ASSESSMENT OF RESPIRATION

DEFINITION
• Respiration is defined as the act of breathing in which oxygen is inhaled through the nose and the carbon dioxide is exhaled out.

Or

• It is the process of taking in oxygen & leaving out carbon dioxide.

FACTORS AFFECTING RESPIRATION

• Factors that Increase Respiration
  • Age
    • Younger Children have higher oxygen demand compared to the adults and therefore their respiratory rate is increased.
  • Stress/ Anxiety: During the stress / Anxiety, the body tries to breathe faster in an effort to quickly distribute oxygen-rich blood to the cells.
  • Exercise: During exercise there is an increase in physical activity and muscle cells respire more than they do when the body is at rest. The rate and depth of breathing increases.
  • Altitude/ atmosphere:  At high altitude, where the pressure of oxygen in the atmosphere is less than at sea level, the body compensates by increasing ventilation.
  • Body Temperature: As the body temperature the respiratory rate also increases as it is the body’s way of inducing heat loss through Respiration.
  • Dehydration: Dehydration Increases the Respiratory Rate as the body tries to breathe faster & Increase Energy to the cells.
  • Respiratory & Heart Illness:  In Respiratory & Heart Illnesses the lungs tries to breathe faster in order to meet the oxygen demand of the organs.
• Factors that Decrease Respiration
  • Drugs/ Medications: Certain Drugs like sedatives & Narcotics can depress the Respiratory Centre & can result in Low Respiratory rate.
  • Sleep: During Sleep, In Non- REM stage the breathing rate is slow & regular and in REM sleep the breathing gradually rises again with irregular shallow breaths because of the relaxation of the throat muscles and decreased movement of rib cage in Sleep.
  • CNS Dysfunction: CNS disorders like head Injury can depress the respiratory Centre, the area that plays the role of breathing and results in Respiratory Depression.

ASSESSMENT OF REPIRATION

A thorough Respiratory Assessment Includes a Comprehensive health history that provides information about the patient’s status & Respiratory clues along with Inspection, Palpation, Percussion & Auscultation of the Lung fields.

Subjective Assessment
• Collect a detailed health history about the Respiratory Illness, Respiratory Infection & cardiovascular Health.
• Collect recent travel history that can predispose the person to respiratory Infections.
• Information about the family history of Respiratory Illness should be obtained.
• Assess the Immunization status of the person.
• In case of Children & Infants collect Information like birth history & milestone development to identify prematurity as they have weak respiratory muscles.

Objective Assessment
• Inspection
• Palpation
• Percussion
• Auscultation

INSPECTION/ OBSERVATION
• Check the rate of respiration.
• Look for abnormalities in the shape of the patient’s chest.
• Observe for shortness of breath and watch for signs of labored breathing.
• Assess oxygen saturation. If it is below 90%, the person may need oxygen administration.
• Check for flaring nostrils, which could indicate breathing problems.

• Look for retractions or bulging of the muscles between the ribs, which suggest difficulty
getting enough air.

PALPATION
Thoracic Excursions
• The patient should be seated with an erect position; Place examiner fingers and palms symmetrically over the chest wall at a horizontal level so that your thumbs are closely opposing each other or are just touching each other. Ask the patient to take a slow deep, breath allowing your hands to move with the thorax. Check the symmetry and extent of expansion of both hands by looking at the movements of the opposing thumbs. Repeat this procedure at the front and back placing the hands over the lower parts of the chest wall where the thorax shows greater expansion.
Tactile & Vocal Fremitus
• Normal lung transmits a palpable vibratory sensation to the chest wall. This is referred to as fremitus and can be detected by placing the ulnar aspects of both hands firmly against either side of the chest while the patient says the words Ninety-Nine. This maneuver is repeated until the entire posterior thorax is covered.
• A buzzing vibratory sound will be felt in respiratory disorders.

Palpate for Abnormalities
• Palpate the thorax by positioning the palms over the thorax and feeling for bulging, tenderness, and retractions while breathing. Feel the ribs for lumps, scars, and swelling.

PERCUSSION
• Place the middle or index finger of the non -dominant hand on chest wall and tap with the index finger of the dominant hand on the areas between each ribs and in the areas of chest & back.
Percussion Sounds Include:
• A short and high-pitched or very dull sound over muscle or bone. This suggests respiratory consolidation.
• A loud, long, low-pitched and hollow sound over the lungs or stomach that may suggest bronchitis.

• A dull, thudding sound over large organs such as the liver. This may also be a sign of consolidation.
• A loud, low-pitched sound over the stomach that can indicate pneumothorax or emphysema.
• A high-pitched drum sound heard when the chest is expanded. This suggests excess air, often due to a collapsed lung.

AUSCULTATION

• Auscultate the chest, back, and sides with a focus on signs of loud or labored breathing.
Abnormal Respiratory Sounds Include:
• Rales: Crackling, popping, or bubbling sounds, which may indicate pneumonia or pulmonary edema.
• Wheezing: Whistling sound on expiration which can signal pulmonary disease, asthma, allergies, or an infection.
• Pleural friction rub: This grating sound occurs when the pleural surfaces rub together and suggests pneumonia.
• Stridor: Grunt like sound heard on Inspiration caused due to Upper airway obstruction.
• Rhonchi: Coarse rattling respiratory sounds, usually caused by secretions in bronchial airways.

Techniques of Assessing Respiration
• The respiratory rate is counted after taking the pulse rate so that the client is not aware that the respirations are counted.
• After counting the pulse, leave the fingers in place and then begin assessing respiration.
• Observe the chest or abdomen rise and fall. One respiration includes a full respiratory cycle (including both inspiration and expiration). Thus, the rise and the fall of the abdomen or chest is counted as one full breath.
• Count for one full minute. Check for the rate, rhythm, Quality & depth of Respiration.
• Record the respiration as breaths per minute.
• Report & Document if there is respiratory Abnormalities.

Special Considerations
• Assess the movement of respiration in the lower chest and abdomen as newborn, Infants & some adults are diaphragmatic breathers (the abdomen moves).
• Count the Respiratory rate for one full minute as the breathing rates of infants can speed up and slow down with some short periods of apnea.
• When assessing respiration, ensure the movement of chest and abdomen are clearly visible.
• Count the Respiratory rate at rest to obtain accurate measurements. Except in case of emergencies respiratory rate should be counted and reported immediately.
• While assessing respirations, it is important to note signs of respiratory distress, which can include loud breathing, nasal flaring, and intercostal retractions.

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