VITAL SIGN :RESPIRATION AND ITS ALTERATIONS

Presented By Mrs BEMINA JA

Assistant Professor
ESIC College Of Nursing
Kalaburagi
LEARNING OBJECTIVES.
 Define respiration
 Describe the mechanics of respiration
 Explain the characterestics of respiration
 List out the factors affecting respiration
 Discuss the alterations in respiration
INTRODUCTION
 Respiration, or the act of breathing, is the process of
inhaling oxygen into the body and exhaling carbon dioxide.
 One respiration, also called the respiratory cycle, consists of
one expiration (exhalation) and one inspiration (inhalation).
 Respiratory rate is an indicator of how well oxygen is being
provided to the tissues of the body.
 Respirations are counted by watching, listening, or feeling
the movement of inspiration and expiration on the patient’s
back, stomach, or chest.
 A stethoscope also may be used to assist with counting
respirations.
DEFINITION
 Mechanism that body uses to exchange gases between
the atmosphere and the blood and the cells.
 Respiration is the exchange between oxygen and

carbon dioxide in the LUNGS.

Breathing refers to inhalation and exhalation of air
 Normal rate in adult is 12 to 20/minute

Normal breathing is
 quiet,
 effortless, and
 regular in rhythm
MECHANICS OF RESPIRATION
  • INSPIRATION
 • EXPIRATION INSPIRATION

During inspiration
 contraction of muscles of respiration
 diaphragm descends
 rib cage rises.
 abdominal organs move downward and forward
 EXPIRATION

During expiration
 Relaxation of muscles of respiration
 Diaphragm rises
 Rib cage returns to normal position
 Abdominal organs return to original position.
PHYSIOLOGY OF RESPIRATION
It involves
 ventillation,
 diffusion, and
 perfusion.
 Ventillation:
 • It is the movement of gases in and out of the lungs.
 • It is assessed by determining the rate ,depth, rhythm

of respiration.
Diffusion:
 • It is the movement of oxygen and carbon dioxide

between the alveoli and the red blood cells. (in the blood
vessel)
 Perfusion:
 • It is the distribution of red blood cells in the pulmonary
 • capillaries.

 • Oxygen delivers into cells and tissues.

GAS EXCHANGE:
 • Oxygen enters lungs and reaches alveoli
 • Oxygen passes through alveolar membrane into the

blood.(RBC)
 • Distribute into the tissues
Control of Breathing
 Respiration is controlled by:
 1. Respiratory center in the medulla oblongata and

the pons of the brain.

 2. Chemoreceptors located centrally in the medulla in

peripherally in the carotid and aortic bodies.

These centers and receptors
 respond to changes in the concentration of
 oxygen ( O2),
 carbon dioxide ( Co 2), and
 hydrogen ( H+) levels in the arterial blood
Characteristics of the respiration:
 When the respiration rate is taken, several
characteristics should be noted:
 • Rate,
 • Rhythm,
 • Depth, and
 • The quality or characteristics of breathing.
Respiratory Rate:
 It is the number of respirations per minute.
 The normal respiration rate for healthy adults at rest is

12 to 20 cycles per minute.

 Children have a more rapid rate of breathing than

adults.
Respiratory Rate Ranges of Various Age Groups
 Newborn 30–50
 1–2 years old 20–30
 3–8 years old 18–26
 9–11 years old 16–22
 12–Adult 12–20
Respiratory Rhythm:
 It refers to the regular and equal spacing of breaths.
 In a regular respiratory rhythm, the cycles of

inspiration and expiration have about the same rate

and depth.

 With irregular breathing patterns,

 the depth and amount of air inhaled and exhaled and

the rate of respirations per minute will vary.

Respiratory Depth:
 The depth of respiration is the volume of air that is
inhaled and exhaled.
 It is described as either “shallow” or “deep.”
 Rapid but shallow respirations occur in some disease

conditions, such as high fever, shock, and severe pain.

 Hyperventilation refers to deep and rapid

respirations, and
 Hypoventilation refers to shallow and slow

respirations.
Respiratory Quality:
 Respiratory quality or character refers to breathing
patterns — both normal and abnormal.

 Labored breathing refers to respirations that require

greater effort from the patient.
Breath Sounds:
 Normal respirations do not usually have any
noticeable sounds.

 However, certain diseases and illnesses can cause

irregular respiration sounds.
Terms for describing these abnormal breath sounds include the following:

BREATH SOUNDS:
STRIDOR
 A shrill, harsh sound, heard more clearly during

inspiration but that can occur during expiration.

 It occurs at the level of larynx or below
 This sound may occur when there is airway blockage,

such as in children with

croup[Laryngotracheobronchitis with barking cough]
and patients with laryngeal obstruction.
STERTOR (STERTOROUS BREATHING)
 Noisy sounds during inspiration, sounds similar to

those heard in snoring. It occurs above larynx

CRACKLES (ALSO CALLED RALES)

 Crackling sounds resembling crushing tissue paper,

caused by fluid accumulation in the airways.

RHONCHI
 Rattling, whistling, low-pitched sounds made in the throat.

Rhonchi can be heard in patients with

Pneumonia,
Chronic bronchitis,
Cystic fibrosis, or
COPD.

 WHEEZES
 Sounds similar to rhonchi but more highpitched,
 made when airways become obstructed or severely
narrowed, as in asthma or COPD.
 Cheyne-Stokes breathing
IRREGULAR BREATHING THAT
 May be slow and shallow at first,
 Then faster and deeper, and
 That may stop for a few seconds
 Before beginning the pattern again.

This type of breathing may be seen in certain patients

with
 Traumatic brain injury,
 Strokes, and
 Brain tumours.
ASSESSMENT OF RESPIRATION

1.Determine need to assess client’s respirations

 - note risk factors for respiratory alterations
 - assess for signs and symptoms of respiratory

alterations
2.Assess pertinent laboratory values:
 - arterial blood gases (ABGs)
 - Pulse oximetry (SPO2)
 - Complete blood count (CBC)

3. Determine previous baseline respiratory rate from

client’s record
PROCEDURE
 Perform hand hygiene
 Be sure client is in comfortable position preferably sitting
or lying with the head of the bed elevated 45 to 60 degrees.
 Be sure client’s chest is visible. If necessary move bed
linen or gown
 Place client’s arm in relaxed position across the abdomen
or lower chest or place nurse’s hand directly over client’s
upper abdomen
 Observe complete respiratory cycle( one inspiration and
one expiration)
 After cycle is observed, look at watch’s second hand and
begin to count rate.
 When sweep hand hits number on dial, begin time frame,
counting one with firs full respiratory cycle.
 Note depth of respirations, subjectively assessed by
observing degree of chest wall movement while counting rate.
 Nurse can also objectively assess depth by palpating chest
wall excursion or auscultating the posterior thorax after
rate has been counted.
 Note rhythm of ventilator cycle. Normal breathing is regular
and uninterrupted.
 Replace bed linen and client’s gown.
 Perform hand hygiene
 Discuss findings with client as needed
 If respirations are assessed for the first time, establish rate,
rhythm and depth as baseline if within normal range.
 Compare respirations with client’s previous baseline and
normal rate, rhythm and depth.
 .
RECORDING AND REPORTING
 • Record respiratory rate and character in nurse’s notes
or vital sign flow sheet.
 • Indicate type and amount of oxygen therapy is used

by client during assessment

 • Measurement of respiratory rate after administration

of specific therapies should be documented in narrative

form in nurse's notes.
POINTS TO BE REMEMBERED
  Clients with difficulty breathing such as those with
CHF(Congestive heart failure)or abdominal ascites or
in late stages of pregnancy should be assessed in the
position of greatest comfort.

 Repositioning may increase the work of breathing,

which will increase respiratory rate

 Respiratory rate less than 12 or greater than 20 requires

further assessment and may require immediate
intervention
 Any irregular respiratory pattern or periods of apnea
are symptoms of underlying disease in the adult and
must be reported to the physician or nurse in charge.

 Further assessment may be required and immediate

intervention may be needed.

 An irregular respiratory rate and short apneic spells are

normal for newborns.
FACTORS AFFECTING RESPIRATION
 Exercise -Rapid and deep respiration
 Acute pain rapid and shallow respiration.
 Anxiety -increases rate and depth of respiration.
 Smoking -increased rate of respiration
 Age
 Body positions -erect posture promotes full chest expansion.
 Medication -depresses respiration. Certain drugs (e.g., morphine) (e.g.,

epinephrine) 
 Neurological injury -Injury to brain stem impairs the respiratory centre.
 Hemoglobin function
 Allergic reactions
 High altitudes Obstruction of air passage
 Shock
ALTERATIONS IN RESPIRATIONS
 BRADYPNEA: Respiratory rate less than 12 breaths / minute.
 TACHYPNEA: Increased rate of respiration, above 20 breaths/ minute.
 HYPERPNOEA: Labored respiration, increased breathing rate and
depth.
 APNEA: - temporary stoppage of respiration for several seconds.

 HYPERVENTILATION: -increase in rate and depth of respiration.

 HYPOVENTILATION: -low rate and depth of respiration

 CHEYNE-STOKE’S RESPIRATION. - gradual increase in rate and

depth of respiration followed by periods of apnea.( regular)

 KUSSMAUL’SRESPIRATION/ AIR HUNGER -abnormally deep,

regular and rapid respiration
 BIOT’S RESPIRATION -abnormally shallow breaths followed by
irregular period of apnea.
Costal (thoracic) breathing:
 occurs when external intercostal muscles and the other

accessory muscles are used to move the chest upward and

outward.
Diaphragmatic(abdominal) breathing:
 occurs when the diaphragm contracts and relaxes as

observed by movement of the abdomen.

Dyspnea: refers to difficulty in breathing as observed by
labored or forced respirations through the use of accessory
muscles in the chest and neck to breathe.
Orthopnea: discomfort breathing in lying down position
 respiratory condition in which a person must sit or stand in

order to breathe deeply or comfortably.

SUMMARY 
 In this chapter we discussed about
 Meaning of Respiration,
 Mechanics of respiration,
 Physiology and control of respiration,
 Characteristics of respiration,
 Factors affecting respiration,
 Alterations in respiration and
 Assessment of respiration.