Respiration is the movement of oxygen from environment to cells and transport of carbon dioxide from cells to environment. Movement of air into and out the lung is called ventilation.
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- Ventilation: moving air into and out of the lungs.
- Perfusion: exchange gases between air in the lungs and the blood.
- Transport: transport of oxygen to body cells and return of carbon dioxide.
- Internal respiration: Exchange gases between blood and the body cells.
- Cellular respiration: Use of oxygen in cellular processes and production of carbon dioxide.
Respiration Examination
During examination of respiration, following things should be assessed.
- Rate
- Rhythm
- Type
- Depth
- Breathing patterns
Procedure:
- Greet the patient and stand on right side of patient.
- Explain about the procedure and take consent.
- Exposure: The chest is exposed and start the examination.
Respiratory rate:
It is how many breaths patient takes in one minute. It is usually 12-20 breaths per minute.
To asses the respiratory rate, you can directly start the procedure. One up movement and one down movement of chest (or abdomen) is considered one complete cycle. Or your can put piece of paper on the abdomen and count the movement of paper. You can just start the stopwatch and count the respiratory rate. However, some patients may get anxious during procedure and their respiratory rate may increase. For that, you can take respiratory rate indirectly. For eg. You can hold the hand of patient and act like you are taking the pulse, you can rest your hand on abdomen of patient. While doing so you can count the rate.
Normal = 12-20 breaths per minute.
Tachypnoea
Increased respiratory rate or respiratory rate more than 20 breaths per minute.
Causes
- Nervousness
- Pain Exertion
- Fever
- Hypoxia
- Acute pulmonary edema
- Pneumonia
- Pulmonary embolism
- Acute respiratory distress syndrome
- Metabolic acidosis
- Asthma
- Pneumothorax
Bradypnea
Decrease in respiratory rate or respiratory rate less than 12 breaths per minute.
Causes:
- Alkalosis
- Hypothyroidism
- Narcotic drug poisoning
- Raised intracranial tension
- Cardiac arrest
Rhythm
It includes inspiration and expiration cycle (entire breathing cycle).
Regular: Duration of inspiration is longer than expiration with no pause in between. This cycle occurs at regular interval.
Any change from regular rhythm is irregular rhythm.
Type
In woman it is Thoraco-abdominal and in men it is Abdomino-thoracic. In males, diaphragms are stronger compared to intercostals while opposite in female. Female use intercostal more than men.
Depth
It refers to amount of air that is inhaled and exhaled.
- Hyperventilation: increase in depth of respiration.
- Hypoventilation: Decrease in depth of respiration.
- Hyperpnea: Increase in depth and rate of respiration.
Pattern
Abnormal breathing pattern may be regular or irregular.
1. Regular abnormal
a. Cheyne strokes breathing
Hyperpnea followed by apnea. It is seen in
- Left ventricular failure
- Renal failure
- Narcotic poisoning
- Raised intracranial pressure
b. Kussmaul’s breathing
increase in rate and depth of breathing. It is seen in
- metabolic acidosis
- diabetic ketoacidosis
- pontine lesions
- uremia
- hepatic failure
- shock
2. Irregular abnormal patterns
a. Biot’s breathing
Apnea between several shallow or few deep inspirations. It is seen in meningitis.
b. Ataxic breathing
Deep and shallow breaths occur randomly. It is seen in brainstem lesions.
c. Apneustic breathing
Pause at full inspiration, alternating with pause in expiration, lasting for 2 to 3 seconds. It is seen in pontine lesions.
d. Cogwheel breathing
Interrupted type of breathing. It is seen in nervous individuals.
e. Pursed lip breathing
patient breaths out against a pursed lip. It helps in increasing pressure above the surrounding alveoli and prevents collapse. COPD, emphysema.
