Diseases » Asphyxia

Bradypnea

Bradypnea: Excerpt from Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series

Commonly preceding life-threatening apnea or respiratory arrest, bradypnea is a pattern of regular respirations with a rate of less than 10 breaths/minute. This sign results from neurologic and metabolic disorders and drug overdose, which depress the brain’s respiratory control centers. (See Understanding how the nervous system controls breathing, page 64.)

Act Now: Depending on the degree of central nervous system (CNS) depression, the patient with severe bradypnea may require constant stimulation to breathe. If the patient seems excessively sleepy, try to arouse him by shaking and instructing him to breathe. Quickly take his vital signs. Assess his neurologic status by checking pupil size and reactions and by evaluating his level of consciousness (LOC) and his ability to move his extremities.

Place the patient on an apnea monitor, keep emergency airway equipment available, and be prepared to assist with intubation and mechanical ventilation if spontaneous respirations cease. To prevent aspiration, position the patient on his side or keep the head elevated 30 degrees higher than the rest of the body, and clear his airway with suction or finger sweeps, if necessary.

Assessment

History

Obtain a brief history from the patient or his family. Determine if the patient may be experiencing a drug overdose and, if so, try to determine what drugs were ingested, the amount, time, and by what route. Checking extremities for needle marks may indicate possible drug abuse.

After drug overdose is ruled out, determine any chronic illnesses, such as diabetes and renal failure. Check for a medical identification bracelet or an I.D. card that identifies an underlying condition. Also, ask whether the patient has a history of head trauma, brain tumor, neurologic infection, or stroke.

Physical examination

Perform a full respiratory and neurologic assessment, noting respiratory rate and pattern.

Pediatric pointers

Because respiratory rates are higher in children than in adults, bradypnea in children is defined according to age. (See Respiratory rates in children, page 65.)

Geriatric pointers

When drugs are prescribed for older patients, keep in mind that they are at higher risk for developing bradypnea secondary to drug toxicity because many of these patients take several drugs that can potentiate this effect and typically have other conditions that predispose them to it. Warn older patients about this potentially life-threatening complication.

Medical causes

Diabetic ketoacidosis

Bradypnea occurs late in patients with severe, uncontrolled diabetes. Patients with severe ketoacidosis may experience Kussmaul’s respirations. Associated signs and symptoms include decreased LOC, fatigue, weakness, fruity breath odor, and oliguria.

Hepatic failure

Occurring with end-stage hepatic failure, bradypnea may be accompanied by coma, hyperactive reflexes, asterixis, a positive Babinski’s sign, fetor hepaticus, and other signs.

Increased intracranial pressure (ICP)

A late sign of increased ICP — a life-threatening condition — bradypnea is preceded by decreased LOC, deteriorating motor function, and fixed, dilated pupils. The triad of bradypnea, bradycardia, and hypertension is a classic sign of late medullary strangulation.

Renal failure

Occurring with end-stage renal failure, bradypnea may be accompanied by convulsions, decreased LOC, GI bleeding, hypotension or hypertension, uremic frost, and diverse other signs.

Respiratory failure

Bradypnea occurs with end-stage respiratory failure along with cyanosis, diminished breath sounds, tachycardia, mildly increased blood pressure, and decreased LOC.

Other causes

Drugs

Overdose with an opioid analgesic or, less commonly, a sedative, barbiturate, phenothiazine, or other CNS depressant can cause bradypnea. Use of any of these drugs with alcohol can also cause bradypnea.

Nursing considerations

Because a patient with bradypnea may develop apnea, check his respiratory status frequently and be prepared to give ventilatory support if necessary. Don’t leave the patient unattended, especially if his LOC is decreased. Obtain blood for arterial blood gas analysis, electrolyte studies, and a possible drug screen. Ready the patient for chest X-rays and possibly a computed tomography scan of the head.

Administer prescribed drugs and oxygen. Administration of I.V. nalozone, an opioid antagonist, may be required depending on the cause of the respiratory depression. Avoid giving the patient a CNS depressant because it can exacerbate bradypnea. Similarly, give oxygen judiciously to a patient with chronic carbon dioxide retention, which may occur with chronic obstructive pulmonary disease, because excess oxygen therapy can have a negative effect.

When dealing with slow breathing in hospitalized patients, always review all drugs and dosages given during the last 24 hours.

Patient teaching

Inform the patient who regularly takes an opioid — for example, a patient with advanced cancer or sickle cell anemia — that bradypnea is a serious complication. Teach him the early signs of toxicity, such as nausea and vomiting. It’s also important to identify the patient who may be abusing these drugs.

Encourage the family to take a cardiopulmonary resuscitation class.

Pictures

Book Source Details

• Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.

More About Asphyxia

• Back to disease: Asphyxia: Introduction
• Next Book Extract About Asphyxia: Dyspnea (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• More Book Extracts: All Online Books for Asphyxia

More Medical Textbooks Online about Asphyxia

Review other book chapters online related to Asphyxia:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

---

More About This Book: Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-624-5

 » Next page: Dyspnea (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Dyspnea (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Hyperpnea (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Stridor (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Bradypnea (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Dyspnea (Signs & Symptoms: A 2-in-1 Reference for Nurses)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

homepage | back to top

Common Health Mistakes

Choose ... Alzheimers & Dementia Asthma Child ADHD ADHD in Adults Allergy Hypertension Bipolar Breast Cancer Celiac Disease Crohns Disease Colon Cancer Contraception Diabetes Cancer Depression Erectile Disorder Cholesterol COPD GERD Heartburn/Reflux Metabolic Syndrome Migraine/Headache Multiple Sclerosis Obesity Osteoporosis Overactive Bladder Psoriasis Sexual Disorder Sleep Disorders Smoking The Pill Ulcerative Colitis All Common Mistakes

Symptom
Checker

Choose... Fever Rash Pain Headache Fatigue Cough Other symptoms

Search Specialists by State and City

Choose... GENERAL PRACTICE CARDIAC HEALTH WOMEN'S HEALTH CANCER CARE RADIOLOGY MENTAL HEALTH PATHOLOGY EAR, NOSE, THROAT MEDICINE GENETICS NEUROLOGY DIALYSIS CARE SURGERY ORTHOPEDICS/SPORTS MEDICINE CHILDREN'S HEALTH OTHER SPECIALTIES