STUDY - Technical - New Dacian's Medicine
bradypnea
(Classical / Allopathic Medicine)
Commonly preceding
life-threatening apnea or respiratory arrest, bradypnea is a
pattern of regular respirations with a rate of less than 12
breaths/minute. This sign may result from a neurologic or
metabolic disorder or a drug overdose, all of which can
depress the brain's respiratory control centers. (See
Understanding neurologic control of breathing.)
ALERT:
If the patient with bradypnea seems excessively sleepy:
- try to arouse him by shaking and instructing him to breathe, and then secure his airway
- quickly take his vital signs
- assess his neurologic status by checking his pupil size and reactions and by evaluating his level of consciousness (LOC) and his ability to move his extremities
- be prepared to institute emergency measures.
If the bradypnea is asymptomatic, perform a focused assessment.
If the patient with bradypnea seems excessively sleepy:
- try to arouse him by shaking and instructing him to breathe, and then secure his airway
- quickly take his vital signs
- assess his neurologic status by checking his pupil size and reactions and by evaluating his level of consciousness (LOC) and his ability to move his extremities
- be prepared to institute emergency measures.
If the bradypnea is asymptomatic, perform a focused assessment.
Understanding
neurologic control of breathing
The mechanical aspects of breathing are regulated by respiratory centers, groups of discrete neurons in the medulla, and pons that function as a unit. In the medullary respiratory center, neurons associated with inspiration and neurons associated with expiration interact to control respiratory rate and depth. In the pons, two additional centers interact with the medullary center to regulate rhythm: The apneustic center stimulates inspiratory neurons in the medulla to precipitate inspiration; these, in turn, stimulate the pneumotaxic center to inhibit inspiration, allowing passive expiration to occur.
The mechanical aspects of breathing are regulated by respiratory centers, groups of discrete neurons in the medulla, and pons that function as a unit. In the medullary respiratory center, neurons associated with inspiration and neurons associated with expiration interact to control respiratory rate and depth. In the pons, two additional centers interact with the medullary center to regulate rhythm: The apneustic center stimulates inspiratory neurons in the medulla to precipitate inspiration; these, in turn, stimulate the pneumotaxic center to inhibit inspiration, allowing passive expiration to occur.
Normally, the
breathing mechanism is stimulated by increased carbon
dioxide levels and decreased oxygen levels in the blood.
Chemoreceptors in the medulla and in the carotid and aortic
bodies respond to changes in partial pressure of arterial
carbon dioxide, partial pressure of arterial oxygen, and pH,
signaling respiratory centers to adjust respiratory rate and
depth. Respiratory depression occurs when decreased cerebral
perfusion inactivates respiratory center neurons, when
changes in PaCO2 and arterial blood pH affect
chemoreceptor responsiveness, or when neuron responsiveness
to PaCO2 changes is reduced - for example, with
narcotic overdose.
HISTORY:
Ask the patient or whoever accompanied him to the hospital if he may be having a drug overdose. If so, try to determine which drugs he used, how much, when, and by what route.
Review the patient's medical history for diabetes; liver, renal, or brain tumor; neurologic infection; stroke, pulmonary disease, and recent head trauma.
Review with the patient all drugs and dosages taken during the past 24 hours.
HISTORY:
Ask the patient or whoever accompanied him to the hospital if he may be having a drug overdose. If so, try to determine which drugs he used, how much, when, and by what route.
Review the patient's medical history for diabetes; liver, renal, or brain tumor; neurologic infection; stroke, pulmonary disease, and recent head trauma.
Review with the patient all drugs and dosages taken during the past 24 hours.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Inspect the skin for cyanosis or pallor. Administer oxygen at an appropriate rate.
Inspect the head for signs of trauma.
Check the arms for possible signs of drug abuse.
Check neurologic status, including pupil size, LOC, and motor function.
Auscultate the lungs for abnormal sounds.
Take the patient's vital signs.
Inspect the skin for cyanosis or pallor. Administer oxygen at an appropriate rate.
Inspect the head for signs of trauma.
Check the arms for possible signs of drug abuse.
Check neurologic status, including pupil size, LOC, and motor function.
Auscultate the lungs for abnormal sounds.
SPECIAL
CONSIDERATIONS:
Because the patient with bradypnea may develop apnea, frequently check his respiratory status and be prepared to offer ventilatory support, if necessary.
Because the patient with bradypnea may develop apnea, frequently check his respiratory status and be prepared to offer ventilatory support, if necessary.
PEDIATRIC
POINTERS:
Because respiratory rates are higher in children than adults, bradypnea in children is defined according to age.
Because respiratory rates are higher in children than adults, bradypnea in children is defined according to age.
AGING ISSUES:
Elderly patients who are prescribed drugs have a higher risk of developing bradypnea secondary to drug toxicity because they often take several drugs that can potentiate this effect, and they typically have other conditions that predispose them to it. Warn your patient about this potentially life-threatening complication.
Elderly patients who are prescribed drugs have a higher risk of developing bradypnea secondary to drug toxicity because they often take several drugs that can potentiate this effect, and they typically have other conditions that predispose them to it. Warn your patient about this potentially life-threatening complication.
PATIENT
COUNSELING:
Patients taking narcotics regularly, such as patients with advanced cancer or sickle cell anemia, should be alerted to bradypnea as a serious complication and be taught to recognize early signs of toxicity, such as nausea and vomiting.
Patients taking narcotics regularly, such as patients with advanced cancer or sickle cell anemia, should be alerted to bradypnea as a serious complication and be taught to recognize early signs of toxicity, such as nausea and vomiting.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)