RC111 Ch16-Patient Bedside Assessment-Lecture Notes

Disordered Breathing Definitions

Dyspnea

Subjective sensation of breathing discomfort.

Breathlessness

An unpleasant urge to breathe that can occur despite adequate ventilation. It can be triggered by acute hypercapnia, acidosis, or hypoxemia.

Platypnea

Dyspnea triggered by sitting up. It may occur following pneumonectomy, during hypovolemia, in some patients with chronic liver disease (who have the hepatopulmonary syndrome), or in patients with lower cervical injury.

Orthopnea

dyspnea triggered by reclining. It commonly occurs in patients with CHF, mitral valve disease, bilateral diaphragmatic paralysis, and superior vena cava (SVC) syndrome.

Trepopnea

Dyspnea that occurs when a patient with unilateral lung disease lies with the affected side down. It often improves when the patient adopts a different position.

Orthodeoxia

Oxygen desaturation on assuming an upright position.

Cheyne-Stokes respiration

Irregular breathing where breaths increase and decrease in depth and rate with periods of apnea; commonly seen in patients with heart failure or significant brain injury.

Kussmaul's respiration

Deep and fast respirations; often associated with metabolic acidosis, particularly in diabetic ketoacidosis, as the body attempts to eliminate excess carbon dioxide.

Biot respiration

Chaotic breathing pattern characterized by frequent irregularity in both rate and tidal volume that eventually deteriorates to agonal breathing and terminal apnea. Occurs when there’s damage to the medulla or pons caused by stroke or trauma.

Agonal Breathing

Intermittent prolonged gasps that occur before apnea; typically indicative of an impending respiratory arrest and is commonly observed in patients nearing end-of-life or experiencing severe hypoxia.

Apneustic Breathing

Prolonged inspiratory pause at full inspiration typically lasting for 2-3 seconds. It indicates damage to the lower pons.

Central Neurogenic hyperventilation

Persistent hyperventilation driven by abnormal neural stimuli; It is related to midbrain and upper pons damage associated with head trauma, severe brain hypoxia, or lack of blood flow to the brain.

Central Neurogenic hypoventilation

persistent hypoventilation due to inappropriate response to ventilatory stimuli (i.e. CO2); It is associated with head trauma and brain hypoxia, as well as narcotic suppression of the respiratory center in the brain.

Paradoxical breathing

With Abdominal paradoxical breathing: abdominal wall moves inward on inspiration and outward on expiration; It results from diaphragmatic fatigue or paralysis.

With Chest paradoxical breathing: part or all of the chest wall moves in with inhalation and out with exhalation; typically observed in chest trauma with multiple rib or sternal fractures and also found in patients with high spinal cord injury with paralysis of intercostal muscles.