Bradypnea

Commonly preceding life-threatening apnea or respiratory arrest, bradypnea is a pattern of regular respirations with a rate of fewer than 10 breaths/minute. This sign may result from neurologic or metabolic disorders or a drug overdose, all of which depress the brain’s respiratory control centers. (See Understanding how the nervous system controls breathing, page 124.)

Emergency interventions

Connect the patient to 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 his head elevated 30 degrees higher than the rest of the body, and clear his airway with suction or finger-sweeps if necessary.

History and physical examination

Obtain a brief history from the patient, if possible, or from whoever accompanied him to your facility. Ask if he’s experiencing a drug overdose and, if so, try to determine which drugs he took, how much, when, and by what route. Check his arms for needle marks, indicating possible drug abuse. You may need to administer I.V. naloxone, an opioid antagonist.

If you rule out a drug overdose, ask about chronic illnesses, such as diabetes and renal failure. Check for a medical identification bracelet or card that identifies an underlying condition. Also ask whether the patient has a history of head trauma, brain tumor, neurologic infection, or stroke.

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 in end-stage hepatic failure, bradypnea may be accompanied by coma, hyperactive reflexes, asterixis, a positive Babinski’s reflex, 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 in end-stage renal failure, bradypnea may be accompanied by seizures, decreased LOC, GI bleeding, hypotension or hypertension, uremic frost, and diverse other signs.

Respiratory failure

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

Other causes

Drugs

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

Special 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. Keep his bed in the lowest position and raise the side rails. Obtain blood for arterial blood gas analysis, electrolyte studies, and possibly a drug screen. Ready the patient for chest X-rays and possibly a computed tomography scan of the head.

Administer prescribed drugs and oxygen. 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 in 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.

Pediatric pointers

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

Geriatric pointers

When administering drugs to elderly patients, keep in mind that they have a higher risk of developing bradypnea secondary to drug toxicity. That’s because many of them take several drugs that can potentiate this effect or have other conditions that predispose them to it. Warn older patients about this potentially life-threatening complication.

Patient counseling

Alert patients who regularly take an opioid—for example, those with advanced cancer or sickle cell anemia—that bradypnea is a serious complication, and teach them to recognize early signs of toxicity, such as nausea and vomiting. Also, try to identify patients who may be abusing these drugs.

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 Orthopnea

Read excerpts from these other book chapters related to Orthopnea:

Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.

More About Causes of Orthopnea

• Back to symptom: Orthopnea: Introduction (review 41 causes)
• Next Book Extract About Orthopnea: Hyperpnea (Professional Guide to Signs & Symptoms (Fifth Edition))
• All Book Extracts: All Online Book Extracts for Orthopnea

More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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