Fundamentals of Nursing Q 563
In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory complications as:
A. Respiratory acidosis, atelectasis, and hypostatic pneumonia
B. Apneustic breathing, atypical pneumonia and respiratory alkalosis
C. Cheyne-Stokes respirations and spontaneous pneumothorax
D. Kussmaul’s respirations and hypoventilation
Correct Answer: A. Respiratory acidosis, atelectasis, and hypostatic pneumonia
Because of restricted respiratory movement, a recumbent, immobilize patient is at particular risk for respiratory acidosis from poor gas exchange; atelectasis from reduced surfactant and accumulated mucus in the bronchioles, and hypostatic pneumonia from bacterial growth caused by stasis of mucus secretions.
Option B: Apneustic respiration (a.k.a. apneusis) is an abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release. Pneumonia is acquired when a sufficient volume of a pathogenic organism bypasses the body’s cough and laryngeal reflexes and makes its way into the parenchyma. In almost every scenario, respiratory alkalosis is induced by a process involving hyperventilation. These include central causes, hypoxemic causes, pulmonary causes, and iatrogenic causes. Central sources are a head injury, stroke, hyperthyroidism, anxiety-hyperventilation, pain, fear, stress, drugs, medications such as salicylates, and various toxins.
Option C: Cheyne-Stokes respiration is a specific form of periodic breathing (waxing and waning amplitude of flow or tidal volume) characterized by a crescendo-decrescendo pattern of respiration between central apneas or central hypopneas. Unlike obstructive sleep apnea (OSA), which can be the cause of heart failure, Cheyne-Stokes respiration is believed to be a result of heart failure. Spontaneous pneumothorax refers to the abnormal collection of gas in the pleural space between the lungs and the chest wall. Spontaneous pneumothorax occurs without an obvious etiology such as trauma or iatrogenic causes.
Option D: Kussmaul respirations were originally observed and described by Dr. Adolf Kussmaul in 1874. He made his observation in diabetic patients who were comatose and in the late stages of diabetic ketoacidosis. As classically described, Kussmaul respirations are a deep, sighing respiratory pattern. Dr. Kussmaul actually described it as “air hunger.” Hypoventilation is breathing that is too shallow or too slow to meet the needs of the body. If a person hypoventilates, the body’s carbon dioxide level rises. This causes a buildup of acid and too little oxygen in the blood. A person with hypoventilation might feel sleepy.