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 forcesair 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 lessregular 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 doesnot 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.
DONOT 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 = 1Respiration
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.