Chapter 3:	Physical Examination
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IV. Respiration

Normal breathing frequency of an adult is 12-20 breaths per minute. The respiratory rate is counted by watching the patient’s abdomen or chest wall move in and out during respiration. The practiced RCP should be able to easily identify even the most subtle breathing movements of patients at rest. It may be necessary in some cases to place a hand on the patient’s abdomen to confirm the breathing rate. In any event, the RCP should avoid letting the patient become aware that their breathing rate is being counted. One way to accomplish this is to count the respiratory rate is to count the respiratory rate after evaluating the pulse, keeping the fingers on the artery.

Exercise, fever, hypoxia, anxiety, pain, metabolic acidosis, and an increase in the work of breathing can increase frequency (e.g.: fibrosis). Frequency decreases from head trauma, hypothermia, and ventilatory depressing medications.

Breathing patterns and effort should also be observed. Any respiratory abnormalities that increase the work of breathing usually cause the accessory muscles of ventilation to become active, even at rest. A significant reduction in lung volume, as that seen in atelectasis, usually results in rapid, shallow breathing. The greater the loss of lung volume, the higher the patient’s respiratory rate.

Common types of abnormalities seen in patients’ rate and rhythm of breathing include:

• Tachypnea: Breathing that is faster than normal and usually more shallow.



• Bradypnea: An abnormally slow rate of respiration



• Hyperpnea: Deep breathing



• Hyperventilation: Ventilation in excess of that necessary to meet metabolic needs



• Cheyne-Stokes Respirations: An abnormal breathing pattern characterized by alternating periods of apnea and periods of rising then falling tidal volumes



• Kussmaul’s Breathing: Deep gasping type of respiration associated with severe diabetic acidosis and coma



• Obstructive Breathing: In obstructive lung disease, expiration is prolonged because of increased airway resistance. If the patient must increase his respiratory rate, he lacks sufficient time for full expiration. His chest overexpands (air trapping) and his breathing becomes more shallow.



• Biots’ Breathing: Characterized by several short breaths followed by long irregular periods of apnea