Question

The upper and lower airways serve to filter, humidify inspired air. Once capillary blood has been oxygenated, there is perfusion and the body organs and tissues are supplied with oxygen and nutrients. Various factors impact on respiratory functioning, including age-related changes in the older adult, medications such as opiods, lifestyle behaviors, culture, the environment and the psychological health of the patient. These factors can impact on respiratory functioning and may contribute to hyperventilation and hypoventilation. Patient’s experiencing an alteration in respiratory functioning may display symptoms of dyspnea and orthopnea and may show evidence of a barrel chest and pursed-lip breathing. A nurse may auscultate adventitious breath sounds and may carry out interventions such as: apply a pulse oximeter, administer HFA (MDI) and perform chest physiotherapy and teach the patient how to use an incentive spirometer.

1. Define and list the manifestations of hyperventilation and hypoventilation.
2. Define and list the manifestations of hypoxia.
3. How would you know if a patient is orthopneic?
4. What does it mean if a patient has a barrel chest? What is pursed-lip breathing?
5. Identify and describe adventitious breath sounds.
6. Describe the steps involved when using an HFA (MDI).
7. Explain how a patient is to use an incentive spirometer.

Answer 1

1 HYPER VENTILATIONAND HYPO VENTILATION

HYPER VENTILATION

It is the opposite of hypo ventilation where there is an increased amount of air in the in the alveoli, which is also called over breathing.

Manifestations include,

· Hyperpnea

· Tachypnea- Increased respiration rate is an indication of respiratory distress

· Chest pain

· Dyspnea-Shortness of breath (SOB) is an indication of respiratory distress.

· Wheezing

· Dizziness

· Palpitations

· Tetanic cramps

HYPO VENTILATION

The state in which reduced amount of air enters alveoli in the lungs, resulting the increase in carbon dioxide (hypercapnia) and decreased oxygen level.

Manifestations include,

· bluish coloration or cyanosis

· Daytime drowsiness

· Fatigue

· Swelling of ankles

· Walking up from sleep unrested

· Reduced or disturbed sleep patterns

2.Hypoxia is the state of decreased oxygen in tissue level.

It’s of 4 type

· Hypoxic hypoxia

· Stagnant hypoxia

· Histotoxic hypoxia

· Hypemic hypoxia

Manifestations include,

· Tachypnea-Increased respiration rate is an indication of respiratory distress.

· Dyspnea-Shortness of breath (SOB) is an indication of respiratory distress.

· Use of accessory muscles-Use of neck or intercostal muscles when breathing is an indication of respiratory distress.

· Bluish coloration

· Loss of consciousness- as a worsening sign of hypoxia

· Restlessness or anxiety

· Flaring of nostrils or pursed lips-Patients who are hypoxic may breathe differently, which may signal the need for supplemental oxygen

3.Orthopnoea is a shortness of breath that affects a person when they are lying down but subsides in other positions, such as standing or sitting up. Orthopnoea is often a symptom of heart failure or lung disease, but it can also result from other conditions.

Manifestations include,

· Fatigue

· Changes in appetite

· Nausea

· Confusion

· Increased heart rate

· Persistent coughing or wheezing

4. barrel chest(fig.a) is the rounded bulging chest that looks like a barrel, it occurs because the lungs are chronically overinflated with air, so the rib cage stays partially expanded all the time. This makes breathing less efficient and aggravates shortness of breath.

If a patient has barrel chest it means patients lungs are over inflated with air, and chances of COPD, emphysema.

Pursed lip breathing: (fig.b)

Pursed lip breathing is a simple technique for slowing down a person's breathing and getting more air into their lungs. With regular practice, it can help strengthen the lungs and make them work more efficiently. The technique involves breathing in through the nose and breathing out slowly through the mouth

1.Relax your neck and shoulder muscles

2. breath in for 2 seconds through your nose, keeping your mouth closed

4.breath out for 4 seconds through pursed lips. If this is too long for you, simply breath out twice as long as you breathe in.

fig:a.Barrel chest

I UIT UTTU

fig:b.pursed lip breathing