A nurse is caring for a client who is unconscious and has a breathing pattern characterized by alternating periods of hyperventilation and apnea. The nurse should document that the client has which of the following respiratory alterations?
A.
Stridor
B.
Kussmaul respirations
C.
Apneustic respirations
D.
Cheyne-Stokes respirations
The Correct answer and Explanation is:
The correct answer is D. Cheyne-Stokes respirations.
Cheyne-Stokes respirations are a distinct and abnormal breathing pattern that is commonly observed in patients with severe neurological conditions or other serious medical conditions, such as heart failure, stroke, or traumatic brain injury. This pattern is characterized by alternating periods of deep, rapid breathing (hyperventilation) followed by a gradual decrease in breathing that eventually leads to temporary apnea (a period where breathing stops entirely). After the apnea phase, the cycle repeats with progressively deeper and faster breaths.
Explanation:
- Cheyne-Stokes Respiration Pattern: Cheyne-Stokes breathing occurs when the brain’s respiratory centers fail to maintain normal, steady breathing rhythms. It’s often associated with damage or dysfunction in the brainstem, which regulates involuntary breathing patterns. The typical pattern involves a crescendo-decrescendo pattern of breathing, meaning the breaths gradually increase in depth and rate, then gradually decrease, leading to a period of apnea (no breathing). This cycle repeats itself regularly. The periods of apnea can last for several seconds to over a minute in some cases.
- Clinical Causes: Cheyne-Stokes respirations are often observed in critically ill patients, especially those with:
- Congestive heart failure (CHF)
- Stroke
- Traumatic brain injuries
- Increased intracranial pressure
- Terminal stages of illness (such as end-of-life patients)
- Differentiating from Other Respiratory Patterns:
- Stridor (A): Stridor is a high-pitched sound caused by an obstruction in the airway, often heard during inspiration. It is unrelated to the cyclical pattern of breathing seen in Cheyne-Stokes respirations.
- Kussmaul respirations (B): Kussmaul respirations are deep, labored breathing patterns typically seen in patients with metabolic acidosis, such as diabetic ketoacidosis (DKA). This pattern involves consistently rapid and deep breaths without periods of apnea.
- Apneustic respirations (C): Apneustic breathing is characterized by prolonged inspiratory phases followed by brief, insufficient expiratory phases. It is most commonly associated with damage to the pons, a part of the brainstem, and differs from Cheyne-Stokes as it does not involve a cycling pattern with apnea.
In summary, Cheyne-Stokes respirations involve a pattern of crescendo-decrescendo breathing with intermittent apnea and are typically associated with severe medical conditions affecting the brain or heart.