STUDY - Technical - New Dacian's Medicine
Respirations,
abnormal (Classical / Allopathic Medicine)
Characterized
by a deep, low-pitched grunting sound at the end of each
breath, grunting respirations are a chief sign of
respiratory distress in infants and children. They may be
soft and heard only on auscultation or loud and clearly
audible without a stethoscope. Typically, the intensity of
grunting respirations reflects the severity of respiratory
distress.
Grunting
respirations indicate intrathoracic disease with lower
respiratory involvement. Though most common in children,
they sometimes occur in adults who are in severe
respiratory distress. Whether they occur in children or
adults, grunting respirations demand immediate medical
attention.
Respirations
are shallow when a diminished volume of air enters the
lungs during inspiration. The patient with shallow
respirations usually breathes at an accelerated rate.
However, as he tires or as his muscles weaken, this
compensatory increase in respirations diminishes, leading
to inadequate gas exchange and such signs and symptoms as
dyspnea, cyanosis, confusion, agitation, loss of
consciousness, and tachycardia.
Shallow
respirations may develop suddenly or gradually and may
last briefly or become chronic. They're a key sign of
respiratory distress and neurologic deterioration.
Characterized
by a harsh, rattling, or snoring sound, stertorous
respirations usually result from the vibration of relaxed
oropharyngeal structures during sleep or coma, causing
partial airway obstruction. Less commonly, these
respirations result from retained mucus in the upper
airway.
Stertorous
respiration normally occurs in about 10% of individuals,
especially middle-aged, obese men. They may be aggravated
by alcohol or sedative use before bed, which increases
oropharyngeal flaccidity, and by sleeping in the supine
position, which allows the relaxed tongue to slip back
into the airway. The major pathologic causes of stertorous
respirations are obstructive sleep apnea and
life-threatening upper airway obstruction associated with
an oropharyngeal tumor or with uvular or palatal edema.
Obstruction may also occur during the postictal phase of a
generalized seizure when mucous secretions or a relaxed
tongue block the airway.
ALERT:
If the patient exhibits abnormal respirations:
- check for signs and symptoms of associated respiratory distress, including wheezing, tachypnea, accessory muscle use; retractions; nasal flaring; and tachycardia
- institute emergency measures, if necessary.
If the patient isn't in severe respiratory distress, perform a focused assessment.
If the patient exhibits abnormal respirations:
- check for signs and symptoms of associated respiratory distress, including wheezing, tachypnea, accessory muscle use; retractions; nasal flaring; and tachycardia
- institute emergency measures, if necessary.
If the patient isn't in severe respiratory distress, perform a focused assessment.
HISTORY:
Ask the patient when his abnormal respirations began, how long they last, and what makes them better or worse.
Ask the patient if he smokes. If so, ask him how many packs he smokes in a year.
Review the patient's medical history for chronic illness, surgery, trauma, asthma, allergies, heart failure or vascular disease, chronic respiratory disease or infection, or neurologic or neuromuscular disease.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient when his abnormal respirations began, how long they last, and what makes them better or worse.
Ask the patient if he smokes. If so, ask him how many packs he smokes in a year.
Review the patient's medical history for chronic illness, surgery, trauma, asthma, allergies, heart failure or vascular disease, chronic respiratory disease or infection, or neurologic or neuromuscular disease.
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:
Inspect the chest for deformities or abnormal movements, such as intercostal retractions.
Palpate for expansion and diaphragmatic tactile fremitus, and percuss for hyper resonance or dullness.
Auscultate the lungs, especially the lower lobes. Note diminished or abnormal sounds, such as crackles or sibilant rhonchi, which may indicate mucus or fluid buildup.
Characterize the color, amount, and consistency of discharge or sputum, if present.
Inspect the extremities for cyanosis and digital clubbing. Note peripheral edema, if present.
Inspect the chest for deformities or abnormal movements, such as intercostal retractions.
Palpate for expansion and diaphragmatic tactile fremitus, and percuss for hyper resonance or dullness.
Auscultate the lungs, especially the lower lobes. Note diminished or abnormal sounds, such as crackles or sibilant rhonchi, which may indicate mucus or fluid buildup.
Characterize the color, amount, and consistency of discharge or sputum, if present.
Inspect the extremities for cyanosis and digital clubbing. Note peripheral edema, if present.
SPECIAL
CONSIDERATIONS:
Position the patient as nearly upright as possible to ease his breathing, and continue to monitor his respiratory status closely.
Position the patient as nearly upright as possible to ease his breathing, and continue to monitor his respiratory status closely.
PEDIATRIC
POINTERS:
In children, shallow respirations commonly indicate a life-threatening condition. Airway obstruction can occur rapidly.
Causes of shallow respirations in infants and children include idiopathic (infant) respiratory distress syndrome, acute epiglottiditis, diphtheria, aspiration of a foreign body, croup, acute bronchiolitis, cystic fibrosis, and bacterial pneumonia.
In children, the most common cause of stertorous respirations is nasal or pharyngeal obstruction secondary to tonsillar or adenoid hypertrophy or the presence of a foreign body.
In children, shallow respirations commonly indicate a life-threatening condition. Airway obstruction can occur rapidly.
Causes of shallow respirations in infants and children include idiopathic (infant) respiratory distress syndrome, acute epiglottiditis, diphtheria, aspiration of a foreign body, croup, acute bronchiolitis, cystic fibrosis, and bacterial pneumonia.
In children, the most common cause of stertorous respirations is nasal or pharyngeal obstruction secondary to tonsillar or adenoid hypertrophy or the presence of a foreign body.
AGING
ISSUES:
Stiffness or deformity of the chest wall associated with aging may cause shallow respirations.
Stiffness or deformity of the chest wall associated with aging may cause shallow respirations.
PATIENT
COUNSELING:
Teach the patient to cough and deep-breathe to clear secretions and to counteract possible hypoventilation.
Teach the patient to cough and deep-breathe to clear secretions and to counteract possible hypoventilation.
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.