Respiration

Subject: Fundamentals of Nursing

Overview

Respiration

The process of breathing in and out is called respiration. It refers to the gas exchange that occurs between the blood and the lungs. The amount of breaths an individual takes per minute is known as their respiration rate. The rate is often determined while a person is at rest and is as easy as counting how many times the chest rises over a minute. The respiratory center of the brain regulates this natural bodily function. The medulla oblongata, the brain's respiratory center, activates the diaphragm and causes the intercostal muscles to contract when the blood's concentration of carbon dioxide reaches a particular point. This enables the lungs to open up and take in oxygen-rich air. This process is known as inspiration. In the lungs, the exchange of gases occurs; carbon dioxide from the blood and oxygen from the air sacs go back and forth. Expiration—the act of breathing out—removes this carbon dioxide. Pause is the time between inspiration and expiry. When evaluating a patient's pulse, the respiration is often evaluated. Pulse should be obtained such that we don't have to move the patient in order to watch him or her breathe. Adults typically breathe between 16 and 18 times per minute while at rest.

Types of Respiration

External Respiration: The exchange of gases between the blood and air in the lungs is called external or pulmonary respiration.

Internal Respiration: The exchange of gases between the blood and cells is called as internal or tissue respiration.

Characteristics of Normal Respiration

  • Breathing normally is effortless.
  • Typically, breathing is a passive activity.
  • It is automated, silent, and painless.
  • The chest wall rises and falls rhythmically during normal breathing.
  • Adults who are at rest typically take 16 to 18 breaths per minute.
  • The typical respiration to pulse rate ratio is 1 to 4.
  • The respiratory rate rises along with the pulse rate.
  • At birth, the respiratory rate was 30 at 60 m.

                                 Infant       - 30-40 /m

                             Toddler        -25-32/m

                                 Child       - 20-30/m

           Adolescence                 - 16-24 /m

                      Adults                 - 16 to 22 /m

                   Old age                  - 10 to 24 /m

  • Expansion of chest wall on both sides is uniform so that respiration of equal depth occurs in both lungs.
  • Volume or depth should be moderate.

Factors Affecting Respiration

Sex: Females have slightly higher respiration than males.

Age: A person's respiration rate becomes slower as he gets older.

Exercise: Exercise increases rate and depth to meet the body's need for additional oxygen and to rid the body of CO2.

Emotions: Sudden stressful condition such as fear and anxiety influences the respiratory rate and depth as a result of sympathetic stimulation.

Smoking: Chronic smoking changes pulmonary airways, resulting in increased rate of respiration at rest when not smoking.

Changes of 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.

Disease Condition: Severity of the disease conditions may affect the respiratory rate.

Medications: Opioid analgesics, general anesthetics and sedative hypnotics depress rate and depth. Amphetamines and cocaine sometimes increase rate and depth. Bronchodilators slow rate by causing airway dilation.

Rest and Sleep: During rest and sleep metabolism is decreased so respiration rate is normal or decreased.

Hemorrhage: A decreased volume of blood in the body causes an increase in the respiration rate.

Hemoglobin Function: Decreased hemoglobin levels reduce oxygen carrying capacity of the blood, which increases respiratory rate.

Environment: Expose to cold stimulate the respiratory centre reflect and causes the person to breathe deeper. Warm environment decreases the rate and depth of respiration.

Purposes

  • to measure the volume, rhythm, and rate of breathing.
  • to determine whether your illness or health status has changed.
  • to keep an eye on the success of respiratory system-related therapies.
  • to count the number of breaths that happen each minute.

General Instruction

  • The patient is not to be aware that the nurse is monitoring their breathing. The pace of breathing may change if the operation is known to you.
  • If the patient was active, wait 5–10 minutes before helping respirations.
  • Make sure the patient feels at ease. Before counting breaths, check other vital indicators such as the temperature or pulse.
  • Take into account certain aspects of the patient's medical history that raise the possibility of more frequent, less frequent, or irregular breathing.
  • Make sure you can see the client's chest moving. Remove the bedclothes or robe if required.
  • Because newborns' respirations are diaphragmatic, keep an eye out for belly movements.
  • The following should be kept in mind when you breathe in:
    • Rate,
    • Rhythm,
    • Depth of respiration,
    • Abnormal sound,
    • Color of patient,
    • Movement of accessary muscles.

Methods of Checking Respirations 

S.N. Nursing Action Rationale
1 Identify patient. Ensures that right procedure is performed for right patient.
2

Determine the need to assess the client's respiration. 

Assess for factors that may alter respiration.

 Allows nurse to accurately assess for presence and significance of respiratory alteration.
3 Explain procedure to patient. Obtains patient's cooperation and reduces anxiety.
4 Close the door or use screen. Maintains privacy.
5 Wash hands. Prevents cross infection.
6 Prevents cross infection. Arranging articles aids for smooth functioning.
7 Position the patient in sitting or supine position with the head elevated at 45-60 degree. Positioning ensures easy for counting respirations.
8 Ensure that patient is relaxed. Assess temperature and pulse prior to counting respirations. Awareness of the procedure may alter the rate of respiration.
9 Keep your fingers over the wrist as if checking pulse, and position the patient's hand over his lower chest or abdomen. Than place your hand directly over patient's upper abdomen. Makes the patient less aware of his respiration. Keeping hand over chest makes the movement of chest more visible.
10

Observe one complete respiratory cycle- inspiration and expiration. Every rise and fall in chest movement is to consider as one respiration. Assess rate, depth, rhythm and character of respiration.

Count respiration for one whole minute.

 Depth of respiration reveals volume of air moving in and out of the lungs. Abnormalities of rhythm and character revels specific disease condition.

 
11

Replace patient's linen and cloths. Help patient return to comfortable position.

Replace the client's gown & covers with bed linens.

 Promotes client's comfort.

 
12 Wash hands. Reduces chance of infection.
13 Record in TPR sheet and report any abnormalities. Recording helps to communicate findings.

 

Abnormal Respiration

Rate

Tachypnoea: Rate of breathing is more than 24/m of regular respiration. It is commonly found in pneumonia, fever and hemorrhage.

Bradypnoea: Rate of breathing is less than 10/m of regular respiration. It is commonly found in Coma, cerebral conditions.

Aponea: Absence of breathing for a short period usually 5 to 30 seconds.mooA

Hyperpnoea: Respirations are labored, increased in depth, and increased in rate.

Variation in volume (Depth)

Shallow Breathing: The respiration is not deep due to pain while taking inspiration. It is found in shock and lungs diseases.

Deep Respiration: Respirations are long, deep and slow as in air hunger.

Other

Dyspnoea: This is forced, difficult and laboured breathing in which patient struggles for breath. It may be accompanied by pain and cyanosis seen in heart disease, respiratory disease and convulsions.

Wheezing: This is a characteristic hoarse whistling sound produced during expirations that occurs due to partial obstructions of the smaller bronchi and bronchioles. It is seen in asthma or emphysema.

Stridor Respiration: Inspiration is forced or vibrating and accompanied with crowing sounds due to obstruction in larynx, foreign body in the respiratory tract. There is whistling sound.

Cheyne Stroke: Respiratory rate and depth are irregular, characterized by alternating periods of apnoea and hyperventilation. Respiratory cycle begins with slow, shallow breaths that gradually increase to abnormal rate and depth. The patterns reverse; breathing slows and becomes shallow, climaxing in apnoea before respiration resumes. It is usually found in the patients who are near death.

Stertorous Respiration: It is a noisy respiration. Loud snoring inspiration is present. It is due to difficulty in getting the air into lungs due to secretion. It is normal in persons sleeping flat on back with the mouth open and commonly found in cerebral hemorrhage, under anesthesia.

Orthopnea: Difficulty in breathing in supine or patient can breathe in upright position, commonly found in ascites, pregnant woman and cardiac disease.

Hyperapnoea: This is a state when rate and depth of respiration both increase. It is seen in acidosis.

Anoxia: It means lack of oxygen in tissue.

Anoxaemia: Lack of oxygen in the blood stream.

Cyanosis: It is the bluish discoloration of skin and mucous membrane due to lack of oxygen in the tissue.

Asphyxia: This 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.

Granting Respiration: The respiration is forced with a little grunt at the end of each breath.

Kussmaul's Respiration: Respirations are abnormally deep, regular and increased in rate.
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