Respiratory patterns and conditions

Normal adult

• Rate: 10-20 breaths per minute

• Depth: 500-800 mL

• Pattern: even, regular

• Ratio of HR:P = 4:1

Tachypnea

• Rapid, shallow breathing

• Rate > 24 breaths per minute

• Can be a normal response

• Can be respiratory insufficiency, pneumonia, alkalosis, CNS

Hyperventilation

• Rapid, deep breathing

• Can be extreme exertion, fear, anxiety, CNS

• Blows off CO2 can lead to alkalosis

Bradypnea

• Slow breathing, normal depth

• Rate < 10 breaths per minute

• May be drug induced, increased intracranial pressure, diabetic coma

Hypoventilation

• Irregular, shallow breathing

• Can be overdose of narcotics or anesthetics

• May be a/w prolonged bed rest, pain

Cheyne-Stokes

• Abnormal respiratory cycle with waxing and waning respirations

• Causes: heart failure, meningitis, drug overdose, increased ICP

• Can be normal in infants and older adults during sleep

• Abnormal in adults while awake

Biot respirations

• Similar but with irregular pattern

• 3-4 normal respirations then period of apnea

• Trauma, brain abscess, heart stroke, meningitis, encephalitis

Expected findings

• Inspection: AP:T diameter 1:2, relaxed posture, RR 10-20, regular even respirations, no cyanosis or pallor, SpO2 > 95% on RA

• Palpation: symmetric chest expansion, tactile fremitus present and equal bilaterally, no lumps, masses or tenderness

• Percussion: resonance throughout lung fields

• Auscultation: clear lung sounds throughout

Atelectasis: collapsed alveoli

• Inspection: cough, may note slightly elevated RR, mild cyanosis, AP:T diameter WNL, SpO2 may be slightly decreased requiring supplemental O2

• Palpation: chest expansion may be decreased on affected side, tactile fremitus decreased or absent over area

• Percussion: dull over area, remainder of lung fields resonant or may be hyper-resonant

Pleural effusion: fluid in interpleural space → can be fluid, exudate, purulent, blood

• Inspection: tachypnea, dyspnea, dry cough, decreased SpO2, cyanosis

• Palpation: decreased or absent tactile fremitus, decreased chest expansion on affected side

• Percussion: dull over affected area

• Auscultation: absent breath sounds, pleural friction rub

Heart failure: pump failure leading to backup of pulmonary circulation

• Subjective: dyspnea on exertion (DOE), edema, cough

• Inspection: tachypnea, increased WOB, orthopnea, PND, nocturia, dependent edema, pallor; severe may have pink, frothy sputum

• Palpation: skin moist, clammy; tactile fremitus WNL

• Percussion: resonance throughout

• Auscultation: crackles especially at bases, may note extra heart sounds

Pneumothorax: free air in pleural space with fully or partially collapsed lung

• Inspection: unequal chest expansion, if severe may have tachypnea, cyanosis, decreased SpO2, anxiety, tachycardia, hypotension

• Palpation: decreased or absent tactile fremitus, chest expansion decreased on affected side

• Percussion: hyper-resonance on affected side

• Auscultation: lung sounds decreased or absent on affected side

Asthma: bronchospasm and inflammation in airways causing resistance

• Inspection: tachypnea, SOB, decreased SpO2, prolonged expiration

• Palpation: decreased tactile fremitus

• Percussion: resonant

• Auscultation: bilateral wheezing, usually on expiration

Tuberculosis: prolonged infectious process secondary to tubercle bacilli

• Subjection: initially asymptomatic but may be noted on CXR, progresses with weight loss, fatigue, weakness, low grade fever, night sweats

• Inspection: cough nonproductive progresses to purulent yellow-green blood tinged, dyspnea, orthopnea

• Palpation: chest expansion equal

• Percussion: resonant, dull over areas of effusion

• Auscultation: crackles that persist even after coughing

Lobar pneumonia (PNA): infection causes alveoli to be edematous and porous

• Subjective: fever, cough pleuritic chest pain, chills, SOB, fatigue, malaise 

• Inspection: tachypnea, increased WOB, may note cyanosis and hypotension with severe illness

• Palpation: chest expansion decreased on affected side, tactile fremitus may be increased

• Percussion: dull over area of infection

• Auscultation: fine to medium crackles

Acute bronchitis: infection of trachea and larger bronchi, usually viral

• Subjective: cough lasting up to 3 weeks, may have fever, sore throat, fatigue

• Inspection: productive or nonproductive cough, APT:T diameter WNL, no increased WOB

• Palpation: no pain, tactile fremitus WNL, equal chest expansion

• Percussion: resonant

• Auscultation: clear and equal bilaterally

Chronic bronchitis: type of COPD → proliferation of mucus in the airways

• Subjective: SOB, recurrent productive cough

• Inspection: hacking rasping cough with thick mucoid sputum, dyspnea fatigue, decreased SpO2, finger clubbing

• Palpation: tactile fremitus normal

• Percussion: may be hyper-resonant

• Auscultation: may note crackles, prolonged expiration, wheeze especially during exacerbation

Emphysema: type of COPD → destruction of pulmonary connective tissues

• Subjective: SOB worse with activity, chest tightness, cough, history of cigarette smoking

• Inspection: increased AP:T diameter approaching 1:1, may note accessory muscle usage, increased WOB, tripoding, decreased SpO2

• Palpation: decreased tactile fremitus and chest expansion

• Percussion: hyper-resonant

• Auscultation: decreased breath sounds with prolonged expiration

Lung cancer: there is different types keep in mind

• Subjective: fatigue, nausea/vomiting, persistent cough, SOB, poorly localized chest pain; may asymptomatic

• Inspection: weight loss, clubbing, hoarseness, anemia, hemoptysis

• Palpation: WNL

• Percussion: resonant, may note dullness if large tumor

• Auscultation: may note wheezing, decreased lung sounds

Pulmonary embolism: blood clot in pulmonary artery

• Subjective: chest pain worse on deep breath, SOB, anxious

• Inspection: restlessness, mental status change, decreased SpO2, tachycardia, diaphoresis, hypotension

• Palpation: Antiposterior diameter 1:2 tactile fremitus WNL (within normal limits)

• Auscultation: crackles, wheezes

Acute respiratory distress syndrome (ARDS): damage to alveolar capillaries causes permeability and pulmonary edema

• Subjective: acute onset SOB, anxiety

• Inspection: restlessness, disorientation, hypoventilation, productive cough, decreased SpO2, tachycardia, hypotension

• Palpation: equal chest expansion

• Auscultation: crackles/rhonchi throughout lung fields