Labored Breathing?

Neuro Guy NP, DNP, PhD, APRN · May 12, 2011

Well, if O2 sats and other vital signs are normal, I don't see an indication to worry. This patient is lethargic r/t his condition. You did not mention the disease this patient has, so I don't know if the possible mouth breathing is related to a pathophysiologic process or not. More details might be helpful.

bsyrn, ASN, RN · May 12, 2011

Examine the chest, a normal respiratory pattern should be even and regular at 12-20 breaths per minute. Some abnormal signs: breathing through pursed lips, nostril flaring,audible wheezing or gurgling, use of accessory muscles, and or sternal retractions. You also want to monitor for pallor or cyanosis. Hope this helps :nurse:

leslie :-D · May 12, 2011

Well, if O2 sats and other vital signs are normal, I don't see an indication to worry.

not always true.

i've had pts in acute heart failure, all with normal sats.

always, always look at the pt first.

numbers are often very misleading.

op, i agree w/poster about certain signs to be expected.

auscultate lungs, count resps, look for usage of accessory muscles.

mouth-breathing is very common...for the dying and non-dying.

just make sure bed is in semi-fowler position.

leslie

payang0722 · May 12, 2011

Thank you...I will look more on his medical history this afternoon when i go to work.

GHGoonette, BSN, RN · May 12, 2011

As the above posts have mentioned, if his sats and other vitals are ok, you shouldn't have reason to worry. If he is on opiates it will make him lethargic, but a word of warning, which I'm sure I don't have to mention :) opiates depress the respiratory centre in the brain, resulting in slower breathing. Of course, too much and the patient can go into respiratory arrest, so it is necessary to monitor the sats for at least a half hour after administration and/or observe for signs of cyanosis, as described above.

O2 starvation in the conscious patient is usually characterized by restlessness; airway obstruction may be observed by "see-saw" respirations, ie the abdomen rises while the chest wall falls, frequently seen in sufferers of obstructive sleep apnoea. It doesn't sound to me as if your patient has any kind of obstruction, but if you are concerned, and if his condition does not counter-indicate it, you can position him in semi-Fowler's and just keep an eye on his breathing patterns.

Momof2inMO · May 12, 2011

Ok, the person is on hospice. Your job is to make the person comfortable and ease suffering, take the best care possible, prevent sores, best quality of life for time left. These are the goals of hospice. I agree w/previous posters about positioning for optimal respiratory expansion. You can also try alternate positioning of the head and neck to keep airway open and relieve work of breathing as much as possible. Elevate extremities as they can often become swollen. If the person is not aware enough to reposition him/herself, you will need to do this frequently as long as it does not create extra stress on the person.

We often use roxanol (liquid, sub lingual morphine) if our palliative care patients are having respiratory distress-excess fluid diverts to the body's periphery, decreases work of heart and eases fluid overload in lungs if present.

Previous posters have discussed what labored breathing is. Sometimes it is really hard to tell if a dying patient is in distress/labored breathing, in pain etc. Abbey scales are helpful at times, counting respirs, noting how hard the pt is working etc. also helpful. Does your facility have any policies you could utilize? Our unit is a designated palliative care/medical oncology unit and has a "care of the dying patient" policy/protocol that is helpful.

Esme12, ASN, BSN, RN · May 12, 2011

Signs of Respiratory Distress

Learning the signs of respiratory distress:

Persons having difficulty breathing often show signs that they are not getting enough oxygen, indicating respiratory distress. Below is a list of some of the signs that may indicate that a person is not getting enough oxygen. It is important to learn the symptoms of respiratory distress to know how to respond appropriately. Always consult your physician for a diagnosis.

breathing rate
An increase in the number of breaths per minute may indicate that a person is having trouble breathing or not getting enough oxygen.
color changes
A bluish color seen around the mouth, on the inside of the lips, or on the fingernails may occur when a person is not getting as much oxygen as needed. The color of the skin may also appear pale or gray.
grunting
A grunting sound can be heard each time the person exhales. This grunting is the body's way of trying to keep air in the lungs so they will stay open.
nose flaring
The openings of the nose spreading open while breathing may indicate that a person is having to work harder to breathe.
retractions
The chest appears to sink in just below the neck and/or under the breastbone with each breath - one way of trying to bring more air into the lungs.
sweating
There may be increased sweat on the head, but the skin does not feel warm to the touch. More often, the skin may feel cool or clammy. This may happen when the breathing rate is very fast.
wheezing
A tight, whistling or musical sound heard with each breath may indicate that the air passages may be smaller, making it more difficult to breathe.

Are you alone? Is there no one to ask these questions? Are you on orientation? Where is your charge nurse?

A person in distress appear to be in distress.....they are restless, anxious,confused, or breath very loudly with wheezes (whistling) or congestion (rattling)

http://tinyurl.com/5t7xa7c some very good site to learn how to auscultate lung sounds abd what they sound like.........please take the time to listen to the sounds....good luck

akulahawkRN, ADN, RN, EMT-P · May 12, 2011

While I'm not a nurse or LVN or... from the description, it sounds like your patient has a good airway, normal rate/depth, normal/expected vitals... The lethargy/droopy eyelids/mouth breathing sound more like the patient is pretty well snowed on medication of some sort. AFAIK, all the meds that will do that also have the potential for severe respiratory depression... to the point of death. To me, it just looks like that's the kind of patient you have- one that's on some kind of pain or anxiety management plan and the patient is now medicated... Be careful. A med error could end the patient's life prematurely and make life for you or someone else very unhappy.

ErinS, BSN, RN · May 12, 2011

Morphine is the drug of choice to use for dyspnea in a hospice pt. Dyspnea in the dying is characterized by several things, including a respiratory rate of more than 20, use of accessory muscles, strain when breathing (often seen in tensing of the neck muscles, and if the patient reports they feel short of breath. Depending on the medications this pt has received, chances are fairly good he is not in fact 'snowed'. Lethargy and decreased level of consciousness is common in people approaching end of life. And always, always feel free to call the pt's hospice nurse and ask these questions. It is our specialty, and they should be happy to answer your questions and provide guidance.

wee_oneRN · May 13, 2011

Please do not ever just go by the O2 saturation, as a few pple have stated above. I have had pts with sats in the high 90's but breathing rapidly, shallow, using accessory muscles. If I waited to take action until they fatigued enough to no longer be able to keep their saturation up, they would not have survived! This especially holds true for infants, geriatric, and anyone on Hospice/end-of-life. Those populations just don't have a lot of endurance.

akulahawkRN, ADN, RN, EMT-P · May 13, 2011

Please do not ever just go by the O2 saturation, as a few pple have stated above. I have had pts with sats in the high 90's but breathing rapidly, shallow, using accessory muscles. If I waited to take action until they fatigued enough to no longer be able to keep their saturation up, they would not have survived! This especially holds true for infants, geriatric, and anyone on Hospice/end-of-life. Those populations just don't have a lot of endurance.

And I've seen that too. People can decompensate and crash really quickly... If you're not alert to it, it's very possible that a patient can be breathing "normally" by some appearance, but actually be well into resp failure because they've simply gotten too fatigued... A good assessment should be able to tell you if this is the case. From the "picture" presented, I don't get the feeling that this patient is in resp failure but instead is rather well medicated. Change the wording to describe the patient differently and you very easily change my impression of the patient.

The patient in question very well could be showing early signs of respiratory failure. Unfortunately, there's no mention of whether the patient had any meds administered recently that could account for the appearance. If no meds have been given... that might just cause me to worry a bit...