CONCEPT in

OXYGENATION

Objectives
Review

the structure and function of the respiratory function. Describe the process of ventilation and respiration. Explain the role and function of the respiratory system in transporting oxygen and carbon dioxide to and from body tissues

 Identify

factors influencing respiratory function. Identify common manifestations of impaired respiratory function Identify and describe nursing measures to promote respiratory function and oxygenation. Explain the use of therapeutic measures such as medications, inhalation therapy, oxygen therapy, artificial airways and chest drainage to promote respiratory function

 The

concept of oxygenation is a dynamic one that involves the transportation of oxygen to blood cells and removal of carbon dioxide.

 When

atmospheric oxygen is taken into the lungs, it is picked-up by the blood and transported to the cellular levels through a network of blood vessels.

 The

heart functions as the pump that moves the blood thru the lungs where oxygen and carbon dioxide are exchanged.

 The

oxygenated blood is then returned to the lungs and to the body tissue and process repeats itself.

OXYGEN
Clear,

odorless gas that constitutes approximately 21% of the air we breathe Absence of oxygen can lead to DEATH.

RESPIRATION
The

process of gas exchange between the individual and the environment.

2 COMPONENTS OF RESPIRATION
Pulmonary

ventilation or breathing; the movement of air between the atmosphere and the alveoli of the lung Diffusion of oxygen and carbon dioxide between the alveoli and pulmonary capillaries.

STRUCTURE OF RESPIRATORY SYSTEM

UPPER RESPIRATORY SYSTEM

Or the upper tract Or upper airway Warms and filters inspired air so that the lower respiratory tract (the lungs) can accomplish gas exchange.

NOSE
Composed

portion. External portion protrudes from the face and is supported by the nasal bones and cartilage. Anterior nares (nostrils) are the external openings of the nasal cavities.

of external and internal

 Internal

portion of the nose is a hollow cavity separated into left and right nasal cavities by a narrow vertical divider, the SEPTUM. Each nasal cavity is divided into three passageways by the projections of the turbinates (CONCHAE) from the lateral walls. Nasal cavities are lined with highly vascular ciliated mucus membranes called NASAL MUCOSA.

 The

nose serves:

as a passageway for air to pass to and from the lungs Filters impurities Humidifies the air Warms the air Responsible for olfaction (smell) because olfactory nerves are located in nasal mucosa

PARANASAL SINUSES
Are

named by their location

Frontal Ethmoidal Sphenoidal Maxillary

Its

prominent function is to serve as a RESONATING CHAMBER IN SPEECH.

 Common

site for infection. It traps particles.

PHARYNX
Or

THROAT Tube-like structure that connects the nasal and oral cavities to the larynx. Functions as the PASSAGEWAY FOR THE RESPIRATORY AND DIGESTIVE TRACTS

LARYNX
Known

as the VOICE BOX Major function: VOCALIZATION Protects the lower airway from foreign substances and facilitates coughing.

 Consists

of:

Epiglottis covers the opening to the larynx during swallowing Glottis opening between the vocal cords in the larynx Thyroid cartilage largest of the cartilage structures, forms the ADAMS APPLE Vocal cords ligaments controlled by muscular movements that produce sounds

TRACHEA
Or

WINDPIPE Serves as the passage between the larynx and the bronchi

LOWER RESPIRATORY SYSTEM

 Paired

elastic structures enclosed in thoracic cage Composed of 3 lobes on right side and 2 lobes on left side Covered by PLEURA

LUNGS

PLEURA
Serous

membrane that lines the lungs and wall of thorax Visceral pleuracovers the lungs Parietal pleuralines the thorax

PLEURAL FLUID
Serves

to lubricate the thorax and lungs and permit smooth motion of the lungs within the thoracic cavity with each breath.

BRONCHI and BRONCHIOLES

They

are formed by branching if trachea Right main bronchus larger and more vertical than left

 Bronchioles

branch into terminal bronchioles which end in alveoli

ALVEOLI
Arranged

clusters Site for GAS EXCHANGE SURFACTANTreduces surface tension to keep alveoli from collapsing

in

FUNCTION OF THE RESPIRATORY SYSTEM

 The

cells of the body derive energy they need from the oxidation of carbohydrates, fats and proteins. Certain vital tissues, such as those of the brain and heart, cannot survive for long without a continuing supply of oxygen. As a result of oxidation in the body tissues, carbon dioxide is produced and must be removed from cells to prevent build-up of acid wastes.

 Therefore,

the respiratory system performs these functions to facilitate life-sustaining processes.

OXYGEN TRANSPORT
Oxygen

is supplied to, and carbon dioxide is removed from, cells by way of circulating blood. Cells are in close contact with capillaries, whose thin walls permit easy passage or exchange of oxygen and carbon dioxide.

 Oxygen

diffuses from the capillary through the capillary wall to the interstitial fluid. At this point, it diffuses through the membrane of tissue cells, where it is used by mitochondria for cellular respiration. The movement of carbon dioxide occurs by diffusion in the opposite direction from cell to blood.

RESPIRATION
The

whole process of gas exchange between the atmospheric air and the blood and between the blood and cells of the body After tissue capillary exchanges, blood enters the systemic veins (where it is called VENOUS BLOOD)

 The

oxygen concentration in blood within the capillaries of the lungs is lower that in the lungs air sacs (alveoli). Therefore, oxygen diffuses from the alveoli to the blood. Carbon dioxide, which has the higher concentration in the blood than in the alveoli, diffuses from the blood into the alveoli.

 Movement

of air in and out of the airways (ventilation) continually replenishes the oxygen and removes the carbon dioxide from the airways in the lung.

VENTILATION
Movement

lungs Adequate ventilation depends on several factors:

of air in and out of the

Clear airways An intact CNS and respiratory center An intact thoracic cavity capable of expanding and contracting Adequate pulmonary compliance and recoil

PHASES:

Inspiration involves the contraction and descent of the chest is increased and the pressure in the air passages and alveoli decreases, secreting subatmospheric pressure so that air goes into the respiratory area until the pressure gradient is equalized. Expiration a passive process that results in the expulsion of air when the components of the thoracic cage relax.

 Physical

factors that govern the air flow in and out of the lungs are collectively referred to as the mechanics of ventilation and includes
Muscle structure Interpleural pressure Lung compliance Airway resistance

MUSCLE STRUCTURE
Muscle

bundles that influence respiration:

Intercostal muscles Anterior neck muscles such as Scalene, sternocleidomastoid Muscles of abdomen

INTRAPLEURAL PRESSURE
Pressure

in the pleural cavity surrounding the lungs Always slightly negative in relation to atmospheric pressure INTRAPULMONARY PRESSURE (pressure within the lungs)

LUNG COMPLIANCE
Is

the measure of the elasticity, expandability and distensibility of the lungs and thoracic structures Factors that determine lung compliance are the SURFACE TENSION of the ALVEOLI (normally low with the presence of surfactant) and the connective tissue (collagen and elastin) of the lungs.

 Determined

by examining the volume-pressure relationship in the lungs and the thorax. NORMALLY, the lungs and thorax easily stretch and distend when pressure is applied. HIGH or increased compliance occurs when the lungs have lost their elasticity and the thorax is overdistended.

 When

lungs and thorax are stiff, there is LOW or decreased compliance. Conditions associated with this include pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis and ARDS.

AIRWAY RESISTANCE
Refers

to the relationship between airflow and pleural pressure

REQUIREMENTS FOR EFFECTIVE VENTILATION

Patent

airway Elastic, expansible lungs and tracheo-bronchial tree Adequate musculo-skeletal apparatus of chest wall

FACTORS AFFECTING RESPIRATORY FUNCTION

AGE
At

birth, fluid-filled lungs drain, partial pressure of carbon dioxide rises, neonate takes a first breath. Lungs reaches full inflation by 2 weeks of age Changes of aging that affect the respiratory system are infection, physical or emotional stress, surgery, anesthesia and other procedures

 Respiratory

rates are HIGHEST and mist variable in NEWBORNS. Because of rib cage structure, infants rely almost exclusively on DIAPHRAGMATIC MOVEMENT for breathing.

Changes in Elderly
Chest

wall and airways become more rigid and less elastic The amount of exchanged air is decreased The cough reflex and cilia action are decreased Mucus membranes become drier and more fragile Decrease in muscle strength and endurance

 If

osteoporosis is present, adequate lung expansion may be compromised. A decrease in efficiency on the immune system occurs. Gastroesophageal reflux disease is more common in older adults and increases the risk of aspiration. The aspiration of stomach contents into the lungs often causes bronchospasm by setting up an inflammatory response.

ENVIRONMENT

LIFESTYLE
HEALTH STATUS

MEDICATIONS STRESS

PHYSICAL ASSESSMENT and HEALTH HISTORY

The health history focuses on the physical and functional problems of the patient and the effect on these problems on his or her life. Reason patient is seeking health care is often related to:

Dyspnea Pain Accumulation of mucus Wheezing Hemoptysis Edema of ankles and feet Cough Fatigue and weakness

SUBJECTIVE DATA
ASSESSMENT

INTERVIEW

Have you noticed any changes in your breathing pattern? If so, which of your activities might cause these symptoms? How many pillows do you use to sleep at night? Have you had any medical conditions experienced before?

 How

frequently have these occurred? How long did they last? And how were they treated? Do you smoke? If so, how much? Does any of our family member smoke? Do you use alcohol? If so, how many drinks do you usually have per day or per week Describe your exercise patterns.

 How

often and how much do you cough? Is it productive, accompanied by sputum or non productive cough? When is the sputum produced? What is the amount, color, thickness, odor? Is it tinged with blood? Ask for any occurrence of chest pain, risk factors and medication history

OBJECTIVE DATA
Major

signs and symptoms of respiratory disease are:

Dyspnea Cough Sputum production Chest pain Wheezing Clubbing of the fingers Hemoptysis Cyanosis

DYSPNEA
Difficult

or labored breathing Shortness of breath A common symptom to many pulmonary and cardiac disorders. Right ventricle of the heart will be affected ultimately by lung disease because it must pump blood through the lungs against greater resistance.

Clinical Significance
Sudden

dyspnea in HEALTHY PERSON may indicate pneumothorax or ARDS. In IMMOBILIZED PATIENTS, sudden dyspnea may denote pulmonary embolism. ORTHOPNEA (inability to breathe easily except in an upright position) may be found in patients with COPD

 NOISY

BREATHING may result from a narrowing of the airway or localized obstruction of a major bronchus by a tumor or foreign body. Wheezing usually signifies asthma.

Relief Measures
The

management of dyspnea is aimed at identifying and correcting its cause. Relief of the symptom sometimes is achieved by placing the patient at rest with the head elevated (high Fowlers position). In severe cases, administering oxygen.

COUGH
Results

from irritation of the mucus membranes anywhere in the respiratory tract. Patients chief protection against the accumulation of secretions in the bronchi and bronchioles.

Clinical Significance
May

indicate serious pulmonary diseases. The nurse needs to evaluate the character of the cough dry, hacking, brassy, wheezing, loose or severe. Time of coughing is also noted.

 DRY

& IRRITANT COUGH characteristic of an upper respiratory tract infection of viral origin. LARYNGOTRACHEITIS causes an irritative, high-pitched cough. TRACHEAL LESIONS produce a brassy cough BRONCHOGENIC CARCINOMA severe and changing cough

TRACHEAL LESIONS

Coughing

at NIGHT may herald the onset of LEFTSIDED HEART FAILURE or BRONCHIAL ASTHMA. Cough in MORNING WITH SPUTUM PRODUCTION may indicate BRONCHITIS.

BRONCHIAL ASTHMA

BRONCHITIS

cough that worsens when the patient is SUPINE suggests SINUSITIS (postnasal drip). Coughing AFTER food intake may indicate aspiration of material into tracheobronchial tree.

SPUTUM PRODUCTION
The

color of sputum or phlegm, which is the mucus and sometimes pus discharge expectorated from the respiratory tract, is often an indication of the type of respiratory disease that gives rise to sputum production.

 By

examining the type of sputum and noting the color as well as the presenting signs and symptoms, a differential diagnosis may be reached prior to laboratory tests and examination (sputum culture). A thorough case history and complete physical examination is also necessary.

Meaning of Different Sputum Colors

CLEAR, WHITE, GRAY SPUTUM

Clear

sputum is considered as normal, however, there are many conditions that may cause excessive sputum production. A profuse amount of clear sputum should therefore be considered as abnormal.

 Pulmonary

edema (fluid in the lungs) clear, white or pink frothy sputum Viral respiratory tract infections clear to white (acute) Chronic bronchitis (COPD) clear to gray Asthma white to yellow (thick)

CHRONIC BRONCHITIS

CHRONIC BRONCHITIS

YELLOW SPUTUM
Yellow

colored sputum is due to the presence of white blood cells, particularly neutrophils and eosinophils. These cells are often present in chronic inflammation, allergic and infectious causes.

 With

INFECTIONS, it is often in the acute setting that yellow sputum is evident due to the presence of live neutrophils. With ALLERGIC CONDITIONS, particularly airway hypersensitivity, the yellowish sputum is due to the presence of eosinophils.

 Acute

yellow Acute pneumonia white to

bronchitis white to

yellow Asthma white to yellow (thick)

GREEN SPUTUM
Green

mucus is indicative of a long-standing, possibly chronic, infection. The color is a result of the breakdown of neutrophils and the release of verdoperioxidase / myeloperioxidase, an enzyme that is present within these cells.

 It

may also be seen in long standing non-infectious inflammatory conditions. With infections, the green sputum will be more purulent (large amounts of pus). While in non-infectious inflammatory conditions, the green sputum will be more mucoid (large amounts of mucus).

 Pneumonia

white, yellow or green Lung abscess green, sudden accumulation of large amount of sputum if the abscess ruptures Chronic bronchitis clear, grey to green (infection) Bronchiectasis, cystic fibrosis green

LUNG ABCESS

BRONCHIECTASIS

BROWN, BLACK SPUTUM

Brown

or black sputum is an indication of old blood and the color may be due to the breakdown of red blood cells thereby releasing hemosiderin (from hemoglobin). Certain organic and non-organic dusts may also cause a brown to black discoloration of the sputum.

 Chronic

bronchitis green, yellow, brown (infection) Chronic pneumonia white, yellow, green to brown Coal workers pneumoconiosis brown to black Tuberculosis red to brown or black Lung cancer red to brown to black

COAL WORKERS PNEUMOCONIOSIS

SIMPLE COAL WORKERS PNEUMOCONIOSIS

PROGRESSIVE FIBROSIS COAL WORKERS PNEUMOCONIOSIS

RED, PINK RUST-COLORED SPUTUM

Red

sputum is usually an indication of whole blood that is more profuse than bleeding in pink colored sputum. It may completely discolor the mucus or appear as streaks or spots.

 Pink

sputum is also a sign of bleeding but usually of smaller quantities that may stain or streak the sputum. Rust colored sputum is also due to the bleeding although the clotting process may have commenced and the red blood cells may have broken down.

 Pneumococcal

rusty-red Lung cancer - pink to red (frothy) progressing to brown or black Tuberculosis bright red streaks progressing to fully red sputum (hemoptysis) Pulmonary embolism bright red blood (acute)

pneumonia

LUNG CANCER

Meaning Of Different Types Of Sputum

CLEAR SPUTUM
slightly sticky and a bit viscous (thicker than water) is accepted as normal sputum. It is produced and secreted in moderate amounts to moisten the respiratory tract and trap dust and microorganisms (mucus) and lubricate the mouth and aid with chewing, swallowing and digestion (saliva). While any expectorated sputum is considered to be abnormal, small amounts of sputum can be coughed up or spat out with effort even in the absence of any respiratory pathology.

 However,

in certain conditions, particularly related to irritation of the respiratory tract, the amount of sputum may become excessive. In these pathological cases, the color, texture and even odor of the sputum may change. These variations may give an indication of the possible cause.

SEROUS
Normal,

clear sputum is a serous discharge. Large amounts of clear, frothy or pink sputum that is of a similar consistency as normal sputum may be a sign of pulmonary edema, which is an accumulation of fluid in the lungs. If it extremely profuse and lasting for weeks or months, then it may be due to lung cancer.

 Frothy

surfactant in the lung alveoli which reduces the surface tension of the sputum. It indicates that the sputum had contact with the lung alveoli or originated from this site.

sputum is caused by

MUCOPURULENT
Mucoid,

mucopurulent or purulent sputum is thicker and often more sticky than normal sputum. This is partly due to the greater mucus production coupled with pus in the purulent types.

 Mucoid

sputum is a sign of noninfectious airway disease like chronic bronchitis (COPD) and asthma or may occur in the early stages of infection. Mucopurulent sputum is an indication of infection of the respiratory tract, particularly of the bronchi or lungs acute bronchitis and pneumonia.

BLOOD-STAINED
Sputum

may be blood stained where the normal sticky or mucopurulent thick consistency becomes thinner due to the presence of varying amounts of blood.

 In

severe cases involving the coughing up of large amounts of blood (hemoptysis), the consistency of the sputum may be the same viscosity as blood and little or no sputum may be visible. Blood stained sputum may be due to tuberculosis, bronchiectasis, pulmonary embolism or lung cancer.

CHEST PAIN
May

be associated with pulmonary or cardiac diseases. Chest pain associated with pulmonary conditions may be SHARP, STABBING and INTERMITTENT May be DULL, ACHING, PERSISTENT

 May

occur with PNEUMONIA, PULMONARY EMBOLISM with LUNG INFARACTION, PLEURISY LATE SYMPTOM bronchogenic carcinoma CARCINOMA pain may be dull and persistent because the carcinoma has invaded the chest wall, mediastinum or spine

 The

nurse assesses the quality, intensity and radiation of pain. Identifies and explores precipitating factors, along with the relationship of the patients position.

Relief Measures
Analgesic

medications may be effective in relieving chest pain. Non-steroidal anti-inflammatory drugs (NSAIDs) used for pleuritic pain

WHEEZING
A

high-pitched, musical sound heard mainly on expiration. Major finding in a patient with bronchoconstriction or airway narrowing. Can be heard with or without a stethoscope, depending on location

Relief Measures
Oral

or inhalant bronchodilator medications reverse wheezing in most instances.

CLUBBING OF FINGERS
A

sign of lung disease found in patients with chronic hypoxic conditions, chronic lung infections and malignancies of the lung.

Manifested

initially as sponginess of the nail-bed and loss of the nail-bed angle.

HEMOPTYSIS
Expectoration

of blood from the respiratory tract Symptom of both pulmonary and cardiac disorders. Its onset is usually sudden, may be intermittent or continuous. The amount of blood produced is not always proportional to the seriousness of the cause.

Diagnostic Evaluation
Chest angiography Chest x-ray Bronchoscopy

Points to consider when documenting bleeding episode:

Bloody

sputum from the nose or the nasopharynx is usually preceded by considerable sniffing, with blood possibly appearing on the nose.

 Blood

from the lung is usually bright red, frothy, mixed with sputum. Initial symptoms include a tickling sensation in the throat, a salty taste, a burning or bubbling sensation in the chest and perhaps chest pain. The term hemoptysis is reserved for the coughing up of blood arising from a pulmonary hemorrhage. This blood has an alkaline pH (greater than 7.0)

 If

the hemorrhage is in the stomach, the blood is vomited (hematemesis) rather than coughed up. Blood that has been in contact with gastric juice is sometimes so dark that it is referred to as coffee grounds. This blood has an acid pH (less than 7.0).

CYANOSIS
Bluish

discoloration of the skin VERY LATE indicator of hypoxia. Assessment of cyanosis is affected by room lighting, the patients skin color and the distance of the blood vessels from the surface of the skin.

 In

pulmonary condition, central cyanosis is assessed by observing the color of the tongue and lips. This indicates a decrease in oxygen tension in the blood. Peripheral cyanosis results from decreased blood flow to a certain area of the body, as in vasoconstriction of the nailbeds or earlobes from exposure to cold, and DOES NOT necessarily indicate a central systemic problem.

Physical Assessment of Lower Respiratory Structure and Breathing Patterns

CHEST CONFIGURATION
Normally,

the ratio of the anteroposterior diameter to the lateral diameter is 1:2. There are four main deformities of the chest associated with respiratory disease that alter this relationship:
Barrel chest Funnel chest (pectus excavatum) Pigeon chest (pectus carinatum) kyphoscoliosis

BARREL CHEST
Due

to overinflation of the lungs. There is an increase in the anteroposterior diameter of the thorax.

 In

patient with emphysema, the ribs are more widely spaced and the intercostal spaces tend to bulge on expiration.

 The

appearance of the patient with advanced emphysema is thus quite characteristic and often allows the observer to detect its presence easily, even from a distance.

FUNNEL CHEST (Pectus excavatum)

Occurs

when there is a depression in the lower portion of the sternum. This may compress the heart and great vessels resulting in MURMURS.

 Funnel

chest may occur with rickets or Marfans syndrome.

PIGEON CHEST ( Pectus carinatum)

Occurs

as a result of displacement of sternum.

KYPHOSCOLIOSIS
Characterized

by elevation of the scapula and corresponding Sshaped spine.

 This

deformity limits lung expansion within the thorax. It may also occur with osteoporosis and other skeletal disorders that affect the thorax.

NORMAL BREATH SOUNDS

 Distinguished

by their location over a specific area of the lung:

Vesicular Bronchovesicular Bronchial (Tubular) Tracheal

The

LOCATION, QUAILITY and INTENSITY of breath sounds are determined during auscultation.

Adventitious Sounds
-Discrete,

Sound -Continuous Musical Sound (Wheezes) -Friction Rubs

Noncontinuous

DISCRETE, NONCONTINUOUS SOUND

CRACKLES
Formerly

referred to as RALES Result form delayed opening of deflated airways. Friction rubs result from inflammation of the pleural surfaces that induces a crackling, grating sound usually heard in inspiration and expiration.

 May

or may not be cleared by coughing Reflect underlying inflammation or congestion Present in conditions as pneumonia, bronchitis, heart failure, bronchiectasis, and pulmonary fibrosis

Fine Crackles
Usually

audible at the end of inspiration and originate from alveoli Sound is like rubbing several pieces of hair next to ones ear.

Coarse Crackles
A

gross, moist sound produced in the large bronchi and are audible in early and mid-inspiration.

CONTINUOUS SOUNDS (Wheezes)

Sibilant Wheezes
Caused

by air passing thru narrowed tracheobronchial tree Found in asthma or airway obstruction

Originate in brochi and bronchioles Whistling sound Musical noise during inspiration or expiration Louder during expiration May be cleared with coughing

Sonorous Wheezes
Called

GURGLES or RONCHI SOUNDS Deep, low-pitched rumbling sound heard primarily during expiration.

 Caused

by the movement of air through the airways that are partially obstructed or narrowed airways Such as in tumors or mucosal swelling

Friction Rubs

Pleural Friction Rubs

Harsh,

crackling sound, like two pieces of leather rubbed together Heard during inspiration alone or during both inspiration and expiration.

May

subside when patient holds breath. Coughing will NOT clear sound It is secondary to inflammation and loss of lubricating pleural fluid.

VOICE SOUNDS

Vocal

resonance

The sound heard through the stethoscope as the patient speaks

The

vibrations produced in the larynx are transmitted to the chest wall as they pass through the bronchi and alveolar tissue.

Voice

sounds are assessed by the having the patient repeat ninety-nine or eee while the nurse listens with the stethoscope in corresponding areas of the chest.

 BRONCHOPHONY

Describes vocal resonance that is more INTENSE and CLEARER than normal.
EGOPHONY

Describes the voice sounds that are distorted. Best appreciated by having the patient repeat the letter E The distortion produced by consolidation transforms the sounds into a clearly heard A rather than E

BREATHING PATTERNS and RESPIRATORY RATES

EUPNEA
Normal,

easy, quiet breathing Respirations are regular in depth and rhythm

DYSPNEA
TYPES:

Orthopnea shortness of breath when lying down Paroxysmal nocturnal dyspnea sudden dyspnea at night while lying down

APNEA
Varying

periods of cessation of breathing May occur briefly during other disorders, such as with sleep apnea This can be life-threatening is sustained.

BRADYPNEA
Slow

breathing Slower than normal rate (<10 breaths per minute), with normal depth and rhythm

TACHYPNEA
Rapid,

shallow breathing >24 breaths per minute

BIOTS RESPIRATION
Cluster

breathing Cycles of breaths that vary in depth and have varying periods of apnea. Periods of normal breathing (3-4 breaths) followed by a varying period of apnea (usually 10 seconds to 1 minute)

 Seen

in some central nervous system disorder.

CHEYNE-STOKES
Regular

cycle where the rate and depth of breathing increase, then decrease until apnea (usually 20 seconds) occurs. Characterized by rhythmic and waning of depth of respiration

 Seen

typically in severe heart failure and coma caused by neurologic disorder. Near death breathing pattern

KUSSMAULS BREATHING
Or

hyperventilation Or polypnea Marked by increase in rate and depth Associated with severe diabetic acidosis or renal origin

HYPOVENTILATION
Or

oligopnea Abnormally low amount of air that enters the lungs Shallow, irregular breathing

INTERRUPTED
Cogwheel

or Waxy respiration Jerky breathing pattern Respiratory and expiratory sounds are clearly split into two or more sounds.

ORTHOPNEA
Inability

to breath except when the trunk is in upright position