Assessing Respiration: Rate, Rythm, and Effort Flashcards
factors that can affect respiratory rate
exercise, anxiety, acute pain, smoking, and medications.
what position should the patient be in?
Help the patient into a comfortable position, preferably sitting or lying with the head of the bed elevated 45 to 60 degrees.
Respiration
is the exchange of oxygen (O2) and carbon dioxide (CO2) between cells of the body and the atmosphere
Three processes of respiration are
ventilation: mechanical movement of gases into and out of the lungs
diffusion, movement of oxygen and carbon dioxide between the alveoli and the red blood cells
perfusion: distribution of red blood cells to and from the pulmonary capillaries.
risk factors for respiratory alteration
fever, diseases of the chest wall or muscles, gastric distention, chronic pulmonary diseases, traumatic injury to the chest wall with or without collapse of underlying lung tissue, presence of a chest tube, respiratory infection, pulmonary edema or emboli, head injury with damage to the brain stem, and anemia.
signs and symptoms of respiratory alteration
such as bluish or cyanotic appearance of nail beds, lips, mucous membranes, and skin; restlessness, irritability, confusion, or reduced level of consciousness; pain during inspiration; labored or difficult breathing; orthopnea; accessory muscle use; adventitious breath sounds; inability to breathe spontaneously; thick, frothy, blood-tinged, or copious sputum produced on coughing, complaints of shortness of breath (dyspnea).
factors that can affect respiratory rate
activity, anxiety, acute pain, smoking, medications, body position, or presence of abdominal incisions or dressings.
If the patient has been active
wait 5 to 10 minutes before assessing respiration.
Assess respiration after
measuring the pulse, so that the patient will not try to voluntarily control his or her breathing.
inform NAP of the following
The frequency of measurement and factors related to patient history or risk of increased or decreased respiratory rate or irregular respiration.
The patient’s usual respiratory values and the need to report to you any unusual values.
Average respiratory rate (breaths per minute) for newborns is
Infant (6 months to 1 year) is
toddler (2 years) is
and child from 3 to 12 years
30 to 60 30 30 25 to 32 20.1
Children up to age 7 breathe abdominally; thus …
respirations are observed by abdominal movement.
An irregular respiratory rate and short apneic spells are normal for newborns.
Nurses can simply observe infant or young child while chest and abdomen are exposed.
Use cardiorespiratory monitors for infants or newborns that are at risk for respiratory compromise or sustained apnea.
Aging causes ossification of costal cartilage and downward slant of ribs, resulting in
more rigid rib cage, which reduces chest wall expansion.
Depth of respirations tends to decrease with aging.
Change in lung function with aging results in respiratory rates generally higher in older adults, with a range of 12 to 24 breaths/min.
Some older adults depend more on accessory abdominal muscles during respiration than weakened thoracic muscles.
Kyphosis and scoliosis may also
restrict chest expansion.
