Tachypnea
A common sign of cardiopulmonary disorders, tachypnea is an abnormally fast respiratory rate—20 or more breaths/minute. Tachypnea may reflect the need to increase minute volume—the amount of air breathed each minute. Under these circumstances, it may be accompanied by an increase in tidal volume—the volume of air inhaled or exhaled per breath—resulting in hyperventilation. Tachypnea, however, may also reflect stiff lungs or overloaded ventilatory muscles, in which case tidal volume may actually be reduced.
Tachypnea may result from reduced arterial oxygen tension or arterial oxygen content, decreased perfusion, or increased oxygen demand. Increased oxygen demand may result from fever, exertion, anxiety, or pain. It may also occur as a compensatory response to metabolic acidosis or may result from pulmonary irritation, stretch receptor stimulation, or a neurologic disorder that upsets medullary respiratory control. Generally, the respiratory rate increases by 4 breaths/minute for every 1° F (0.5° C) increase in body temperature.
Emergency interventions
If you detect tachypnea, quickly evaluate the patient’s cardiopulmonary status; obtain vital signs including oxygen saturation; and check for cyanosis, chest pain, dyspnea, tachycardia, and hypotension. If the patient has paradoxical chest movement, suspect flail chest and immediately splint his chest with your hands or with sandbags. Then administer supplemental oxygen by nasal cannula or face mask and, if possible, place the patient in semi-Fowler’s position to help ease his breathing. Intubation and mechanical ventilation may be necessary if respiratory failure occurs. Also, insert an I.V. line for fluid and drug administration and begin cardiac monitoring.
History and physical examination
If the patient’s condition permits, obtain a medical history. Find out when the tachypnea began. Did it follow activity? Has he had it before? Does the patient have a history of asthma, chronic obstructive pulmonary disease (COPD), or any other pulmonary or cardiac conditions? Then have him describe associated signs and symptoms, such as diaphoresis, chest pain, and recent weight loss. Is he anxious about anything or does he have a history of anxiety attacks? Note whether he takes any drugs for pain relief. If so, how effective are they?
Begin the physical examination by taking the patient’s vital signs, including oxygen saturation, if you haven’t already done so, and observing his overall behavior. (See Differential diagnosis: Tachypnea, pages 744 and 745.) Does he seem restless, confused, or fatigued? Then auscultate the chest for abnormal heart and breath sounds. If the patient has a productive cough, record the color, amount, and consistency of sputum. Finally, check for jugular vein distention, and examine the skin for pallor, cyanosis, edema, and warmth or coolness.
Medical causes
Acute respiratory distress syndrome (ARDS)
Tachypnea and apprehension may be the earliest features of this life-threatening disorder. Tachypnea gradually worsens as fluid accumulates in the patient’s lungs, causing them to stiffen. It’s accompanied by accessory muscle use, grunting expirations, suprasternal and intercostal retractions, crackles, and rhonchi. Eventually, ARDS produces hypoxemia, resulting in tachycardia, dyspnea, cyanosis, respiratory failure, and shock.
Alcohol withdrawal syndrome
A late sign in the acute phase of this syndrome, tachypnea typically accompanies anorexia, insomnia, tachycardia, fever, and diaphoresis. The patient may also experience anxiety, irritability, and bizarre visual or tactile hallucinations.
Anaphylactic shock
In this life-threatening type of shock, tachypnea develops within minutes after exposure to an allergen, such as penicillin or insect venom. Accompanying signs and symptoms include anxiety, pounding headache, skin flushing, intense pruritus and, possibly, diffuse urticaria. The patient may exhibit widespread edema of the eyelids, lips, tongue, hands, feet, and genitalia. Other findings include cool, clammy skin; rapid, thready pulse; cough; dyspnea; stridor; and change or loss of voice associated with laryngeal edema.
Anemia
Tachypnea may occur in this disorder, depending on the duration and severity of anemia. Associated signs and symptoms include fatigue, pallor, dyspnea, tachycardia, orthostatic hypotension, bounding pulse, an atrial gallop, and a systolic bruit over the carotid arteries.
Anxiety
Tachypnea may occur during high-anxiety states because of the “fight-or-flight” response. Associated signs and symptoms include tachycardia, restlessness, chest pain, nausea, and light-headedness, all of which dissipate as the anxiety state resolves.
Aspiration of a foreign body
A life-threatening upper airway obstruction may result from aspiration of a foreign body. In a partial obstruction, the patient abruptly develops a paroxysmal dry cough with rapid, shallow respirations. Other signs and symptoms include dyspnea, gagging or choking, intercostal retractions, nasal flaring, cyanosis, decreased or absent breath sounds, hoarseness, and stridor or coarse wheezing. Typically, the patient appears frightened and distressed. A complete obstruction may rapidly cause asphyxia and death.
Asthma
Tachypnea is common in life-threatening asthma attacks, which commonly occur at night. These attacks usually begin with mild wheezing and a dry cough that progresses to mucus expectoration. Eventually, the patient becomes apprehensive and develops prolonged expirations, intercostal and supraclavicular retractions on inspiration, accessory muscle use, severe audible wheezing, rhonchi, flaring nostrils, tachycardia, diaphoresis, and flushing or cyanosis.
Bronchiectasis
Although this disorder may produce tachypnea, its classic sign is a chronic productive cough that produces copious amounts of mucopurulent, foul-smelling sputum and, occasionally, hemoptysis. Related findings include coarse crackles on inspiration, exertional dyspnea, rhonchi, and halitosis. The patient may also exhibit fever, malaise, weight loss, fatigue, and weakness. Clubbing is a common late sign.
Bronchitis (chronic)
Mild tachypnea may occur in this form of COPD, but it isn’t typically a characteristic sign. Chronic bronchitis usually begins with a dry, hacking cough, which later produces copious amounts of sputum. Other characteristic findings include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, and cyanosis. Clubbing and barrel chest are late signs.
Cardiac arrhythmias
Depending on the patient’s heart rate, tachypnea may occur along with hypotension, dizziness, palpitations, weakness, and fatigue. The patient’s level of consciousness (LOC) may be decreased.
Cardiac tamponade
In life-threatening cardiac tamponade, tachypnea may accompany tachycardia, dyspnea, and paradoxical pulse. Related findings include muffled heart sounds, pericardial friction rub, chest pain, hypotension, narrowed pulse pressure, and hepatomegaly. The patient is noticeably anxious and restless. His skin is clammy and cyanotic, and his jugular veins are distended.
Cardiogenic shock
Although many signs of cardiogenic shock appear in other types of shock, they’re usually more severe in this type. Besides tachypnea, the patient commonly displays cold, pale, clammy, cyanotic skin; hypotension; tachycardia; narrowed pulse pressure; a ventricular gallop; oliguria; decreased LOC; and jugular vein distention.
Emphysema
This form of COPD commonly produces tachypnea accompanied by exertional dyspnea. It may also cause anorexia, malaise, peripheral cyanosis, pursed-lip breathing, accessory muscle use, and a chronic productive cough. Percussion yields a hyperresonant tone; auscultation reveals wheezing, crackles, and diminished breath sounds. Clubbing and barrel chest are late signs.
Febrile illness
Fever can cause tachypnea, tachycardia, and other signs.
Flail chest
Tachypnea usually appears early in this life-threatening disorder. Other findings include paradoxical chest wall movement, rib bruises and palpable fractures, localized chest pain, hypotension, and diminished breath sounds. The patient may also develop signs of respiratory distress, such as dyspnea and accessory muscle use.
Head trauma
When trauma affects the brain stem, the patient may display central neurogenic hyperventilation, a form of tachypnea marked by rapid, even, and deep respirations. The tachypnea may be accompanied by other signs of life-threatening neurogenic dysfunction, such as coma, unequal and nonreactive pupils, seizures, hemiplegia, flaccidity, and hypoactive or absent deep tendon reflexes.
Hyperosmolar hyperglycemic nonketotic syndrome
Rapidly deteriorating LOC occurs along with tachypnea, tachycardia, hypotension, seizures, oliguria, and signs of dehydration.
Hypovolemic shock
An early sign of life-threatening hypovolemic shock, tachypnea is accompanied by cool, pale skin; restlessness; thirst; and mild tachycardia. As shock progresses, the patient develops clammy skin and an increasingly rapid and thready pulse. Other findings include hypotension, narrowed pulse pressure, oliguria, subnormal body temperature, and decreased LOC.
Hypoxia
Lack of oxygen from any cause increases the rate (and often the depth) of breathing. Associated symptoms are related to the cause of the hypoxia.
Interstitial fibrosis
In this disorder, tachypnea develops gradually and may become severe. Associated features include exertional dyspnea, pleuritic chest pain, a paroxysmal dry cough, crackles, late inspiratory wheezing, cyanosis, fatigue, and weight loss. Clubbing is a late sign.
Lung abscess
In this type of abscess, tachypnea is usually paired with dyspnea and accentuated by fever. However, the chief sign is a productive cough with copious amounts of purulent, foul-smelling, usually bloody sputum. Other findings include chest pain, halitosis, diaphoresis, chills, fatigue, weakness, anorexia, weight loss, and clubbing.
Lung, pleural, or mediastinal tumor
These types of tumors may cause tachypnea along with exertional dyspnea, cough, hemoptysis, and pleuritic chest pain. Other effects include anorexia, weight loss, and fatigue.
Mesothelioma (malignant)
Commonly related to asbestos exposure, this pleural mass initially produces tachypnea and dyspnea on mild exertion. Other classic symptoms are persistent dull chest pain and aching shoulder pain that progresses to arm weakness and paresthesia. Later signs and symptoms include a cough, insomnia associated with pain, clubbing, and dullness over the malignant mesothelioma.
Neurogenic shock
Tachypnea is characteristic in this life-threatening type of shock. It’s commonly accompanied by apprehension, bradycardia or tachycardia, oliguria, fluctuating body temperature, and decreased LOC that may progress to coma. The patient’s skin is warm, dry, and perhaps flushed. He may experience nausea and vomiting.
Plague
The onset of the pneumonic form of this virulent bacterial infection is usually sudden and marked by chills, fever, headache, and myalgia. Pulmonary signs and symptoms include tachypnea, a productive cough, chest pain, dyspnea, hemoptysis, increasing respiratory distress, and cardiopulmonary insufficiency. The pneumonic form may be contracted by inhaling respiratory droplets from an infected person. It could also be contracted from aerosolization and inhalation of the organism in biological warfare.
Pneumonia (bacterial)
A common sign in this infection, tachypnea is usually preceded by a painful, hacking, dry cough that rapidly becomes productive. Other signs and symptoms quickly follow, including high fever, shaking chills, headache, dyspnea, pleuritic chest pain, tachycardia, grunting respirations, nasal flaring, and cyanosis. Auscultation reveals diminished breath sounds and fine crackles; percussion yields a dull tone.
Pneumothorax
Tachypnea, a common sign of life-threatening pneumothorax, is typically accompanied by severe, sharp, and commonly unilateral chest pain that’s aggravated by chest movement. Associated signs and symptoms include dyspnea, tachycardia, accessory muscle use, asymmetrical chest expansion, a dry cough, cyanosis, anxiety, and restlessness. Examination of the affected lung reveals hyperresonance or tympany, subcutaneous crepitation, decreased vocal fremitus, and diminished or absent breath sounds. The patient with tension pneumothorax also develops a deviated trachea.
Pulmonary edema
An early sign of this life-threatening disorder, tachypnea is accompanied by exertional dyspnea, paroxysmal nocturnal dyspnea and, later, orthopnea. Other features include a dry cough, crackles, tachycardia, and a ventricular gallop. In severe pulmonary edema, respirations become increasingly rapid and labored, tachycardia worsens, crackles become more diffuse, and. the cough produces frothy, bloody sputum. Signs of shock—such as hypotension, thready pulse, and cold, clammy skin—may also occur.
Pulmonary embolism (acute)
In pulmonary embolism, tachypnea occurs suddenly and is usually accompanied by dyspnea. The patient may complain of angina or pleuritic chest pain. Other characteristic findings include tachycardia, a dry or productive cough with blood-tinged sputum, low-grade fever, restlessness, and diaphoresis. Less common signs include massive hemoptysis, chest splinting, leg edema, and—with a large embolus—jugular vein distention and syncope. Other findings include pleural friction rub, crackles, diffuse wheezing, dullness on percussion, diminished breath sounds, and signs of shock, such as hypotension and a weak, rapid pulse.
Pulmonary hypertension (primary)
In this rare disorder, tachypnea is usually a late sign that’s accompanied by exertional dyspnea, general fatigue, weakness, and episodes of syncope. The patient may complain of angina on exertion, which may radiate to the neck. Other effects include a cough, hemoptysis, and hoarseness.
Septic shock
Early in septic shock, the patient usually experiences tachypnea; sudden fever; chills; flushed, warm, yet dry skin; and possibly nausea, vomiting, and diarrhea. He may also develop tachycardia and normal or slightly decreased blood pressure. As this life-threatening type of shock progresses, the patient may display anxiety; restlessness; decreased LOC; hypotension; cool, clammy, and cyanotic skin; rapid, thready pulse; thirst; and oliguria that may progress to anuria.
Other causes
Salicylates
Tachypnea may result from an overdose of these drugs.
Special considerations
Continue to monitor the patient’s vital signs closely. Be sure to keep suction and emergency equipment nearby. Prepare to intubate the patient and to provide mechanical ventilation if necessary. Prepare the patient for diagnostic studies, such as arterial blood gas analysis, blood cultures, chest X-rays, pulmonary function tests, and an electrocardiogram.
Pediatric pointers
When assessing a child for tachypnea, be aware that the normal respiratory rate varies with the child’s age. (See Normal pediatric vital signs, pages 742 and 743.) If you detect tachypnea, first rule out the causes listed above. Then consider these pediatric causes: congenital heart defects, meningitis, metabolic acidosis, and cystic fibrosis. Keep in mind, however, that hunger and anxiety may also cause tachypnea.
Geriatric pointers
Tachypnea may have a variety of causes in elderly patients, such as pneumonia, heart failure, COPD, anxiety, or failure to take cardiac and respiratory medications appropriately; mild increases in respiratory rate may be unnoticed.
Patient counseling
Reassure the patient that slight increases in respiratory rate may be normal.
Pictures
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Breathlessness on exertion
Read excerpts from these other book chapters related to Breathlessness on exertion:
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Breathlessness on exertion
» Next page: Paroxysmal nocturnal dyspnea (Professional Guide to Signs & Symptoms (Fifth Edition))
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