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More from Baddegama Ganithage Inoka Sandamali Ariyarathne
Breathing mechanism
- 1. BREATHING Unit VII B GI S Ariyarathne RN, BSc Nsg(Hon)1st class Tutor Trainee
- 2. Unit Outcome At theend of this unit, student should be able to, identify the patient who is experiencing difficult in breaching by using theoretical knowledge in the clinical care setting
- 3. Specific outcomes At theend of this unit students should be able to, • describe the normal mechanism of respiration • identify the sign and symptoms of abnormal breathing • develop skill in assisting the patient who is experiencing difficulty in breathing
- 4. The importance ofbreathing The human body can survive • 3 weeks without food • 3 days without water • but only 3 minutes without air
- 5. The importance ofbreathing cont.. • Without air the brain starves of oxygen, normal bodily functions cease to exist and essentially we die • That makes breathing high on the priority list for human life • Breathing is something the body does automatically
- 6. • But theway of breathe changes depending on state of mind and feelings • Breathing pattern changes with emotions or in certain situations • When person is stressed or fearful , tend to take fast and shallow breaths • When relaxed and at ease breathe gently and more steadily
- 7. Review of theRespiratory system • What are the main organs of the respiratory system? • Nasal cavity • Pharynx • Larynx • Trachea • Bronchi • Bronchioles • Alveoli • Lungs
- 8. Organs of therespiratory system
- 10. Review of howair moves in the body • Air enters the nose or mouth and travels down the: – pharynx, larynx, trachea and down the bronchi • The bronchi branch to form bronchioles • At the end of bronchioles are the alveoli (air sacs) where gas exchange occurs – What gases are exchanged here? – Oxygen and carbondioxide!
- 11. Mechanism of Breathing •Respiration- Exchange of oxygen & carbon dioxide in lungs • 1 respiration = 1 inhalation + 1 exhalation • Diaphragm (muscle under lungs) helps move air in and out of the body
- 12. Mechanism of Breathing •Breathe in INHALATION= the diaphragm contracts and moves down to allow air to move into lungs • Breathe out EXHALATION= opposite – Diaphragm relaxes to return to the normal shape – Gases are pushed out
- 13. Breathing involve twoprocess Inhalation • Breath in • Diaphragm contracts and flattens • increased volume in the thoracic cavity • Lungs expand • Decreased air pressure in the lung • difference in air pressure causes air Exhalation • Breathing out • Diagram expand and relax • Volume in the thoracic cavity decrease • Lungs compress • Air pressure in the lungs increased • air rush out of the lungs
- 15. Gas exchange betweenthe blood and alveoli • Occurs after the alveoli are ventilated • Gases diffuse according to their partial pressures Alveoli: • PO2 100mmHg • PCO2 40mmHg
- 16. Gas exchange betweenthe blood and alveoli cont.. Venous blood: • PO2 60mmHg • PCO2 45mmHg oO2 diffusion from alveoli to pulmonary blood vessels oC2O diffusion from pulmonary blood vessels to alveoli
- 17. Gas exchange betweenthe blood and alveoli cont… • External respiration : gases exchanged between air and blood • Internal respiration : gases exchanged with tissue fluids • Oxygen transport : bound to hemoglobin in red blood cells or dissolved in blood plasma
- 18. Gas exchange betweenthe blood and alveoli • Carbon dioxide transport : dissolved in blood plasma, bound to hemoglobin, or in the form of plasma bicarbonate • Gas Exchange & Transport: A Passive Process
- 21. Respiratory regulation • Bothneural and chemical control affect to maintain the correct concentration of O2 and CO2 • A chemosensitive center in the medulla oblongata is highly responsive to increase in blood CO2 or hydrogen iron concentration
- 22. Respiratory regulation • toreduce high concentration of CO2, increase activity of inspiration by increasing rate and depth of the respiration • Carotid artery stimulate to increase O2 by increasing ventilation when O2 concentration decreased
- 23. Factors affecting respirations increasethe rate Decrease the rate Exercise Age Increase metabolism Decreased environmental temperature Stress Certain medication e.g. Narcotics Increase environmental temperature Increase intracranial pressure Lowered O2 concentration
- 25. Characteristics of normal breathing •Eupnea-----normal breathing pattern • Rate- 12-18 breaths per minute (healthy adult) • Rhythm- equal pause between each breaths • Volume- around 500ml • Sound-quiet • Effort- effortless
- 26. Altered Breathing • Inspirationor expiration that does not provide adequate ventilation • Alteration of rate, volume/depth and rhythm of breathing • Ineffective breathing pattern leads to insufficient O2
- 28. • Tachypnea------ Rapidrate is seen with, Abnormally fast respirations(more than 25) • Quick shallow breath • Lack of oxygen or too much carbon dioxide is the common cause • e.g. fever, metabolic acidosis , pain • Asthma, Pneumonia
- 30. Bradypnea • Abnormally slowbreathing • Less than 10 per minutes • Causes:- Exposure to drugs or toxins (Including alcohol and opioids),Drug overdose Hormonal imbalance (Hypothyroidism)
- 31. Apnea • Temporary absenceof breathing • No air flow into or out from the lungs
- 33. Kussmaul Breathing • Rapidgasping and very deep type of breathing • Respiration of increased rate (more than 20) and increased depth • It can be seen in metabolic conditions like Diabetic ketoacidosis, Renal failure
- 35. Cheyne-stokes breathing • Alsocalled as “periodic breathing”. • Characterized by alternate periods of tachypnea and apnea. • Occurs as a compensation for changing serum pO2 & pCO2, and classically seen in damage to pons • Can see, Stroke ,Traumatic brain injury ,Brain tumors Heart failure ,Toxic metabolic encephalopathy
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- 38. Dyspnea • subjective sensationof uncomfortable breathing, feeling “short of breath” • Ranges from mild discomfort after exertion to extreme difficulty breathing at rest • dyspnea is a sign of serious disease of the lungs or heart • A sudden onset of dyspnea should not be ignored ,need medical attention
- 39. Signs of dyspnea: •Flaring nostrils • Use of accessory muscles in breathing • Retraction (pulling back) of intercostal spaces
- 40. Types of dyspnea Orthopnea; •caused by the horizontal position, which redistributes body water, causes the abdominal contents to exert pressure on the diaphragm, and decreases the efficiency of the respiratory muscles
- 41. • Some individualswith left ventricular failure wake up at night gasping for air and must sit up or stand to relieve the dyspnea, • this type of positional dyspnea is termed Paroxysmal nocturnal dyspnea (PND) • PND results from fluid in the lungs caused by the redistribution of body water while the individual is recumbent
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- 43. Cyanosis • Bluish discolorationof the tissues and mucous membrane • when the absolute level of reduced hemoglobin (Deoxyhemoglobin) in the capillary bed exceeds 5g/dL or • increased concentration of abnormal Hemoglobine derivatives (eg. Methemoglobinemia, sulphaemoglobinemia) in the superficial blood vessels
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- 45. Hypoxia • is acondition insufficient oxygen anywhere in the body, from the inspired gas to the tissue • Causes : -Disease of respiratory muscle -Drugs, or anesthesia with hypoventilation
- 47. Chest movements • Intercostalretraction- In drawing between the rib • Substernal retraction- In drawing beneath the breast bone • Suprasternal retraction- In drawing above the Clavicles
- 48. Secretion and coughing •Hemoptysis- presence of the blood in the sputum • Productive cough- a cough accompanied by expectorated secretions • Non productive cough- a dry, harsh, cough without secretions
- 50. Hyperventilation • Breathing isdeep, irregular and sighing • Patient feel unable to fill their lungs completely • Hyperventilation is a common response to acute anxiety or emotional distress • During asthma attack or some patient with head injuries
- 51. Hypoventilation • Not breathingsufficiently • With severe obstructive air way disease • Respiratory function has been diminished by narcotics, barbiturates, or trauma
- 52. Abnormal breathing sounds •Breathing can also be noisy • Noisy respiration can hear without stethoscope 1. Stridor 2. Wheezing 3. Crackles/Rales 4. Rhonchi
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- 61. Hiccough • It isdue to Spasms of diaphragm and glottis
- 62. Qualities to observefor Respiration • Rate(normal vs. increased/decreased) • Rhythm( normal vs. shallow/deep) • Depth – norm, shallow, deep • Effort involved to breathe(any sign of accessory muscle use, inspect neck)
- 63. Qualities to observefor Respiration • Position (resident /adopts) • Sounds that accompany it • Color of skin, mucous membranes, nail beds – check for cyanosis
- 64. Signs of AbnormalBreathing • Slower than 8 breaths/min or faster than 24 breaths/min • Muscle retractions • Pale or cyanotic skin • Cool, damp (clammy) skin • Shallow or irregular respirations • Pursed lips Nasal flaring
- 65. Breathing Assessment Spontaneous breathing •Chest rise and fall (depth and symmetry) • Skin color • General respiratory rate • Normal • Slow • Fast • Pattern of breathing • Regular • Irregular • Cheyne Stokes • Integrity of the soft tissue and bony structures of the chest wall
- 66. Breathing Assessment cont… •Use of accessory and/or abdominal muscles • Bilateral breath sounds: Auscultate the lungs bilaterally at the second intercostal space midclavicular line and at the fifth intercostals space at the anterior axillary line • Jugular veins and position of trachea
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