Breathing, Heart, and Lungs
An anxious patient is having rapid and shallow breathing. After a few moments, he complains of a tingling sensation.
1)What could be the causes of this tingling sensation?
Anxiety can increase in those patients that are already having rapid and shallow breathing. Hyperventilation added to this can cause the tingling sensation due to a decrease in C02.
2)What are the various patterns of respiration and their significance?
Normal respirations are 10-20 is also called sigh rate, depth is 500-800ml “air moving in and out with each respiration, pattern is even”. (Jarvis 2016 pg. 442). “These values increase as a normal response to exercise, fear, or fever”. (Jarvis 2016 pg. 442).
Tachypnea Hyperventilation Rapid is shallow breathing. Has an increased rate greater than 24 per minute. This rate can increase with respiratory insufficiency, alkalosis, pleurisy, pneumonia, pleurisy, diabetic ketoacidosis, salicylate overdose, hepatic coma and lesions of the midbrain and alteration in blood gas concentration, but it a normal response to fever, fear, or exercise.
Bradypnea Hypoventilation: Slow breathing. Is a decreased but regular rate less than 10 per minute. Can be caused by drugs, increased intracranial pressure and diabetic coma.
“An irregular shallow pattern caused by an overdose of narcotics or anesthetics” (Jarvis 2016 pg. 442). It may also occur with conscious splinting of the chest to avoid respiratory pain and with prolonged bed rest.
Cheyne-Stokes Respiration: “respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing”. (Jarvis 2016 pg. 442). Breathing periods are 30-45 seconds with about 20 second period of apnea. Common causes are severe heart failure, renal failure, meningitis, drug overdose, and increased intracranial pressure.
Biot Respiration is similar to Cheyne-Stokes respiration, except that the pattern is irregular and seen with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis.
3)Ethnicity and culture influence risk factors for heart disease. Do you agree? Why or why not?
Heart disease knows no ethnic/culture. Some risk factors that cause heart disease is obesity, tobacco use and high cholesterol. These are modifiable. In other words, most of these can be prevented. High blood pressure is mainly in the Africa American culture and for some of them, blood pressure can be prevented or at least controlled. If not controlled, it can lead to heart disease.
4)What is the technique of percussion and palpation of the chest wall for tenderness, symmetry, bulges, fremitus, and thoracic expansion? Explain.
To palpate the chest wall, place your hands on the anterolateral wall with your thumbs along the coast margins with hands pointing toward the xiphoid process. You ask the patient to take a deep breath while watching your thumbs move apart symmetrically and take note of the smooth chest expansion with your fingers. “Any limitation in thoracic expansion is easier to detect on the anterior chest because greater range of motion exists with breathing here” (Jarvis 2016 pg. 432).
To assess tactile fremitus, began palpating over the lung apices in the supraclavicular areas comparing vibrations from one side to the other as the person repeats the words ninety-nine.
You then palpate the anterior chest wall looking for tenderness or detect any superficial lumps or masses. Note the skin mobility, turgor, temperature and moisture.
With percussion of the chest, you start at the apices in the supraclavicular area, going to the interspaces, comparing one side with the other, going in a downward motion, down the anterior chest.
5)Would you anticipate hearing hyper-resonance on a patient with a history of tobacco use? Why or why not?
Yes. Hyperresonance is found when too much air is present like in emphysema which is caused from tobacco use.
6)What are the mechanics of breathing with reference to lung borders and the anatomical structure of the lungs and diaphragm?
Inspiration is the breathing in air into the lungs, the chest wall increases in size. When it is expelled it is caused expiration. This is the mechanical action of breathing. Expansion and contraction. There are four major functions of the respiratory system. Supplying oxygen to the body for energy production, removing carbon dioxide as a waste product of energy reactions, maintaining homeostasis of arterial blood and maintain heat exchange.
