Definition Of Hyperventilation

Definition of Hyperventilation: Hyperventilation is rapid or deep breathing that can occur with anxiety or panic. It is also called overbreathing, and may leave you feeling breathless. See also: Rapid shallow breathing

Considerations: When you breathe, you inhale oxygen and exhale carbon dioxide. Excessive breathing leads to low levels of carbon dioxide in your blood. This causes many of the symptoms you may feel if you hyperventilate. In medicine, hyperventilation (or overbreathing) is the state of breathing faster and/or deeper than necessary, bringing about lightheadedness and other undesirable symptoms often associated with panic attacks. Hyperventilation can also be a response to metabolic acidosis, a condition that causes acidic blood pH levels. Counterintuitively, such side effects are not precipitated by the sufferer's lack of oxygen or air. Rather, the hyperventilation itself reduces the carbon dioxide concentration of the blood to below its normal level, thereby raising the blood's pH value (making it more alkaline), initiating constriction of the blood vessels which supply the brain, and preventing the transport of certain electrolytes necessary for the function of the nervous system.[1] Increased lung size/activity - commonly confused terms Dyspnea - shortness of breath Hyperventilation - faster and/or deeper breathing Hyperpnea - deeper breathing Tachypnea - faster breathing Hyperaeration/Hyperinflation - Increased lung volume

Hyperventilation can, but does not necessarily always cause symptoms such as numbness or tingling in the hands, feet and lips, lightheadedness, dizziness, headache, chest pain, slurred speech and sometimes fainting, particularly when accompanied by the Valsalva maneuver. Sometimes hyperventilation is induced for these same effects.

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challenged and removed. (November 2008) The first step that should be taken is to treat the underlying cause of the hyperventilation. The patient should be encouraged to control their breathing. If this cannot be achieved, supplemental oxygen may be given to reduce tissue hypoxia. Oxygen therapy should be continued until a hypoxic episode has been clinically discounted. Have the patient lie in semi-erect position. If patient is conscious, ask him/her to rebreath into paper bags to increase inspired co2 and to overcome alkalization. Note, however, that some physicians do not advise the paper bag rebreathing method (or limiting its use to one or two minutes) due to the possibility of inhaling too much carbon dioxide and decreasing inspired oxygen to a hypoxic patient. If the patient is unconscious, maintain proper airway until he/she regains consciousness. This condition is a self limiting one and eventually the patient will settle. For possible behavior therapy see Treatment in Hyperventilation syndrome. Drug management is sometimes necessary. Parenteral drugs may have to be administered to reduce the patients anxiety and to slow the rate of breathing. Diazepam or midazolam are sometimes used. Intro Some people believe that breathing faster and deeper at high altitudes can compensate for oxygen lack. This is only partially true. Such abnormal breathing, known as hyperventilation, also causes you to flush from your lungs and blood much of the carbon dioxide your system needs to maintain the proper degree of blood acidity. The chemical imbalance in the body then produces dizziness, tingling of the fingers and toes, sensation of body heat, rapid heart rate, blurring of vision, muscle spasm and, finally unconsciousness. The symptoms resemble the effects of hypoxia and the brain becomes equally impaired. A little knowledge is all you need to avoid hyperventilation problems. Since the work itself means excessive ventilation of the lung, the solution lies in restoring respiration to normal. First, however, be sure that hyperventilation, and not hypoxia, is at the root of your symptoms. If oxygen is in use, check the equipment and the flow rate. Then, if everything appears normal, make a strong conscious effort to slow down the rate and decrease the depth of your breathing. Talking, singing, or counting aloud often helps. Normally paced conversation tends to slow down a rapid respiratory rate. If you have no one with you, talk to yourself. Nobody will ever know. Normal breathing is the cure for hyperventilation. The body must be allowed to restore the proper carbon dioxide level, after which recovery is rapid. Better yet, take preventive measures. Know and believe that overbreathing can cause you to become disabled by hyperventilation.

Hyperventilation Treatment Self-Care at Home If you have signs and symptoms of hyperventilation syndrome, you should go to a hospital's emergency department to make sure you're not having other, more worrisome, causes of these symptoms. In other words, home care for hyperventilation syndrome is

only for people who have been told by their doctors that they have hyperventilation syndrome. •

If you have been diagnosed with hyperventilation syndrome, you may briefly try certain breathing and relaxation exercises that your doctor has already taught you. This may work to stop an attack.

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Breathing into a paper bag is no longer recommended.

Medical Treatment Once the doctor is sure that your diagnosis is hyperventilation syndrome and not something more serious, the doctor will arrange follow-up care with a psychiatrist or your primary care doctor. These doctors will teach you about the syndrome and what techniques may help control the attacks. Sometimes, usually after talking with your regular doctor, certain medications may be ordered. If your condition gets worse after visiting the emergency department, you should return for a recheck. What’s Normal and What’s Not When you bring your infant home from the hospital, you suddenly realize you’re on your own. Where are those wonderful maternal-infant nurses? Who do you ask for advice when you have questions about what is normal infant behavior and what warrants a call to the doctor? Among your many questions, no doubt you will have concerns about your baby’s breathing. It goes without saying that you should call your pediatrician immediately if you suspect your infant is having serious trouble breathing. However, there are some normal breathing irregularities that may cause you concern, but should not cause you to panic. What’s Normal? By the time your baby is born, he’s been essentially underwater for months. It takes time for his nasal passages to clear. According to pediatrician Robert Sears, “many newborns will have a stuffy nose for several weeks.” This harmless stuffiness can interfere with feeding and breathing, but is “virtually never a reason to page your doctor after hours.” Dr. Sears recommends a squirt of nasal saline into the nose and suction with a bulb syringe. (You probably left the hospital with the one used on your newborn). Another mild breathing problem is chest congestion caused by saliva or regurgitated milk. Again, Dr. Sears states that this is not a reason to phone your doctor after hours. Try holding your baby upright and letting him sleep upright in your arms or a carseat, and telephone your doctor during business hours to be sure your baby’s symptoms are normal. Newborns may also exhibit rapid breathing or panting. According to the Children’s Hospital of Philadephia, “rapid breathing is more than 60 breaths each minute.” An overheated baby or one who is upset and crying may breathe more rapidly, but once the

baby stops crying or is no longer too hot, the rate should slow. If rapid breathing or panting comes and goes, and your baby has no other sign of illness, you probably have no reason to worry. Babies occasionally will take in too much milk and get choked on it. This, too, is probably harmless. However, persistent coughing or choking warrants an exam by your pediatrician. What’s Serious? Any sign of your baby’s breathing irregularity is, of course, going to elicit your concern, but it is important to note when “normal” becomes “abnormal.” Croup, with its seal-like, barking cough, sounds terrible, but pediatricians say that, unless a child is having trouble breathing, immediate treatment is not necessary. A parent listening to a croupy child, though, may have trouble distinguishing what is a normal symptom and what means respiratory distress. Signs of respiratory distress in infants are similar to those in adults. Flaring nostrils, for instance, indicate the baby is struggling to take in oxygen. A blue color similarly indicates a lack of oxygen. If baby’s chest is caved in, or he is grunting, he may have a serious respiratory problem. If you see any of these symptoms, get immediate medical attention. Play it Safe When it comes to your baby, you will consider any sort of breathing irregularity to be “abnormal,” so you should always trust your instincts and telephone your doctor if you have concerns for your baby’s safety. Keep in mind, though, that baby’s breathing is different from that of an adult, so your concern does not have to turn into panic.

Case Study INTRODUCTION Pneumonia is an inflammation of the lungs caused by an infection. It is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a special concern for older adults and those with chronic illnesses, it can also strike young, healthy people as well. It is a common illness that affects thousands of people each year in the Philippines, thus, it remains an important cause of morbidity and mortality in the country. There are many kinds of pneumonia that range in seriousness from mild to lifethreatening. In infectious pneumonia, bacteria, viruses, fungi or other organisms attack your lungs, leading to inflammation that makes it hard to breathe. Pneumonia can affect

one or both lungs. In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. It’s best to do everything we can to prevent pneumonia, but if one do get sick, recognizing and treating the disease early offers the best chance for a full recovery. A case with a diagnosis of Pneumonia may catch one’s attention, though the disease is just like an ordinary cough and fever, it can lead to death especially when no intervention or care is done. Since the case is a toddler, an appropriate care has to be done to make the patient’s recovery faster. Treating patients with pneumonia is necessary to prevent its spread to others and make them as another victim of this illness. ANATOMY AND PHYSIOLOGY

The lungs constitute the largest organ in the respiratory system. They play an important role in respiration, or the process of providing the body with oxygen and releasing carbon dioxide. The lungs expand and contract up to 20 times per minute taking in and disposing of those gases. Air that is breathed in is filled with oxygen and goes to the trachea, which branches off into one of two bronchi. Each bronchus enters a lung. There are two lungs, one on each side of the breastbone and protected by the ribs. Each lung is made up of lobes, or sections. There are three lobes in the right lung and two lobes in the left one. The lungs are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch out into minute pathways that go through the lung tissue. The pathways are called bronchioles, and they end at microscopic air sacs called alveoli. The alveoli are surrounded by capillaries and provide oxygen for the blood in these vessels. The oxygenated blood is then pumped by the heart throughout the body. The alveoli also take in carbon dioxide, which is then exhaled from the body. Inhaling is due to contractions of the diaphragm and of muscles between the ribs. Exhaling results from relaxation of those muscles. Each lung is surrounded by a twolayered membrane, or the pleura, that under normal circumstances has a very, very small amount of fluid between the layers. The fluid allows the membranes to easily slide over each other during breathing. PATHOPHYSIOLOGY

Pneumonia is a serious infection or inflammation of your lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has trouble reaching your blood. If there is too little oxygen in your blood, your body cells can’t work properly. Because of this and spreading infection through the body pneumonia can cause death. Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs. Bacteria are the most common cause of pneumonia. Of these, Streptococcus pneumoniae is the most common. Other pathogens include anaerobic bacteria, Staphylococcus aureus, Haemophilus influenzae, Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella (Branhamella) catarrhalis, Legionella pneumophila, Klebsiella pneumoniae, and other gram-negative bacilli. Major pulmonary pathogens in infants and children are viruses: respiratory syncytial virus, parainfluenza virus, and influenza A and B viruses. Among other agents are higher bacteria including Nocardia and Actinomyces sp; mycobacteria, including Mycobacterium tuberculosis and atypical strains; fungi, including Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus fumigatus, and Pneumocystis carinii; and rickettsiae, primarily Coxiella burnetii (Q fever). The usual mechanisms of spread are inhaling droplets small enough to reach the alveoli and aspirating secretions from the upper airways. Other means include hematogenous or lymphatic dissemination and direct spread from contiguous infections. Predisposing factors include upper respiratory viral infections, alcoholism, institutionalization, cigarette smoking, heart failure, chronic obstructive airway disease, age extremes, debility, immunocompromise (as in diabetes mellitus and chronic renal failure), compromised consciousness, dysphagia, and exposure to transmissible agents. Typical symptoms include cough, fever, and sputum production, usually developing over days and sometimes accompanied by pleurisy. Physical examination may detect

tachypnea and signs of consolidation, such as crackles with bronchial breath sounds. This syndrome is commonly caused by bacteria, such as S. pneumoniae and H. influenzae. NURSING PROFILE a. Patient’s Profile Name: R.C.S.B. Age: 1 yr,1 mo. Weight:10 kgs Religion: Roman Catholic Mother: C.B. Address: Valenzuela City b. Chief Complaint: Fever Date of Admission: 1st admission Hospital Number: 060000086199 c. History of Present Illness 2 days PTA – (+) cough (+) nasal congestion, watery to greenish (+) nasal discharge Tx: Disudrin OD Loviscol OD Few hrs PTA - (+) fever, Tmax= 39.3 C (+) difficulty of breathing (+) vomiting, 1 episode Tx: Paracetamol Sought consultation at ER: Rx=BPN, Salbutamol neb.

IE: T = 38.3C, CR= 122’s, RR= 30’s (+) TPC SCE, (-) retractions, clear BS, (-) cyanosis, (-) edema d. Past Illness (-) asthma (-) allergies e. Family History PMHx: (+) asthma (mother) f. Activities of Daily Living •

Sleeping mostly at night and during afternoon

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Usually wakes up early in the morning (5AM) to be milkfed.

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Eats a lot (hotdogs, chicken, crackers, any food given to her)

• Active, responsive • BM (1-2 times a day) • Urinates in her diaper (more than 4 times a day) • Likes to play with those around her g. Review of Systems Neuromuscular: weakness of muscles Integumentary: (-) cyanosis Respiratory: tavhypnea; (+) DOB; (+) coarse crackles, (+) wheezes, Digestive: food aversion, vomits ingested milk

DRUG STUDY View NCP NURSING ACTIONS INDEPENDENT • • •

positioning of the patient with head on mid line, with slight flexion rationale: to provide patent, unobstructed airway , maximum lung excursion auscultating patient’s chest rationale: to monitor for the presence of abnormal breath sounds provide chest and back clapping with vibration rationale: chest physiotheraphy facilitates the loosening of secretions

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considering that the patient is an infant, and has developed a strong stranger anxiety as manifested by “white coat syndrome” , it is a nursing action to play with the patient. rationale: to establish rapport, and gain the patients trust

DEPENDENT •

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administer due medications as ordered by the physician, bronchodilators, anti pyretics and anti biotics rationale: bronchodilators decrease airway resistance, secondary to bronchoconstriction, anti pyretics alleviate fever, antibiotics fight infection placing patient on TPN prn rationale: to compensate for fluid and nutritional losses during vomiting

COLLABORATIVE •

assist respiratory therapist in performing nebulization of the patient rationale: nebulization is a favourable route of administering bronchodilators and aid in expectorating secretions, hence patient’s breathing

PHYSICIAN’S ORDER SHEET 11/19/06 Admit patient to ROC under the service of Dr. Vitan secure consent for admission and management, TPR every shift then record. May have diet for age with strict aspiration precaution, IVF D5 0.3NaCl 500cc to run at 62-63mgtts/min.May give paracetamol 125mg 1supp/rectum if oral paracetamol is not tolerated. 11/20/06 For urinalysis, IVF to follow D5 0.3 NaCl 500 at SR (62-63mgtt/m Use zinacef brand of cefuroxine 750mg- given ½ vial 375mg every 8hours, nebulize (Ventolin 1 nebule) every 6 hours, paracetamol drugs prn every 4hours (Temp 37.8). 11/21/06 Continue cefuroxine and nebulizer every 6 hours. May not reinsert IVF, revise Cefuroxine IV to Cefuroxine 500mg via deep Intramuscular BID,continue management. 11/22/06 Continue management and refer.

DISCHARGE PLANNING •

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Take the entire course of any prescribed medications. After a patient’s temperature returns to normal, medication must be continued according to the doctor’s instructions, otherwise the pneumonia may recur. Relapses can be far more serious than the first attack. Get plenty of rest. Adequate rest is important to maintain progress toward full recovery and to avoid relapse. Drink lots of fluids, especially water. Liquids will keep patient from becoming dehydrated and help loosen mucus in the lungs. Keep all of follow-up appointments. Even though the patient feels better, his lungs may still be infected. It’s important to have the doctor monitor his progress. Encourage the guardians to wash patient’s hands. The hands come in daily contact with germs that can cause pneumonia. These germs enter one’s body when he touch his eyes or rub his nose. Washing hands thoroughly and often can help reduce the risk. Tell guardians to avoid exposing the patient to an environment with too much pollution (e.g. smoke). Smoking damages one’s lungs’ natural defenses against respiratory infections. Give supportive treatment. Proper diet and oxygen to increase oxygen in the blood when needed. Protect others from infection. Try to stay away from anyone with a compromised immune system. When that isn’t possible, a person can help protect others by wearing a face mask and always coughing into a tissue.