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2. Factors necessary for respiration Adequate O2 in the atmosphere A functioning respiratory tract Functioning thoracic muscles and nerves to control the thoracic cage Blood to transport the gases Capillaries in close proximity to the cells to allow the exchange of gases. 2

3. Regulation of respiration The automatic control is located in the respiratory centers of the brain stem. Reflex responses and chemical signals control these centers. Chemical control is usually reliant on the level of CO2 in the blood. We can voluntarily control respirations for a short time – speaking, swallowing. 3

4. Factors affecting respiratory function Availability of O2 – usually 20% in air Regulating mechanisms –cerebral Oedema, medications. Passage of gases – accumulation of secretions, injury / disease to chest Diffusion of gases – COAD Transport of gases – anaemia, CCF Influences on characteristics of breathing- Pain, emotion, exercise. 4

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6. Breath sounds site http://www.cvmbs.colostate.edu/clinsci/callan/breath_sou nds.htm http://www.med.ucla.edu/wilkes/inex.htm 6

7. Characteristics of respiration Rate; Tachypnoea- increased respiratory rate (exercise, fever, pneumonia, COAD, lesions in the pons varolii). Bradypnoea – decrease in respiratory rate ( opioids, brain tumours) 7

8. Characteristics of respiration Rhythm – evenly spaced Hyperventilation- an increase in both the rate and depth of respirations (extreme exertion, fear / anxiety, fever, midbrain lesions, acid –base imbalance, blood gas concentration). Cheyne –stokes – periodic breathing with gradual increase in depth then apnoea. Biot’s respiration – interrupted breathing patterns like Cheyne – Stokes but depth remains the same (meningitis). 8

9. Characteristics of respiration Depth – should be constant and relaxed Dyspnoea – undue breathlessness and an awareness of discomfort with breathing Exhertional dyspnoea- exercise, CCf Orthopnoea – shortness of breath on lying down, relieved by sitting upright (LVF) Paroxsmal nocturnal dyspnoea – sudden breathlessness that occurs at nigh when patient is lying down (APO, LVF). 9

10. Characteristics of respiration Sound – usually inaudible Stertorous laboured breathing with a snoring sound (obstructed airway) Wheezing – high pitched and squeaky (asthma) Rales – bubbly or crackly (eg PO) Ronchi – course and rattly (bronchitis) Stridor – high pitched musical sound on inspiration (croup). 10

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12. Monitoring respirations Patient has a respiratory condition Evaluate their condition Monitoring effectiveness of treatment Postoperatively Critically ill Patient receiving o2 therapy 12