What is respiration??- It is the act of breathing.

Two processes involved in breathing:

1. Inhalation or inspiration- refers to the intake of air into the lungs

2. Exhalation or expiration- refers to the breathing out or movement of gases from the lungs to the atmosphere.

Ventilation is also used to refer to the movement of air in and out of the lungs.

Two Basic Types of Breathing:

1. Costal (thoracic) breathing- It involves the external intercostal muscles and other accessory muscles, such as the sternocleidomastoid muscles. It can be observed by the movement of chest upward and outward.

2. Diaphragmatic (abdominal) breathing- It involves the contraction and relaxation of the diaphragm and it is observed by the movement of the abdomen.

Factors Affecting Respirations:

Exercise Stress Environmental temperature Increased altitude Certain medications Body position

yOu neeD to knOw.. Tidal volume- It is the amount of air a person takes in during normal inspiration and expiration.

Hyperventilation- It refers to deep, rapid respirations. Hypoventilation- It refers to very shallow respirations.

Respiratory rhythm- It refers to the regularity of the expirations and inspirations.

Respiratory quality or character- It refers to those aspects of breathing that are different from normal, effortless breathing.

Altered Breathing Patterns and SoundsBREATHING PATTERNS BREATH SOUNDS

Rate Audible Without Amplification Tachypnea Stridor Bradypnea Stertor Apnea Wheeze

BubblingVolume Hyperventilation Chest Movements Hypoventilation Intercostal retraction

Substernal retractionRhythm Suprasternal retraction Cheyne-Stroke breathing

Secretions and CoughingEase or Effort Hemoptysis Dyspnea Productive cough Orthopnea Nonproductive cough

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ASSESSING RESPIRATIONS PURPOSES

To acquire baseline data against which future measurements can be compared.

To monitor abnormal respirations and respiratory patterns and identify changes.

To monitor respirations before or following the administration of a general anesthetic or any medication that influence respirations.

To monitor clients at risk for respiratory alterations.

ASSESSMENT

Assess Skin and mucous membrane color (e.g., cyanosis or pallor) Position assumed for breathing (e.g., use of orthopneic position) Signs of cerebral anoxia (e.g., irritability, restlessness, drowsiness or loss of consciousness) Chest movements (e.g., retractions between the ribs or above or below the sternum) Activity tolerance Chest pain Dyspnea Medications affecting respiratory rate

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PLANNING

Delegation

Counting and observing respirations may be delegated to UAP. The follow-up assessment, interpretation of abnormal respirations and determination of appropriate responses are done by the nurse.

Equipment

Watch with a second hand indicator

IMPLEMENTATION

PREPARATION

» For a routine assessment of respirations, determine the client’s activity schedule and choose a suitable time to monitor the respirations. A client who has been exercising will need to rest for a few minutes to permit the accelerated respiratory rare to return to normal. Performance

1. Prior to performing the procedure, introduce self and verify the client’s identity using agency protocol. Explain to the client what you are going to do and how he or she can cooperate. Discuss how the results will be used in planning further care and treatments.

2. Perform hand hygiene and observe appropriate infection control procedures.

3. Provide for client privacy.

4. Observe or palpate and count the respiratory rate. The client’s awareness that the nurse is counting the respiratory rate could cause the client to purposefully alter the respiratory pattern. If you anticipate this, place a hand against the client’s chest to feel the chest movements with breathing, or place the client’s arm across the chest and observe the chest movements while supposedly taking the radial pulse.

Count the respiratory rate for 60 seconds.

5. Observe the depth, rhythm and character of respirations. Observe the respirations for depth by watching the movement of the chest. Rationale: During deep respirations, a large volume of air is exchanged; during swallow respirations, a small volume is exchanged. Observe the respirations for regular or irregular rhythm or irregular rhythm. Rationale: Normally, respirations are evenly spaced. Observe the character of respirations- the sound they produce and the effort they require. Rationale: Normally, respirations are silent and effortless.

6. Document the respiratory rate, depth, rhythm and character on the appropriate record.

SAMPLE DOCUMENTATION5/17/07 Respirations irregular, varying from 18-

34/ min. in the past hour. Shallower resp. during tachypnea. Slight wheezing noted. Resp. therapist called to provide treatment. D. Katano, RN.

EVALUATION Relate respiratory rate to other vital signs, in particular pulse rate; relate respiratory rhythm and depth to baseline data and health status.

Report to primary care provider a respiratory rate significantly above or below the normal range and any notable change in respirations from previous assessments; irregular respiratory rhythm; abnormal character of breathing– orthopnea,wheezing, stridor or bubbling; and any complaints of dyspnea.

Conduct appropriate follow-up such as administering oxygen or other appropriate medications or treatments, positioning the client to ease breathing and requesting involvement of other members of the health care team such as the respiratory therapist.

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..THE END!!!..

“Ask not what your country can do for you; ask what you can do for the

country.” - John f. Kennedy, Inaugural

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