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. Heightened oxygen demand, for example, may result from fever, exertion, anxiety, and 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, respirations increase by 4 breaths/minute for every 1°F (17.2° C) increase in body temperature.

Emergency interventions

After detecting tachypnea, quickly evaluate cardiopulmonary status; obtain a set of vital signs with 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. 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)

With life-threatening ARDS, tachypnea and apprehension may be the earliest features. 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.

Anaphylactic shock

With anaphylactic shock — a 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, affecting 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.

Aspiration of a foreign body

Life-threatening upper airway obstruction may result from aspiration of a foreign body. With a partial obstruction, the patient abruptly develops a dry, paroxysmal 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 with 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.

Bronchitis (chronic)

Mild tachypnea may occur in chronic bronchitis (a form of COPD) but it isn’t typically a predominant sign. Usually, chronic bronchitis begins with a dry, hacking cough, which later produces copious amounts of sputum. Other characteristics 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

With 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

Emphysema — a chronic pulmonary disorder — commonly produces tachypnea accompanied by exertional dyspnea. It may also cause anorexia, malaise, peripheral cyanosis, pursed-lip breathing, accessory muscle use, and chronic productive cough. Percussion yields a hyperresonant tone; auscultation reveals wheezing, crackles, and diminished breath sounds. Clubbing and barrel chest are late signs.

Flail chest

Tachypnea usually appears early in life-threatening flail chest. 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.

Hyperosmolar hyperglycemic nonketotic syndrome

Rapidly deteriorating LOC occurs 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’s skin becomes clammy; his pulse is increasingly rapid and thready. 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 commonly the depth) of breathing. Associated symptoms are related to the cause of the hypoxia.

Interstitial fibrosis

With interstitial fibrosis, 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

With lung 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.

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 neurogenic shock — a 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

i>( Yersinia pestis). The onset of the pneumonic form of plague is usually sudden with chills, fever, headache, and myalgias. Pulmonary signs and symptoms include tachypnea, productive cough, chest pain, dyspnea, hemoptysis, and increasing respiratory distress and cardiopulmonary insufficiency. The pneumonic form may be contracted from person-to-person direct contact via the respiratory system. This would also be the form contracted in biological warfare from aerosolization and inhalation of the organism.

Pneumonia (bacterial)

A common sign of pneumonia, 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, 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 on the affected side. The patient with tension pneumothorax also develops a deviated trachea.

Pulmonary edema

An early sign of life-threatening pulmonary edema, tachypnea is accompanied by exertional dyspnea, paroxysmal nocturnal dyspnea and, later, orthopnea. Other features include a dry cough, crackles, tachycardia, and a ventricular gallop. With severe pulmonary edema, respirations become increasingly rapid and labored, tachycardia worsens, and crackles become more diffuse. The patient’s cough also produces frothy, bloody sputum. Signs of shock — such as hypotension, thready pulse, and cold, clammy skin — may also occur.

Pulmonary embolism (acute)

Tachypnea occurs suddenly with pulmonary embolism and is usually accompanied by dyspnea. The patient may complain of angina or pleuritic chest pain. Other common characteristics 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.

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 salicylates.

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, page 584.) 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 — and mild increases in respiratory rate may be unnoticed.

Book Source Details

• Book Title: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

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