Assignment No.

4
NUR-221 (Pediatric Nursing)

BAUTISTA, ANABELLE G.
Name of Student

BSN-2C
Level / Section

04/12/2023
Date of Submission

1. Different abnormal breath sound, and where it can be seen?

DIFFERENT ABNORMAL DEFINITION/S
BREATH SOUNDS
Crackles  Also called rales, crackles tend to sound
like discontinuous clicking, rattling, or
bubbling when the person inhales.
Crackling breath sounds may sound wet or
dry, and doctors might describe them as
either fine or coarse.
Wheezing  Wheezing noises are high-pitched and
continuous and may sound like a breathy
whistle. Sometimes, wheezing can be loud
enough to hear without a stethoscope. A
squawk is a short version of a wheeze that
occurs during inhalation.
Rhonchi  Rhonchi are continuous, lower-pitched,
rough sounds that many people compare to
snoring.
Pleural friction rub  Auscultated during inspiration and
expiration. Low pitched, harsh/grating
sound.
Stridor  Auscultated during inspiration. High
pitched whistling or gasping sound with
harsh sound quality.
WHAT DISEASES IT CAN BE
SEEN?
 Crackles can be heard and seen
in patients with pneumonia,
atelectasis, pulmonary fibrosis,
acute bronchitis,
bronchiectasis, acute
respiratory distress syndrome
(ARDS), interstitial lung
disease or post thoracotomy or
metastasis ablation. Pulmonary
edema secondary to left-sided
congestive heart failure can
also cause crackles.
 Inflammation and narrowing of
the airway in any location,
from your throat out into your
lungs, can result in wheezing.
The most common causes of
recurrent wheezing can be seen
in asthma and chronic
obstructive pulmonary disease
(COPD) patients, which both
cause narrowing and spasms
(bronchospasms) in the small
airways of your lungs.
 These breath sounds are
associated and can be seen with
conditions such as chronic
obstructive pulmonary disease
(COPD), bronchiectasis,
pneumonia, chronic bronchitis,
or cystic fibrosis.
 Common and can be seen
in pneumonia, pulmonary
embolism, and pleurisy.
 May be seen in children with
condition such as croup or
epiglottitis, or anyone with
airway obstruction, etc.
  There are two types of abnormal breath sounds
DISCONTINUOUS SOUND
 Coarse crackles: low-pitch, wet bubbling sounds that
can occur mainly during inspiration but can extend
into expiration.
 Fine crackles: high-pitch, crackling noises mainly on
inspiration and can't be cleared when coughing
 Pleural friction rub: a harsh, grating sound heard
during inspiration and expiration.
CONTINUOUS SOUND
 Low-pitched, monophonic wheeze: Heard mainly
in expiration and have a low-pitched whistling tune
or whine with ONE sound quality.
 High-pitched, polyphonic wheeze: are heard
mainly in expiration and have a high-pitched
musical instrument tune with MORE THAN ONE
sound quality.
 Stridor: heard during inspiration and is a high-
pitched whistling or gasping sound with a harsh
sound quality.

2. Type of Breathing Pattern, and where it can be seen?

 Tachypnea is an abnormal breathing pattern characterized by rapid breathing. It is defined as a respiratory
rate that is greater than 20 breaths per minute. Tachypnea does not have a single specific cause, but it is often
seen in patients who are struggling to breathe, such as those with heart failure, COPD, or pneumonia.
Some other common causes of tachypnea include:
o Sepsis
o Hypoxemia
o Diabetic ketoacidosis
o Carbon monoxide poisoning
o Pulmonary embolism
o Asthma
o Pleural effusion
Tachypnea is treated based on the underlying cause. For example, if hypoxemia is present, the patient may benefit
from receiving supplemental oxygen.

 Bradypnea is the opposite of tachypnea and is defined as a respiratory rate of fewer than 12 breaths per minute.
As with tachypnea, bradypnea does not have a single specific cause, but it is often seen in patients who are
sedated or have a central nervous system disorder.
Some other common causes of bradypnea include:
o Drug overdose
o Hypothyroidism
o Brain injury
Bradypnea is treated based on the underlying cause. For example, if the patient is breathing slower than normal
due to a drug overdose, naloxone (Narcan®) may be indicated to reverse the effects of the drug.

 Apnea is a term that refers to the absence of spontaneous breathing. Therefore, the breathing pattern for apnea
appears as a flat line because the patient is not performing inhalation or exhalation.
This means that there is no effort or movement of the inspiratory muscles, and the volume of the lungs does not
change.
Apnea can cause severe complications throughout the body because, without breathing, the tissues and organs are
unable to obtain the oxygen that is required for survival.
Some of the common causes of apnea include:
o Cardiac arrest
o Severe brain trauma
o Neuromuscular disorders
o Central nervous system disorders
o Narcotic overdose
Apnea can also occur voluntarily by breath-holding, and it can be mechanically induced by choking or
strangulation.
The treatment for apnea often involves intubation and mechanical ventilation.
 Cheyne-Stokes breathing an abnormal respiratory pattern that is characterized by periods of shallow and deep
breathing, separated by brief periods of apnea.
This breathing pattern is often seen in patients who are in a comatose state and is caused by a lack of oxygen
to the brain.
Some other causes include:
o Increased intracranial pressure
o Traumatic brain injury
o Stroke
o Heart failure
o Hyponatremia
o Brain tumor
The treatment for Cheyne-Stokes breathing involves reversing the underlying cause. In some cases, noninvasive
ventilation (NIV) is indicated (e.g., CPAP).

 Kussmaul breathing is an abnormal respiratory pattern that is characterized by deep and rapid breathing. This is
often seen in patients with metabolic acidosis.
The treatment for Kussmaul breathing involves treating the underlying cause of the patient’s acid-base imbalance.

 Biot’s breathing is a chaotic respiratory pattern that is characterized by irregular periods of deep, shallow, fast,
and slow breathing. This pattern eventually turns into agonal breathing, which then leads to apnea.
Biot’s breathing is often seen in patients with an acute neurological disease that results in damage to the
medulla or pons in the brain.
This can occur due to a stroke, trauma, or severe intracranial hypertension.

 Hyperpnea an abnormal breathing pattern characterized by an increased depth of breathing with or without an
increase in rate. Therefore, the blood gas values of a patient with hyperpnea are normal.
The most common causes of hyperpnea include:
o Exercise
o High altitude
o Anemia
o Asthma
o Acute lung injury
o COPD
Treatment for hyperpnea is usually not necessary; however, in some cases, such as with high altitude sickness,
supplemental oxygen may be indicated.

 Hypopnea an abnormal respiratory pattern characterized by a decrease in depth of breathing with or without a
decrease in rate. This can result in hypoxemia and an increase in PaCO2.
This breathing pattern is often associated with obstructive sleep apnea and is caused by a partial obstruction of the
upper airway.
Hypopnea is often treated with continuous positive airway pressure (CPAP), which is a device that uses positive
pressure to help prevent the obstruction.

 Orthopnea an abnormal respiratory pattern characterized by shortness of breath while lying flat. This is often
seen in patients with congestive heart failure (CHF) and is caused by the accumulation of fluid in the lungs.
The treatment for orthopnea is aimed at treating the underlying cause. This may involve diuretics, supplemental
oxygen, and/or changes in position.
Patients may experience relief by sitting up or propping themselves up on pillows.

 Apneustic breathing is an abnormal respiratory pattern characterized by a deep and gasping inspiration with a
pause at full inspiration, followed by a brief, partial expiration.
This pattern is often seen in patients who’ve experienced severe brain damage to the upper medulla or pons
caused by a stroke or trauma. It is also seen in patients with a hypoglycemic coma or those with profound
hypoxemia.
Apneustic breathing is caused by basilar artery occlusion and usually has a poor prognosis.

 Agonal breathing an abnormal respiratory pattern characterized by intermittent gasping and labored breathing.
It is caused by a preterminal brainstem reflex and eventually progresses to complete apnea. This breathing pattern
often occurs during the final breaths before death.
 Some of the most common causes of agonal breathing include:
o Cerebral ischemia
o Extreme hypoxemia
o Anoxia
Agonal breathing may also occur during cardiac arrest or cardiogenic shock, where labored respirations may
persist after the cessation of the patient’s heartbeat.
This type of respiration occurs in approximately 40% of cardiac arrest cases that take place outside of the hospital
setting. Treatment is focused on resuscitation and support.

 Ataxic breathing an abnormal respiratory pattern characterized by irregular respirations with abnormal pauses
and periods of apnea.
This means that the patient will have a variable respiratory rate, breathing cycle, and inconsistent tidal volumes
with both small and large breaths. The periods of apnea occur abruptly and sporadically throughout the breathing
cycle.
This breathing pattern often occurs when there is damage to the medullary respiratory center in the brain,
which is caused by:
o Head trauma
o Traumatic brain injury
o Brain tumor
o Increased intracranial pressure
This pattern is generally a sign that a patient is in critical condition with a poor prognosis. Therefore, treatment is
focused on supporting the patient and managing any underlying causes.

 Paradoxical breathing an abnormal respiratory pattern characterized by an inward movement of the chest wall
during inhalation followed by an outward movement during exhalation.
This breathing pattern is associated with a decreased pressure gradient that fails to stimulate normal breathing and
can result in respiratory failure.
It can result from diaphragmatic fatigue or paralysis; however, it’s most commonly associated with trauma or an
injury to the chest wall.
For example, a flail chest is a traumatic injury where a portion of the rib cage is fractured and becomes detached.
When this occurs, the flail section moves in the opposite direction, which is known as a paradoxical movement.
This abnormal pattern may also occur in infants and children as a sign of respiratory distress.

Other Irregular Breathing Patterns

 Shallow breathing is a type of abnormal respiration in which the patient takes shallow, quick breaths.
This type of breathing can result in hypoventilation and lead to hypercapnia, which is an accumulation of
carbon dioxide in the blood.
Some of the most common causes of shallow breathing include:
o Anxiety disorders
o Panic attacks
o Asthma
o Pneumonia
o Shock
o Pulmonary edema
Treatment for shallow breathing depends on the underlying cause. For example, if the patient has asthma, the
treatment may involve inhaled bronchodilators to help open up the airways.

 Dyspnea is a breathing pattern characterized by shortness of breath and difficulty breathing as perceived by the
patient. It is a symptom of many different conditions and can range from mild discomfort to a life-threatening
emergency.
The most common causes of dyspnea include:
o Asthma
o COPD
o Emphysema
o Pneumonia
o Pulmonary embolism
o Bronchitis
o Congestive heart failure
 o Pulmonary edema
o Pneumothorax
o Carbon monoxide poisoning
o Pleural effusion
Treatment for dyspnea depends on the underlying cause. If it is accompanied by hypoxemia, supplemental oxygen
therapy would be indicated.
Intubation and mechanical ventilation may be necessary if it progresses to respiratory failure.

 Hyperventilation is a type of abnormal respiration characterized by an increase in the rate and depth of
breathing. This results in a decrease in the levels of carbon dioxide in the blood, which results in respiratory
alkalosis.
Some of the most common causes of hyperventilation include:
o Anxiety disorders
o Panic attacks
o Severe pain
o Lung infections
o COPD
o Asthma
o Myocardial infarction
o Diabetic ketoacidosis
o Head injuries
Hyperventilation syndrome
The treatment for hyperventilation depends on the underlying cause. In some cases, such as during a panic attack,
simply slowing down the breathing can help to ease the symptoms.
In other cases, such as with COPD or asthma, the use of oxygen or bronchodilators may be necessary.

 Hypoventilation is a type of respiratory depression characterized by a decrease in the rate and depth of breathing.
This results in an increase in the levels of carbon dioxide in the blood, which results in respiratory acidosis.
Some of the most common causes of hypoventilation include:
o Stroke
o Brainstem injury
o Drug overdose
o Hypocapnia
o Obesity hypoventilation syndrome
o Neuromuscular diseases
o Chest wall deformities
o Obstructive sleep apnea
The treatment for hypoventilation depends on the underlying cause. In some cases, supplemental oxygen may be
all that is needed. In other cases, mechanical ventilation may be required.
Sighing
Sighing is a breathing pattern characterized by an involuntary inspiration that is deeper and longer than a normal
tidal volume breath.
Sighing plays an important role in preventing atelectasis because the inhalation of a larger breath helps open the
alveoli, preventing a collapse.
While this is a normal part of respiration, excessive sighing can be a sign of an underlying respiratory condition.
It can also occur as a response to an emotional trigger, such as anxiety.

 Air trapping is an abnormal respiratory pattern in which air gets trapped in the lungs, and it becomes difficult to
exhale.
This can result in hyperinflation of the lungs, which often leads to respiratory distress. Air trapping is often seen
in obstructive lung diseases, such as:
o Asthma
o COPD
o Chronic bronchitis
o Emphysema
o Bronchiolitis obliterans syndrome
Air trapping is not considered to be a disease but rather a symptom of an underlying condition. Therefore, the
treatment for air trapping depends on the underlying cause.
 Obstructive breathing pattern is characterized by prolonged expiration due to narrowed airways and increased
airway resistance.
The most common causes of an obstructive breathing pattern include:
o Asthma
o COPD
o Chronic bronchitis
o Emphysema
o Similar to air trapping, the treatment for obstructive breathing depends on the underlying cause. In most
cases, the use of bronchodilators can help to ease the symptoms.
In severe cases, intubation and mechanical ventilation may be necessary.

 Asthmatic breathing is a respiratory pattern caused by narrowing of the airways due to inflammation. This can
lead to wheezing, chest tightness, and shortness of breath.
The most common causes of asthma respirations include the following triggers:
o Allergens
o Exercise
o Cold air
o Respiratory infections
o Certain medications
When a trigger occurs, the airways become inflamed and narrowed, making it difficult to breathe. The treatment for
asthma respirations depends on the severity of the symptoms.
In mild cases, the use of bronchodilators can help to ease the symptoms. In severe cases, ventilatory support may be
indicated.

 Central neurogenic hyperventilation is an abnormal breathing pattern characterized by deep, rapid breaths at a
respiratory rate of at least 25 breaths/min.
This results in a decrease in the levels of carbon dioxide in arterial blood, which results in respiratory alkalosis.
The most common causes of central neurogenic hyperventilation include:
o Brain stem lesions
o Severe brain hypoxia
o Head trauma
o Lack of cerebral perfusion
o Ischemia
o Narcotic suppression
There is no set treatment for central neurogenic hyperventilation. However, the focus should be on reversing the
underlying cause.
Patients with this breathing pattern may require mechanical ventilatory support in order to treat or prevent respiratory
failure.

 Paroxysmal nocturnal dyspnea (PND) is an abnormal breathing pattern characterized by severe episodes of
shortness of breath that occur while the patient is sleeping.
This breathing pattern often occurs as a symptom of congestive heart failure (CHF), and it can also be caused by
other conditions that lead to fluid retention.
Similar to orthopnea, patients with PND can find relief by sitting upright, as symptoms are often worse
when lying down.
The treatment for PND depends on the underlying cause. In most cases, diuretics can help to reduce the amount of
fluid retention and ease the symptoms.
Beta blockers and ACE inhibitors may also be indicated in patients who are experiencing PND due to CHF.

 Postictal breathing is an abnormal respiratory pattern that can occur after a seizure. This breathing pattern is
often described as being stertorous, meaning that respirations are noisy and labored.
The postictal breathing pattern may sound similar to the snoring or gurgling that occurs during deep sleep.

 Pursed-lip breathing is a breathing pattern that is often performed to ease shortness of breath. This technique
involves exhaling through pursed lips, which creates resistance and helps decrease the rate breathing.
Pursed-lip breathing can help to improve ventilation and gas exchange, as well as reduce the work of breathing.
It’s a common breathing pattern in patients with COPD, as it can ease symptoms of dyspnea by prolonging the
expiratory portion.
 Diaphragmatic breathing, also known as “belly breathing” or “abdominal breathing,” is a breathing pattern that
is helpful in taking deep breaths.
This technique involves contracting the diaphragm, expanding the stomach, and performing deep inhalations.
This results in a decreased respiratory rate, which increases the amount of blood that is available for perfusion
and gas exchange.

 Gasping is a type of labored breathing with sudden, forced inspirations that often indicates shortness of breath or
dyspnea.
It’s an abnormal breathing pattern that can be a symptom of various underlying medical conditions, such as
asthma, chronic obstructive pulmonary disease (COPD), heart failure, and panic attacks.
Gasping is often associated with apneustic and agonal breathing, which are abnormal patterns of respiration that
occur due to problems within the brain.
However, it can also be a normal physiological response to intense physical activity or emotional stress.
Regardless of the cause, gasping can be a distressing experience that can interfere with daily activities and quality
of life.

 Platypnea is an abnormal breathing pattern in which the patient experiences shortness of breath when sitting or
standing upright.
Therefore, symptoms can be eased by having the patient lie down, as they tend to breathe better in this position.
The causes of platypnea include:
o Intracardiac shunts
o Lung parenchymal diseases
o Hepato-pulmonary syndrome
o Parkinson’s disease
Platypnea is not a disease but rather a symptom of an underlying condition. Treatment should be focused on
reversing the underlying cause.
However, patients experiencing this breathing pattern usually benefit from supplemental oxygen.

 Mouth breathing is a common respiratory pattern, especially in children. This technique is often used when the
nose is obstructed, making it difficult to breathe through the nose.
Mouth breathing can also occur as a result of problems with the autonomic nervous system, such as cerebral palsy.
In some cases, mouth breathing can lead to sleep apnea.
While mouth breathing is not necessarily an abnormal breathing pattern, it can be problematic if it progresses to
other respiratory problems.
Treatment for mouth breathing usually involves addressing the underlying cause, such as nasal obstruction.
Newborn Breathing Patterns
The first few days after birth, it is common for newborns to have irregular breathing patterns. This is due to the
fact that they are adjusting to breathing outside of the womb.
Most newborns will establish a regular breathing pattern within a few days. However, some may experience apnea
spells, which are periods where they stop breathing for 10 seconds or more.
It is also important to remember that newborns breathe faster than adults. They typically take 40-60 breaths per
minute, while adults average about 12-20 breaths per minute.

 Types of Abnormal Newborn Respiratory Patterns

If a newborn is in respiratory distress, they may experience one or more of the following irregular breathing patterns:
 Tachypnea – breathing rate of more than 60 breaths per minute
 Bradypnea – breathing rate of fewer than 40 breaths per minute
 Apnea – period without breathing of 10 seconds or longer
 Retractions – infant’s chest pulls in with each breath
 Grunting – sound an infant makes with each breath
 Nasal flaring – widening of the nostrils with each breath
The treatment for irregular breathing patterns in newborns will depend on the underlying cause. If the cause is
unknown, the infant may be observed for a period of time to see if the breathing pattern improves on its own.
In some cases, supplemental oxygen may be necessary. If the infant is having difficulty maintaining adequate oxygen
levels, they may need to be intubated and placed on a mechanical ventilator.