L2.3: Vital Signs - Respiration

• Respiration

  • It is the act of breathing.
  • Transport of oxygen and carbon dioxide.
  • Consists of pulmonary ventilation, external respiration, and internal respiration.
• Where and How does Respiration occur?

  • Respiration occurs in the Alveoli in the lungs, which are tiny air sacs at the end of the bronchioles.
  • It is the process of gas exchange between atmosphere, blood, and body cells.
• Diaphragm

  • The diaphragm is a large, dome-shaped muscle that contracts rhythmically and continually, and most of the time, involuntarily.
  • Inspiration
  • Expiration
• Diaphragm

  • Inspiration
  • Inhalation
  • Intake of oxygen into the lungs
  • Breathing IN
  • Active process
  • Contractions of the diaphragm and external intercostal muscles enlarge the chest cavity and create a partial vacuum
• Diaphragm

  • Expiration
  • Exhalation
  • Gives out carbon dioxide
  • Breathing OUT
  • Passive Process
  • Relaxation of the diaphragm and external intercostal muscles decreases the size of the chest cavity and forces air out of the lungs.
• Characters of Respiration

  • Respiratory Rate
  • Respiratory Depth
  • Respiratory Pattern or Rhythm
  • Respiratory Quality or Character
• Characters of Respiration

  • Respiratory Rate
  • Normally described in breaths per minute
  • Varies considerably in healthy people
  • Newborns: 30-to-60 breaths/min
  • Infants: 30-to-40 breaths/min
  • Children: 20-25 breaths/min
  • Adolescents: 15-20 breaths/min
  • Adults: 12-20 breaths/min
• Characters of Respiration

  • Respiratory Depth
  • Individual inspired 500 ml of air and expired approximately 450 ml of air.
  • Deep when inspired air is above 500 ml
  • Shallow if it is less than 500 ml
  • Depth of respirations normally varies from shallow to deep
  • Depth of each respiration is about the same when resting or sleeping.
  • Periodically, each person automatically inhales deeply (sighs), filling the lungs with more air than the usual depth of respiration.
• Characters of Respiration

  • Respiratory Pattern or Rhythm
  • Regularity of the expirations and inspirations
  • Normally, respirations are evenly spaces.
  • Can be described as regular or irregular.
  • An infant’s may be less regular than an adult’s.
• Characters of Respiration

  • Respiratory Quality or Character
  • Aspects of breathing that are different from normal, effortless breathing.
  • 2 aspects
  • The amount of effort a client must exert to breath
  • Sound of breathing
• Characters of Respiration

  • Respiratory Quality or Character
  • The amount of effort a client must exert to breath
  • Breathing does not require noticeable effort
  • Sometimes, clients can breathe with substantial effort.
  • Substantial effort is called as “labored breathing”.
• Characters of Respiration

  • Respiratory Quality or Character
  • Sound of breathing
  • Normal breathing is silent.
  • Abnormal sounds such as wheezing are obvious to the healthcare provider’s ear.
  • Sounds occur as a result of the presence of fluid in the lungs and are most clearly heard with a stethoscope.
• Nature and Character of Respiration

  • Eupnea
  • Dyspnea
  • Orthopnea
  • Bradypnea
  • Tachypnea
  • Hyperpnea
  • Polypnea
  • Apnea
  • Hyperventilation
  • Hypoventilation
  • Cheyne-stokes
  • Sighing respiration
  • Stertorous
  • Kussmaul breathing
• Nature and Character of Respiration

  • Eupnea
  • Normal rate and depth of respiration.
• Nature and Character of Respiration

  • Dyspnea
  • Difficulty in breathing.
• Nature and Character of Respiration

  • Bradypnea
  • Slow respirations.
• Nature and Character of Respiration

  • Orthopnea
  • Difficulty in breathing when in lying position.
• Nature and Character of Respiration

  • Tachypnea
  • Rapid/fast shallow respirations.
• Nature and Character of Respiration

  • Hyperpnea
  • Respiration with increased depth.
• Nature and Character of Respiration

  • Polypnea
  • Increased rate of respiration.
• Nature and Character of Respiration

  • Apnea
  • Cessation of breathing.
• Nature and Character of Respiration

  • Hyperventilation
  • Increased rate and depth of respiration.
• Nature and Character of Respiration

  • Hypoventilation
  • Under expansion of the lungs characterized by shallow respirations.
• Nature and Character of Respiration

  • Cheyne-Stokes
  • Periods of hypernea alternating with periods of apnea.
• Nature and Character of Respiration

  • Sighing respiration
  • Breathing punctuated by frequent signs.
• Nature and Character of Respiration

  • Stertorous
  • Noisy breathing
• Nature and Character of Respiration

  • Kussmaul Breathing
  • Very deep and only slightly rapid breathing and usually accompanied by sigh.
• Assessing Respiration (1)

  • After taking the pulse rate, the examiner keeps their fingertips in place so that the client thinks they are still taking the pulse rate.
  • DO NOT inform the client that you are taking their respiratory rate, having the client informed and aware that you are taking their respiratory rate may alter the client’s breathing.
• Assessing Respiration (2)

  • Count the rise and fall of the client’s chest for one full minute (60 seconds)
  • 1 Respiration and 1 Expiration = 1 Respiration
  • DO NOT only take the first 15 seconds then multiplying the result by four (4). It is not a valid way of assessing the client’s respiration rate.
• Assessing Respiration (3-4)

  • Take note for the client’s rate, depth, and character of respiration as well as the movement and expansion of the chest, the client’s color, and the position they assume.
  • Document and report pertinent data.
• Respiration

  • External respiration – the exchange of oxygen and carbon dioxide between the alveoli of the lungs and the pulmonary blood system
  • Internal respiration - the interchange of oxygen and carbon dioxide between the circulating blood and cells throughout the body
  • Inspiration (inhalation) - the intake of air into the lungs
  • Exhalation (expiration) - the movement of gases from the lungs to the atmosphere.
• Phases and Mechanics of Breathing

  • negative pressure breathing: H --> L
  • Respiratory Inhalation ( 1 – 1.5 sec)
  • Respiratory Exhalation (2-3 sec)
• INHALATION

  • rib cage expands as rib muscles contract
  • diaphragm contracts (move down)
  • volume decreases
  • pressure decreases
  • air rushes in
• EXHALATION

  • rib cage gets smaller as rib muscles relax
  • diaphragm relaxes (moves up)
  • volume decreases
  • pressure increases
  • air rushes out
• Respiration

  • neural regulation
  • respiratory centers: medulla oblongata, pons
• Types of Breathing

  • costal/thoracic: Involves chiefly the external intercostal muscles & other accessory muscles (sternocleidomastoid)
  • diaphragmatic/abdominal: Involves contraction & Relaxation of diaphragm, Observed by movement of Abdomen
• Respiratory rate

  • bradypnea, polypnea/tachypnea, apnea

  Respiratory depth

  • hyperventilation, hypoventilation

  Respiratory pattern/rhythm

  • Kussmaul's breathing
• RESPIRATORY DEPTH/TIDAL VOLUME

  • On the average, an individual inspires 500 ml of air & expires approximately 450 ml. of air
  • Can be assessed by observing the movement of the chest wall and the use of accessory muscles.
  • Can be described as: Deep or Shallow
  • Tidal Volume: is the volume or the amount of air that moves in or out of the lungs with each respiratory cycle
• Factors Affecting Respiration

  • Age
  • Gender
  • Exercise
  • Acid-base balance
  • Brain lesions
  • Increased altitude
  • Respiratory disease
  • Anemia
  • Anxiety
  • Medications
  • Acute pain
  • Metabolism
  • Environment
• How to take respiration rate?

  • the clients should not be made aware that you are doing so.
  • Assess the respiratory rate after or before taking the radial pulse, while holding the client’s wrist.
  • Count the respiratory rate for 30 seconds if the respirations are regular. Count for 60 seconds if they are irregular. An inhalation and an exhalation count as one respiration.
  • Observe the depth, rhythm, and character of respirations by watching the movement of the chest.
  • Record rate and characteristics of respirations