ASSESSING
BREATHING For a healthy adult, the normal respiratory rate is 12-20 times per minute. Patients breathing less than 10 times or more than 30 times per minute may need assistance. Respiratory rate and quality is one of the vital signs necessary to assess the needs of your patient. Breathing should be assessed every few minutes, noting changes in rate, sound and effort.
To assess quality and quantity of respirations, count the number of times the patient inhales in a 15-second period. Then, take that number and multiply it by 4. That will tell you respirations per minute. Also, listen for the sound of each breath. Normal breathing is a silent and effortless action where the chest and stomach move in a rhythmic pattern. If your patient is using accessory muscles of the abdomen, shoulder or neck while breathing, it is safe to assume some type of respiratory distress is a concern.
Infants and children have their own special considerations when it comes to breathing. Their lungs and tracheas are smaller and more easily obstructed. An infant’s tongue takes up proportionally more space in the mouth. Because of small physical size, infants and children have a smaller lung capacity. A child’s trachea is also more flexible, which makes accurate breathing assessment more difficult.
Because their heads are larger in proportion to their bodies, infants in particular, require different positioning of their heads for breathing assessment. An open airway for an infant or child is obtained by keeping the head and neck in a open position by raising the chin a little. Be careful not to hyper extend. A normal respiratory rate for an infant is 30-40 per minute, whereas for a child over 12 months old, normal is 20-35 times per minute.
ABNORMAL BREATHING
Loud, noisy or strained breathing usually indicates something is wrong. Any patient who is wheezing, whistling, snoring or gurgling during breathing may have a problem. Respiratory concerns can be characterized as either a restriction or an obstruction. If the patient is unresponsive, simply repositioning the airway using the head tilt-chin lift method may be all that is needed. If the condition continues, the problem may be in the lower airways and will require more intervention.
Dyspnea (difficulty breathing) can be brought on by many causes, some due to an upper respiratory cause; others are due to a lower airway issue. Your job is to identify respiratory distress quickly and begin the proper treatment.
Respiratory problems in children are also quite common and can result from illness or injury. Infections, asthma, drowning, near-drowning, allergic reactions and trauma are other possible causes of respiratory distress in children.
Always be alert for the child who is working hard to breathe. This, coupled with a decreasing level of responsiveness, represents an ominous situation. As a child grows more tired from continuing efforts to breathe, respirations will begin to slow.
Children who experience respiratory problems quickly compensate by an increase in heart rate and breathing. Unfortunately, when these compensation methods fail, infants and children deteriorate rapidly.
During your initial assessment and beyond, try to keep the infant or child calm. As children become frightened, they will start to breathe even faster, which only makes matters worse. If the child you are treating finds a position of comfort, do your best to maintain that position.
ASTHMA
Asthma is a chronic respiratory disease that affects the breathing tubes in your lower airways. These tubes carry air in and out of your lungs. Asthma patients have inflammation in the walls of these tubes. This swelling makes the airways very sensitive, and they react strongly to things you are allergic to or find irritating.
When the airways react, they tend to narrow, causing less airflow through to your alveoli. This causes a
26 Respiratory System
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