Assessing Respirations

Resting respirations should be assessed when the client is at rest because exercise affects respirations, increasing their rate and depth as well. Respirations may also need to be assessed after exercise to identify the client’s tolerance to activity. Before assessing a client’s respirations, a nurse should be aware of

• The client’s normal breathing pattern

• The influence of the client’s health problems on respirations

• Any medications or therapies that might affect respirations

• The relationship of the client’s respirations to cardiovascular function

The rate, depth, rhythm, and special characteristics of respirations should be assessed.

The respiratory rate is normally described in breaths per minute. A healthy adult normally takes between 15 to 20 breaths per minute. Breathing that is normal in rate and depth is called eupnea. Abnormally slow respirations are called tachypnea or polypnea. For the respiratory rated of different groups several factors influence respiratory rate;

The depth of a person’s respirations can be established by watching the movement of the chest. Respiratory depth is generally described as normal, deep, or shallow. Deep respirations are those in which a large volume of air is inhaled and exhaled, inflating most of the lungs. Shallow respirations involve the exchange of a small volume of air and often the minimal use of lung tissue. During a normal inspiration and expiration, an adult takes in about 500 ml of air. This volume is called the tidal volume and pulmonary capacities.

Body position also affects the amount of air that can be inhales. People in a supine position experience two physiologic processes the suppress respiration: an increase in the volume off blood inside the thoracic cavity and compression of the chest. Consequently, clients in a back lying position have poorer lung aeration, which predispose them to the stasis on fluids and subsequent infection. Certain medications also affect the respiratory depth. For example, barbiturates such as secobarbital sodium, when taken in large doses, depress the respiratory centers in the brain, thereby depressing the respiratory rate and depth.

Respiratory rhythm or pattern refers to the regularity of the expirations and the inspirations. Normally, respirations are evenly spaced. Respiratory rhythm can be described as regular or irregular. An infant’s respiratory rhythm may be less regular than an adult’s.

Respiratory quality or character refers to those aspects of breathing that are different from normal, effortless breathing. Two of these are the amount of effortless breathing. Two of these are amount of effort a client must exert to breathe and the sound of breathing. Usually, breathing does not require noticeable effort, some client, however, breathe only with decided effort.

The sound of breathing is also significant. Normal breathing is silent, but a number of abnormal sounds such as a wheeze are obvious to the nurse’s ear. Many sounds occur as a result of the presence of fluid in the lungs and most clearly heard with a stethoscope. For auscultation and percussion methods used to assess lung sounds. For details about altered breathing patterns and terms used to describe various patterns and sounds.

BREATHING PATTERN AND SOUNDS

Breathing Patterns Rate
• Eupnea – normal respirations that is quit, rhythmic, and effortless
• Tachypnea – rapid respiration marked by quick, shallow breaths
• Bradypnea – abnormally slow breathing

Volume
• Hyperventilation – an increase in the amount of air in the lungs characterized by prolonged and deep breaths; may be associated with anxiety.
• Hypoventilation – a reduction in the amount of air in the lung; characterized by shallow respirations.

Rhythm
• Cheyne-stroke breathing – rhythmic waxing and waning of respirations; from very deep to very shallow breathing and temporary apnea; often associated with cardiac failure, increased intracranial pressure, or brain damage.

Ease or effort
• Dyspnea – difficult and labored breathing, during which the individual has a persistent, unsatisfied need of air and distressed.
• Orthopnea – ability to breath only in upright sitting or standing positions.


Breath Sounds

Audible without amplification
• Stridor – a shrill, harsh sound hear during inspiration with laryngeal obstruction.
• Stertor – snoring or sonorous respiration, usually due to a partial obstruction of the upper airway.
• Wheeze - continuous, high-pitched musical squeak or whistling sound occurring on expiration and sometimes on inspiration when air moves through a narrowed or partially obstructed airway.
• Bubbling – gurgling sounds heard as air passes through moist secretions in the respiratory tract.

Audible by stethoscope
• Crackles (formerly called (rales) – dry or wet crackling sounds stimulated by rolling a lock of hair near the ear, generally heard on inspiration as air moves through accumulated moist secretion. Fine – to – medium crackles when air passes through moisture in small air passages and alveoli. Medium to coarse crackles occur when air passes through moisture in bronchioles, bronchi, and the trachea.

Chest Movements
• Intercostal retraction – indrawing between the ribs
• Substernal retraction – indrawing beneath the breastbone
• Suprasternal retraction – indrawing above the clavicles
• Tracheal tug – indrawing and downward pull during inspiration
• Flail chest – the ballooning out of the chest wall through injured rib spaces; results in paradoxical breathing, during which the chest wall balloons on expiration but is depressed or sucked inward on inspiration.

Secretions and Coughing
• Hemoptysis – the presence of blood in the sputum
• Productive cough – a cough accompanied by expectorated secretions
• Nonproductive cough – a dry, harsh cough without secretions


Procedure in Counting Respirations