Certified Nursing Assistant Easy and Fun Tutorial Part Twenty-One **********Normal Breathing
Normal respirations are 12-18 BPM or beats per minute. Greater than 24 beats per minute is tachypnea. Less than 10 BPM is bradypnea. Actually, if it doesn’t look right and the person is just lying there use your instincts and get a nurse.
Normal respiration for infants is 20-30 BPM and the beats are often irregular. Older children have 20-26 breaths per minute.
What you breathe in or the tidal volume is about 500 ml breathed in normally and 500 ml breathed out, but only 350 ml of the 500 ml is new air that is exchanged with the functional residual capacity volume during each respiratory cycle.
Breathing can be measured with a spirometer. You can observe the chest expansion on both sides of the chest. You can observe the physical characteristics namely the ribs.
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You can place the back of the hand next to the patient’s nose and mouth feeling the air. Is the nose flaring? Are the ribs moving?
**********Tachypnea
Tidal volume may be decreased, the heart rate may be increased.
Cheyne-Stokes breathing is when a patient breathes and breathes and then they stop. This is right before death.
Cheyne-Stokes breathing is regularly increasing and decreasing depth of respirations. The person is close to unconscious when they do that.
In tachypnea the breathing is rapid and shallow and they may have a fever and hyperventilate.
In bradypnea there is slow but regular breathing and it may be cause by sleep drugs.
OMG! I was working in the hospital one night and this almost blind elderly man walked out of his room which was a room he shared with another man and walked across the hall to a room shared by two females.
He goes in there and sits down on this woman’s bed and starts talking to her. She rings the call bell and I come running because it is my room. Sure enough he was sitting on the side of her bed relegating war stories. It was hilarious!
I told the nurse and she said, well we can’t give him any more Ambien to help him sleep. We all got a kick out of that at the nurse’s station.
When someone is hyperventilating there is an increased depth and increased rate of breathing and excessive anxiety. This is when you would have someone breathe into a brown paper bag and that actually works.
If someone is breathing slowly then it may be drug induced like morphine which is an end of life drug.
When someone is hypoventilating there is decreased depth of breathing and decreased rate of breathing which may also be drug induced.
Ataxic breathing is short bursts of irregular breathing interspersed with periods of pauses and apnea. There is usually brain damage and respiratory distress.
“Ataxic respiration is an abnormal pattern of breathing characterized by complete irregularity of breathing, with irregular pauses and increasing periods of apnea. As the breathing pattern deteriorates, it merges with agonal respirations.
It is caused by damage to the medulla oblongata due to strokes or trauma. It generally indicates a poor prognosis, and usually progresses to complete apnea.
The term is sometimes used interchangeably with Biot's Respirations, but technically, Biot's respirations refers to groups of similar-sized breaths alternating with regular periods of apnea.” From http://en.wikipedia.org/wiki/Ataxic_respiration
************Pulse oximetry and blood pressure
Pulse oximetry measures oxygen saturation in the blood. Oxygen saturation is 100% in a healthy person. The amount of oxygen in the hemoglobin is how much oxygen is hooked to how much hemoglobins in your blood. Pulse oximetry measures how much of your hemoglobin in your red blood cells is saturated with oxygen.
Blood pressure is the force exerted against a blood vessel. MAP= Mean Arterial Pressure. Systole is when the ventricles contract and diastolic is when the ventricles relax. Systole is the top number and diastole is the bottom number.
Does the heart contract or relax for a longer period of time? It relaxes longer 1/3 to 2/3 longer. The resting phase is about twice as long in the resting phase.
MAP= Mean Arterial Pressure on average it contracts 1/3 and relaxes 2/3 of the time.
The MAP= Mean Arterial Pressure it the average of the systolic contraction pressure + diastolic relaxation pressure + diastolic pressure and the sum of that divided by three.
********** MAP= Mean Arterial Pressure
MAP is an average pressure of 60 so I can perfuse or get blood to all of my organs.
The heart contracts systolic and then it releases and releases.
So a sample MAP would be:
(120 + 80 + 80)/3 so it would be 280/3=93.3 MAP
When you take a pulse and you hear lub-dub, lub-dub and then you hear silence after that silence between them is the other resting part.
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