This article is written for Nurses, by a Lecturer in Health Sciences. It describes the different types of respirations nurses see frequently in the Hospital situations. Respirations indicate the severity of illness and are often helpful in assessing the patients overall condition. This article will be useful for care givers and medical students as well. The diagrammatic representations are copyrighted materials of this author.
In this article the following are discussed and explained - Iron lungs, normal respiration, Bradypnea, Tachypnea, Kussmaul's respirations, Biot's respirations, Cheyne-stokes Respirations, apnea and respiratory arrest.
The ordinary word for respiration is breathing. Respiration is the movement of air from the exterior of the patient to the interior. Strictly speaking, this is called external respiration. Internal respiration is the metabolic process at cell level, equated with (combustion) because during this process oxygen is combined with carbohydrates to produce energy. Heat is a by-product of metabolism. During metabolism, energy is created for use by muscles for functions of life.
For optimal external respiration to occur, the patient must be placed in the optimal position for him/her. Patient positions are discussed in another article. The hyperlink is attached. Shergill , diagrams of the different positions are also available at that site.
Normal inspiration occurs because muscle activity, maily contraction, changes the volume of the intrathoracic cavity. When the volume increased, the pressure is decreased. The decreased pressure on the interior forces the air from the exterior to enter the lungs until the two pressures become roughly equal. At this point the stretch receptors stop the lung from expanding any further, in fact, the intercostal muscles relax. By recoil the pressure on the interior increses and expel air to the exterior. Normal tidal volumes and other respiratory parameters are found here. Iron lungs worked be decreasing the pressure on the outside, thereby lifting the rib cage to decrease the intra thoracid pressure.
Picture 1. Patient inside iron lungs for external respiration (victim of polio).
Iron lungs are now redundant. They have been replaced by high tech ventilators.
In the hospital environment, Nurses are the eyes and ears of the treatment team because they are with the patient all the time and usually know the patient best. As the patients condition changes so will his respiration. A brief description of the different types of respiration is given below. The normal respiratory rate is 12 to 18 breaths per minute. During each breath cycle the air moves in and out of the lungs quietly. The rib case rises and falls. There will also be some movement of the diaphragm, and abdominal region.
1. Normal Respiration . Respiratory rate depends upon age and condition of patient. Infants have very high respiratory rates. In Adults the respiratory rate is between 12 and 20 breaths per minute. In silent breathing the rise and fall is about the same. Small variations occur. In natural breathing, sighs occur naturally. A sigh is a larger than usual breath. In this type of breathing, there is a complete absence adventitious of sounds. The trained individual will be able to hear normal air enty and exit from the lungs. Diagramatic representation of rate and amplitude of breathing are shown in diagram numbered 1 (below).
Diagram 1. Graphic Representation of Normal Respirations / minute.
2. Bradypnea . This is a slow repiratory rate which is seen in the post anaesthetic or sedated patient. If blood gases are normal, the nurse will need to keep a close eye on the patient. If oxygen saturation and blood gases are compromised then the patient may need to be given naloxone or some other respiratory stimulant. Bradypnea is also seen in patients who have taken overdoses of barbiturates and/or hypnotics. Bradypnea with a respiratory rate of more than ten breaths may correct itself as the patient recovers from the anaesthetic gases. Sometimes, in bradypnea, the patient compensates by increasing the tidal volume thereby the blood gases and oxygen saturation remain stable. Diagramatic representation of bradypnea is shown in diagram numbered 2 (below).
Diagram 2. Graphic Representation of Bradypnea. Respiratory rate is 8b/min.
3. Tachypnea . Tachypnea means elevated respiratory rate. In some situations, this might be usual, for example when climbing a flight of stairs. In disease it is indicative of problems with oxygenation. It occurs when the patient is breathing really hard to compensate for the higher than usual PCO2. When the patient is tachypneic it is imporant to sit him up in bed. For nursing positions, please see: this article.
A diagramatic representation is shown in diagram 3 (below). In tachypnea the tidal volume is decreased, the minute volume may be the same because the respiratory rate is increased. Decreased tidal volume will have bad consequences for the patient because a lot of energy is being spent on moving dead air space which does not help oxygenate the interior of lungs where gas exchange takes place.
