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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.

Treatment
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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.

• 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 life-
threatening. 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 two-
layered 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

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

• 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
• 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

• 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

• 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.