STUDY - Technical - New Dacian's Medicine
Cheyne
Stokes respirations (Classical / Allopathic Medicine)
The most common
pattern of periodic breathing, Cheyne-Stokes respirations are
characterized by a waxing and waning period of hyperpnea that
alternates with a shorter period of apnea. This pattern can
occur normally in patients with heart or lung disease. It
usually indicates increased intracranial pressure (ICP) from a
deep cerebral or brain stem lesion or a metabolic disturbance
in the brain.
Cheyne-Stokes
respirations may indicate a major change in the patient's
condition — usually for the worse. For example, in a patient
who has had head trauma or brain surgery, Cheyne-Stokes
respirations may signal increasing ICP.
ALERT:
If you detect Cheyne-Stokes respirations:
- quickly take the patient's vital signs
- time the periods of hyperpnea and apnea for 3 to 4 minutes to evaluate respirations and to obtain baseline data; be alert for prolonged periods of apnea
- elevate the patient's head 30 degrees
- check skin color and obtain a pulse oximetry reading to detect signs of hypoxemia; administer oxygen, if appropriate
- perform a rapid neurologic examination noting the patient's level of consciousness, pupillary reactions, and ability to move his extremities
- maintain airway patency, and institute emergency measures if necessary.
If the patient's condition permits, perform a more thorough focused assessment.
If you detect Cheyne-Stokes respirations:
- quickly take the patient's vital signs
- time the periods of hyperpnea and apnea for 3 to 4 minutes to evaluate respirations and to obtain baseline data; be alert for prolonged periods of apnea
- elevate the patient's head 30 degrees
- check skin color and obtain a pulse oximetry reading to detect signs of hypoxemia; administer oxygen, if appropriate
- perform a rapid neurologic examination noting the patient's level of consciousness, pupillary reactions, and ability to move his extremities
- maintain airway patency, and institute emergency measures if necessary.
If the patient's condition permits, perform a more thorough focused assessment.
HISTORY:
Review the patient's medical history for head trauma, recent brain surgery, and other brain insults.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Review the patient's medical history for head trauma, recent brain surgery, and other brain insults.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
In addition to the emergent examination, auscultate for abnormal breath sounds and note chest expansion during respirations.
Monitor vital signs and neurologic status.
In addition to the emergent examination, auscultate for abnormal breath sounds and note chest expansion during respirations.
Monitor vital signs and neurologic status.
SPECIAL
CONSIDERATIONS:
When evaluating Cheyne-Stokes respirations, be careful not to mistake periods of hypoventilation or decreased tidal volume for complete apnea.
When evaluating Cheyne-Stokes respirations, be careful not to mistake periods of hypoventilation or decreased tidal volume for complete apnea.
PEDIATRIC
POINTERS:
Cheyne-Stokes respirations rarely occur in children, except during late-stage heart failure.
Cheyne-Stokes respirations rarely occur in children, except during late-stage heart failure.
AGING ISSUES:
Subtle evidence of Cheyne-Stokes respirations can occur normally in elderly patients during sleep.
Subtle evidence of Cheyne-Stokes respirations can occur normally in elderly patients during sleep.
PATIENT
COUNSELING:
Advise the patient or his family members that sleep apnea differs from Cheyne-Stokes respirations in both causes and methods of treatment.
Advise the patient or his family members that sleep apnea differs from Cheyne-Stokes respirations in both causes and methods of treatment.
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)