Respiration consists of a cycle which includes inspiration, expiration, a pause and is controlled by a collection of nerve cells in the medulla oblongata called the respiratory centre. The steady rise and fall of the chest wall is the apparent sign of respiration and is what the nurse must count and record. Normal respiration should be rhythmical, quiet, regular, comfortable and being neither too deep nor too shallow.
RESPIRATION RATE VARIES WITH AGE AND SEX
FOR NEWBORN BABIES: The rate at which newborn infants respire varies from 30 to 35 times per minute.
FOR TWELVE MONTHS OLD INFANT( A YEAR): The rate of respiration varies from 25 to 30 times per minute.
FOR TWO TO FIVE YEARS OLD: The rate of respiration varies from 20 to 25 times per minute.
FOR ADULT: The respiration varies from 14 to 18 times per minute.
It is usually slightly more rapid in women than in men. Normal increase in the rate occurs during and for a time after taking exercise. Now in states of excitement and emotion, where there is sudden chilling of the body and in decreased atmospheric pressure. Normal decrease in the rate occurs during rest, sleep and fatigue.
In the hospital, nurse usually counts the respiration after he or she has counted the pulse but before he or she moves her hand from the patient’s wrist. In this way, the patient will not be aware of what is being done. This can be important to some extent to control the rate of respiration.
When taking the respiration,there are certain points that the nurse should note:
- Degree of discomfort displayed by the patient.
ABNORMALITIES OF RESPIRATION
When the respiration is more rapid than normal, they are usually shallow and when slower than normal, they are usually deeper. An increase rate may occur in:
- Some heart diseases
- Disease of the lungs and air passages
- Febrile conditions
- Heamorrhage and shock.
Reduction in respiration rate occurs in:
- Coma due to toxaemia
- Following the administration of drugs which depress the resoiratory centre. For example morphia.
- Increased intracranial pressure
Grunting at the end of expiration is sometimes noticed in pneumonia.
Sighing Respiration: or air hunger is apparent by slow inspiration and rapid expiration. This occurs in shock following haemorrhage.
Whoop: is the long drawn out noisy inspiration occuring after a paroxysm of coughing in whooping cough.
Stridulous Breathing: is where an a person or an individual makes a harsh whistling sound due to an obstruction in the larynx.
Stertorous Breathing: is manifested by loud snoring and puffing out of the cheeks and is often associated with damage to the brain following injury or cerebrovascular accident.
Wheezing: may be noticed in a person suffering from asthma and bronchitis as a result of air passing through fluid in the air passages.
Cheyne Stokes: Breathing is a distinctive type of breathing which occurs in certain cerebral conditions in uraemia and in morphia poisoning. It is characterised by respiration which gradually become deeper and deeper until they reach a climax, after which they decline until there is a complete cessation of breathing for a few seconds. The period during which breathing has stopped is called a period of apnoea and the climax of the cycle is a period of hyperpnoea.
Inverse Respiration: is the name given to a condition that can be found in children when the pause in the respiratory cycle occurs after inspiration instead of after expiration.
Dyspnoea is the name given to a condition where you have difficulties in breathing, that may or may not be accompanied by pain. The difficulty may be in inspiration or expiration or even both. Dyspnoea is a characteristic of some lung and heart diseases and may be present when there is an excess of fluid in the abdominal cavity like ascites. It can relieve the person at least to some degree, that is by keeping the person in an upright position in bed. If this position is adopted, the person or patient should be well supported by pillow.
This is when an individual or a person is having an extreme difficulty in breathing unless sitting upright. It is associated with advanced heart disease. In several cases, it is helpful to pull a bed table up to the person or patient, cover it with a pillow and allow the person to lean forward.
CHARTING AND CHARTS
The temperature chart is a record of the patient’s progress. On it are charted the temperature, pulse and respiration. This may be taken twice in a day and also in every four hours or frequently in special occasions. It may also be used to record daily bowel movement, total amount of urine excreted daily, times and amount of vomit, blood pressure, the occurrence of a rigor and treatment.