Hyperventilating Trach Pt

Nurses General Nursing

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Okay...don't wanna sound ignorant but I am an agency nurse who has little experience with trachs. On top of this, the pt is MRDD. Her VS were perfectly fine...except for her respirations. At the end of my shift her respiration increased to 28, deep breaths. Her pulse was in the 70's and bp wnl. She was congested all shift so deep suctioned quite a bit. Gave an Albuterol TX, CPT. At the end of my shift she was pretty much out of it, eyes closed but breathing very rapid and deep. I put her on O2. Oh, and her O2 prior to O2 administration was 98%. She couldn't communicate with me bc she is developmentally disabled. I am just puzzled. Maybe she was breathing deeply and rapidly and this is why her O2 sat was so good, but pulse was wnl. I'm just puzzled. I didn't know how to calm her breathing down. It was a home care setting. Does anyone have any insight or suggestions. (I am writing this on my phone so I apologize in advance for any grammatical errors). By the way, I don't know how she did bc I had to give report to the oncoming nurse but will be working with her tomorrow.

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Specializes in family practice.

I work home health also. Did u reposition her, did u check her trach to see if it was in. Sincw u said o2sats with oxygrn was 98 i would not b so worried unless she was hyperventulating. With oxygen, then i woukd have called 911.also does this pt have a vent, i would check the settings also

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Her O2 sat was 98% before I applied O2, then jumped up to 99-100% while on O2, but she was still hyperventilating, even on O2. Techs stated she gas a hx of this. It just puzzled me. Is there anything else I should have done? VS were WNL before and after O2 administration, just the rapid deep breathing.

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No vent...had to reposition her to her wc due to a Dr appt. and that's when the rapid breathing started. Hmmm....

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Specializes in Emergency Department.

Compensating for alkalosis? Could be caused by excessive suctioning...

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Compensating for alkalosis? Could be caused by excessive suctioning...

Alkalosis would cause resp depression in an attempt to hold on to CO2, No? Hard to say without having the H&P but I think CNL is on the right track. If her O2 was fine I would maybe start thinking either anxiety/pain or pH imbalance? maybe think about Kidney function?

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Specializes in Emergency Department.

Right, of course. Thanks!

Maybe she was responding positively to the improved lung expansion after CPT and suctioning?

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Not enough medical or med history given.

Did she have a self inflating bag at beside for suctioning which would indicate she might need positive pressure breaths?

Color and consistency of secretions?

Core temp and glucose? I&Os? Any decrease in urine output? Bowel Movement? Abdominal distension? Rigidity? Condition of skin? Risk for pulmonary emboli?

The patient may be trying to correct an acidosis.

Or, a pain issue.

HR and BP might be stable but what meds is the patient taking that might keep it lower?

Neuro check?

There are many things that can be occuring with this patient and the trach could be a distractor. If you have a patent trach, you do have an airway. Clear the trach and continue to do a thorough assessment beyond just vital signs. Also, go back a little further in the VS chart. What might be "normal" is not for this patient but the changes may have started trending a day or two prior.

Another point is that you do not know she is "hyperventilating" which is a decrease in PaCO2. The patient is tachypneic and if she has a PNA or some other condition creating a significant mismatch, PaCO2 could be wanting to climb until she goes into failure.

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Is she normally on RA? How much O2 did you give her? What are the parameters for giving O2 and notifying the parents/doctor?

What kind of trach is this? Some tubes are much softer than others and can partially occlude if she is chin-to-chest in her WC.

Do you normally deep suction? How deep were you going? What size trach does she use? Deep suctioning is not allowed in our house. You can so irritate the carina that you will cause airway swelling and/or bleeding.

Was the albuterol and CPT given at a scheduled time or did you do that in response to her respiratory distress?

Are her vital signs "normal" or "normal for her"? Don't the parents have some sort of chart listing changes, procedures and notifications? We do. I have flow charts for everything. For example, if my son's respirations are above 20 there is a list of things to check/do. If they continue or increase after intervention, the nurses are to notify me immediately so I can decide whether I wish to call his pulm or go to the ER.

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I know this post is quite old but would just like to give everyone an update. I am still seeing this patient today and have become very attached to her. She is doing great! She does have these episodes of tachypneic from time to time but I have figured out her triggers and yes, the trach was a distraction as I was not experienced with trachs at the time I posted this.

A lot of times repositioning her helps, left side. Making sure she has had regular bowel movements are also something I am very diligent with as she is in a wheelchair and constipation is definitely an issue. There are also many other things such as assessing for pain and anxiety. Since she is MRDD, she can't tell me exactly what is going on, but the more I get to know her I learn how to help.

I have developed a close bond with her and her sister is a nurse practitioner and I have learned a lot from her and her history with my patient.

Thank you all for your comments and suggestions. :-)

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