Respiratory Function
Certain adaptive responses are compensatory during immobility: basal metabolism decreases, cells require less oxygen for synthesis of proteins, and less carbon dioxide is produced as a by-product of cell metabolism. In addition, the rate of respiration decreases, there is less movement of secretions, and oxygen-carbon dioxide balance is altered.
Added to the compensatory decrease in respiration during periods of bedrest are a number of factors that are significant for nursing care. Chest expansion may be adversely affected. The bed may splint the chest by its pressure, especially if the patient maintains one position too long. Some postures may compress the thorax. Abdominal distention or a tight binder or dressing may prevent the normal descent of the diaphragm during inspiration. Drugs that depress the central nervous system will affect the respiratory center in the medulla, motor areas of the cerebral cortex, and the cells of the spinal cord.
Pooling of secretions follows respiratory embarrassment. Inflamation of the trachea and the bronchial tree leads to a further decrease in the ability to use normal cleansing mechanisms, such as coughing and deep breathing. Stagnant secretions provide a receptive medium for the growth of microorganisms, thereby increasing the chances of threatening sequelae.
Lack of respiratory movement and the pooling of secretions result in oxygen-carbon dioxide imbalance. The first adaptational response resulting from increased accumulation of carbon dioxide in the blood is temporary stimulation of the respiratory centers. Continuous stimulation causes the aortic and carotid bodies to react against the stimulus, and overadaptation to excessive stimulation causes the respiratory centers to become depressed. Respiratory acidosis follows and may lead to cardiac failure unless reversed.
Nursing measures for prevention of functional respiratory disabilities are those that preserve the patient`s ability to breathe. This begins with astute observation of his respirations-their rate, depth, and quality. The way in which he uses his muscles to breathe is important. He may be using neck muscles to supply force. His position may give a clue to difficulty in breathing; or he may speak in partial, clipped sentences, indicating an inability to inspire sufficient air. Listening to his breathing and then using a stethescope to ausculate breath sounds will provide a basis for accurate reporting of signs and symptoms.
Turning, coughing, and deep breathing are among the simplest and yet most effective methods for preserving the immobilized patient`s respiratory function. Teaching the patient how to do this regularly and encouraging him toward self-care is his disability permits will provide support for cardiopulmonary functions, which in turn promotes healthy adaptive responses in other systems.
References :
Olson, Edith V., “The Hazards of Immobility”, American Journal of Nursing, 67: No.4, 1971.
Murray, RB and Zentner JP., Nursing Concepts for Health Promotion, Second Edtion, Prentice-Hall, Inc, Englewood Cliffs, N.J, 1979.
