Internal respiration: the exchange of gases between the blood and the tissue cells is called as internal or tissue respiration
• Regulation of respiration: it is a rhythmical movement’s respiration is regulated by respiratory center in the brain called medulla oblongata, nerve fibers of the autonomic nervous system and the chemical composition of the blood

Normal Rates

• At birth 30 to 40 breaths/minute
• One year 26 to 30 breaths/minute
• 2 to 5 years 20 to 26 breaths/minute
• Adolescence 20 breaths/minute
• Adults 16 to 20 breaths/minute
• Old age 10 to 24 breaths/minute

Characteristics of commonly Observed Respiratory Patterns

Factors Influences Respiration

• Sex: female has slightly rapid respiration than the male
• Exercise: exercise of any type increase the metabolic rate and stimulate respiration
• Rest and sleep: during rest and sleep metabolism is decreased so respiration rate is normal or decreased
• Emotions: sudden stressful condition such as fear and anxiety influences the respiratory rate
• Changes in atmospheric pressure: in high altitudes, the content of oxygen in the atmosphere is very low. So rate of respiration is increased and the increased demand of oxygen is fulfilled

Characteristics of Respiration

• Normal breathing is effortless
• It is painless, quiet and automatic
• Normal respiration consists of rhythmical rising and falling of the chest wall
• Respiratory rate is resting adult is 16 to 18 breaths/minute
• Eupnea – it is regular, even and produces no noise.

Range of Respiratory Rates

Group – age – breaths/min

• Newborn to 6 weeks – newborn to weeks – 30-60
• Infant – 6 weeks to 6 months – 25-40
• Toddler – 1 to 3 years – 20-30
• Young children – 3 to 6 years – 20-25
• Older children – 10-14 years – 15 -20
• Adults – adults – 12-20

Abnormal Respirations

1. Normal respiration: 16-20 per minute, regular rhythm, ratio of respiration and pulse rate is 1:4
2. Hyperventilation or Kussmaul’s breathing: increased in depth and rate hyperpnea – increases (↑) in depth only
3. Periodic respiration: alternating hypernea, shallow respiration and apnea – some time called Cheyne-Strokes respiration frequently occur in severely ill
4. Sighing respiration: deep and audible; audible portion sounds like a sign
5. Air trapping: present in obstructive pulmonary disease – air is trapped in the lungs; respiration rate rise and breathing becomes shallow
6. Biot’s respiration: shallow breathing – interrupted by apnea found in CNS disorders and sometimes in healthy persons

• Strider respiration: it is noisy shrill and vibrating respiration. It is due to obstruction in the upper airway. It is commonly seen in laryngitis and foreign body in the respiratory tract
• Wheezing: expiration is difficult and louder. It is due to partial obstruction of the smaller bronchi and bronchioles. It is seen in asthma and emphysema
• Apnea: this is a temporary cessation of breathing due to excessive oxygen and lack of carbon dioxide
• Dyspnea: this is forced, difficult or labored breathing. It may be accompanied by pain and cyanosis; it is seen in heart diseases, respiratory diseases, convulsions, etc
• Orthopnea: the patient can breathe only in upright position. Commonly found in congestive cardiac failure
• Cheyne-Stokes respiration: this is respiration which gradually increases in rate and volume until it reaches a climax. Then slowly pause occurs and breathing stops for 5 to 30 seconds and then cycle begins again. It is a periodic breathing usually found in the patients who are near death
• Asphyxia: It is a state of suffocation when the lungs do not get a sufficient supply of fresh air to the vital organs and they are deprived of oxygen
• Cyanosis: it is the blueness or discoloration of the skin and mucous membrane due to lack of oxygen in the tissues
• Rale: an abnormal rattling or bubbling sound caused by the mucus in the air passages in seen in the bronchitis of pneumonia
• Kussmaul’s respiration: respiration is abnormally deep but regular, rate is increased. It is seen in diabetic ketoacidosis
• Blot’s respiration: it is shallow breathing interrupted by irregular periods of apnea, seen in central nervous system disorders

General Instruction

• Patient to be unaware of the nurse counting respiration
• Inform to physician in case of bradypnea, tachypnea or other abnormal respiratory patterns noticed
• Maintain half hourly checking of respiration and pulse when indicated

Preliminary Assessment

• Determine the need to assess client’s respiration
• If client has been active, wait 5 or 10 minutes before assessing respiration
• Assess respirations as first vital sign in infant or child
• Assess respiration after pulse measurement in adult
• Be sure client is in a comfortable position, preferably sitting
• Be sure client’s chest movement is visible. If necessary remove bed lines or gown

Equipment

• Wrist watch with second hand or digital display
• Pen and flow sheet or record form
• TPR chart

Procedure

• Place client’s arm in a relaxed position across the abdomen or lower chest
• Observe complete respiratory cycle (one inspiration and one expiration)
• After cycle is observed, look at watch’s second hand and begin to count rate, when sweep hand hits number on dial, begins time frame, counting one with first full respiratory cycle. If rhythm is regular in adult, count number of respirations in 30 seconds and multiply by 2. In infant or young child count respirations for full minute. If adult has irregular rhythm or abnormality slow or fast rate, count for one full minute.
• Note depth of respirations. This can be assessed subjectively by observing degree of chest wall movement while counting rate
• Note rhythm of ventilatory cycle. Normal breathing is regular and uninterrupted. Infants breathe less regularly. Young child may breathe slowly and then suddenly breath fastens
• Replace client’s gown and covers

Normal Breath Sounds Types

Vesicular Sound

Description: soft, low pitched gentle sighing

Location: over bronchioles and alveoli best heard at base of lungs

Characteristics: best heard on inspiration

Bronchial Sound

Description: moderately high pitched harsh

Location: over trachea, not normally heard over lung tissue

Characteristics: best heard on expiration

Bronchovesicular Sound

Description: moderate intensity

Location: over bronchioles lateral to the sternum at the first and second intercostals spaces and between the scapulae

Adventitious Breath Sounds

Rales Sound

Description: fine cracking sounds, alveolar rales are high pitched, bronchial rales are lower pitched

Characteristics: best heard on inspiration

Rhonchi Sound

Description: course gurgling, harsh, louder sounds as air passes through bronchi filled with fluid

Characteristics: best beard on expiration

Wheeze Sound

Description: squeaky musical sounds often indicative of bronchial constriction

Characteristics: best heard on expiration

Friction

Description: rubbing of the pulmonary and visceral pleura, grating sound

Characteristics: best heard over the lower anterior and lateral chest

After Care

• Wash hands
• Compare client’s respirations with previous baseline and normal respiratory rate for age groups
• Record any accompanying signs and symptoms of respiratory alternations in nurse’s notes or flow sheet