Respirations at 30 bpm

Be_Moore · May 4, 2009

Possibly. Probably. It would depend on WHY the person is tachypneic! For example: If the person is breathing 30BPM because they are anxious/agitated, then it would definitely help. Either or. That's why in an ICU setting persons on ventilators are sedated, because being awake and being ventilated causes anxiety, leading to tachypnea, leading to horrible looking blood gases (respiratory alkalosis).

Alternately, the person could be breathing 30BPM for several other reasons..and while the ativan/morphine may slow it, it isn't "fixing" the underlying issue. One possibility would be renal failure vs. acute kidney injury..decreased bicarb leading to metabolic acidosis with hyperventilation as a compensatory mechanism. Another example could be pneumonia/atelectasis/(pneumo or hemo)thorax...anything that can cause diminished lung volumes will also cause compensatory hyperventilation.

So yeah, it would probably help. But WHY is the person breathing that fast?

EDIT: After reading it a second time, with the 30s periods of apnea...is the person sleeping (sleep apnea) or dying (agonal breathing)? If the person is sleeping and has sleep apnea, CPAP may be the answer..the hyperventilation would be present to compensate for the apnea. If the person is dying, well, morphine is good to decrease agonal breathing (as well as make the patient comfortable!)

NursKristy · May 4, 2009

Well, the pt is yes......dying. And I am hoping that the morphine updraft will help. Just started to panic a bit, thank you so much for your response.

Be_Moore · May 4, 2009

Don't panic. Agonal breathing is a natural part of the dying process. Morphine is typically prescribed for it because it makes the breathing more "normal" looking for the people who are with the one dying...it usually isn't prescribed for patient comfort because agonal breathing is probably not uncomfortable for the dying patient, as once agonal patterns happen they are usually unconscious by that point anyway. Good luck!

Virgo_RN, BSN, RN · May 4, 2009

This person would be on a morphine gtt where I work. Typically we'd titrate the dose to achieve a more normal respiratory rate.

FlyingScot, RN · May 4, 2009

Not to be nit-picky but I always knew this respiratory pattern (tachypnea followed by long pauses) to be Cheyne-Stokes breathing while agonal respirations were very slow with long pauses. Have I been wrong all these years?

Christie RN2006 · May 4, 2009

Not to be nit-picky but I always knew this respiratory pattern (tachypnea followed by long pauses) to be Cheyne-Stokes breathing while agonal respirations were very slow with long pauses. Have I been wrong all these years?

I was thinking that is what it sounded like. People tend to do Cheyne-stokes breathing shortly before they die. If they are a DNR pt, medicate them to keep them comfortable, if they are with it I usually try to do ativan and morphine, if they are lethargic or comatose I tend to stick with just the morphine. If the patient is a full code and they start doing that type of breathing, you had better be letting the doctor know asap because they will probably code before long!

HNursing · May 4, 2009

In my floor with give ativan to stable the patient and if patient still have problem with breathing. Call the hospice because they probably have something for the patient.

leslie :-D · May 4, 2009

Don't panic. Agonal breathing is a natural part of the dying process. Morphine is typically prescribed for it because it makes the breathing more "normal" looking for the people who are with the one dying...it usually isn't prescribed for patient comfort because agonal breathing is probably not uncomfortable for the dying patient, as once agonal patterns happen they are usually unconscious by that point anyway. Good luck!

you're right...agonal breathing reflects a primitive level of brain function, therefore, is highly unlikely there is any discomfort since the pt isn't cognizant or conscious.

we'll do stuff more for the families sake.

otherwise, it is a natural, pre-death respiration that is neither invasive or stressful.

leslie

texastaz · May 4, 2009

I was thinking that is what it sounded like. People tend to do Cheyne-stokes breathing shortly before they die. If they are a DNR pt, medicate them to keep them comfortable, if they are with it I usually try to do ativan and morphine, if they are lethargic or comatose I tend to stick with just the morphine. If the patient is a full code and they start doing that type of breathing, you had better be letting the doctor know asap because they will probably code before long!

I do a lot of home hospice and by the time a person has hit 30 BPM - Cheyne-stokes, the patient has already been given the max of ativan and morphine. True the patient is going to code usualy within the next 20 minutes.