Respiratory rate 28 per minute as they call it. Breathing rate

Respiratory rate (RR) and vital capacity. Breathing at rest should be rhythmic and deep. The normal respiratory rate in an adult is 14-18 times per minute. Under load it increases 2-2.5 times. An important indicator of respiratory function is the vital capacity of the lungs (VC) - the volume of air obtained during the maximum exhalation made after the maximum inhalation. Normally in women it is 2.5-4 l, in men it is 3.5-5 l.

Blood pressure (BP). Systolic pressure (max) is the pressure during systole (contraction) of the heart, when it reaches its greatest value throughout the cardiac cycle. Diastolic pressure (min) - determined at the end of diastole (relaxation) of the heart, when it continues cardiac cycle reaches a minimum value.

Formula ideal pressure for each age:

Max. BP = 102+ (0.6 x number of years) min. BP = 63+ (0.5 x number of years)

The World Health Organization suggests that blood pressure for systolic (max.) be considered normal numbers - 100 - 140 mm Hg; for diastolic 80-90 mm Hg.

58. Functional tests and tests

The level of the functional state of the body can be determined using functional tests and tests.

Orthostatic test. The pulse is calculated in a lying position after 5-10 minutes of rest, then you need to stand up and measure the pulse in a standing position. Based on the difference in heart rate while lying down and standing, one can judge functional state cardiovascular and nervous systems. A difference of up to 12 beats/min is a good state of physical fitness, from 13 to 18 beats/min is satisfactory, 19-25 beats/min is unsatisfactory, i.e. lack of physical fitness, more than 25 beats/min - indicates overwork or illness.

Stange's test (holding your breath while inhaling). After 5 minutes of rest while sitting, take 2-3 deep breaths in and out, and then, after doing full breath hold their breath, the time is noted from the moment the breath is held until it stops.

The average indicator is the ability to hold your breath while inhaling for untrained people for 40-55 seconds, for trained people - for 60-90 seconds or more. With increasing training, the time you hold your breath increases; in case of illness or fatigue, this time decreases to 30-35 seconds.

This test characterizes the body's resistance to oxygen deficiency.

One-time test.

Before performing a single-stage test, rest while standing, without moving for 3 minutes. Then the heart rate is measured for one minute. Next, perform 20 deep squats in 30 seconds from the starting position with feet shoulder-width apart, arms along the body. When squatting, the arms are brought forward, and when straightening, they are returned to their original position. After performing squats, heart rate is calculated for one minute.

During the assessment, the magnitude of the increase in heart rate after exercise is determined as a percentage. A value of 20% means an excellent response of the cardiovascular system to stress, from 21 to 40% - good,

from 41 to 65% - satisfactory,

from 66 to 75% - bad,

from 76 and more - very bad.

Genchi test (holding your breath while exhaling). It is performed in the same way as the Stange test, only the breath is held after a complete exhalation. Here, the average indicator is the ability to hold your breath while exhaling for untrained people for 25-30 seconds, for trained people for 40-60 seconds. and more.

Ruffier's test. To assess the activity of the cardiovascular system, you can use the Ruffier test. 1 After a 5-minute calm state in a sitting position, count your pulse for 10 seconds (P1), then perform 30 squats within 45 seconds. Immediately after squats, count your heart rate for the first 10 seconds (P2) and a minute (P3) after the load. The results are assessed by an index, which is determined by the formula:

6 x (P1+ P2+ P3) - 200

Ruffier index =

Cardiac performance assessment:

Ruffier index

0 - athletic heart

0, 1 - 5 - "excellent" (very good heart)

5, 1 - 10 - “good” (good heart)

10, 1 - 15 - “satisfactory” (heart failure)

15 1 - 20 - “poor” (severe heart failure)

25 - 50% - good,

from 50 - 75% bad.

Test to check and evaluate general endurance.

It is carried out using control exercises of 2 types: overcoming the average, long distance or covering the greatest possible distance in a certain time. Examples of these exercises are:

1) running and cross-country at 1000, 2000, 2500, 3000, 5000m;

swimming 200, 400, 500 m,

2) run 12 min.

The most substantiated assessments of general endurance are based on the K. Cooper test. This is a 12-minute run covering a maximum distance (km).

One of the actions carried out during examination by a pediatrician is counting respiratory movements. This seemingly simple indicator carries important information about the state of health in general and about the functioning of the respiratory organs and cardiovascular system in particular.

How to correctly calculate the respiratory rate (RR) per minute? This is not particularly difficult. But certain difficulties arise with the interpretation of the data. This is more true for young parents, because, having received a result from a child that is several times higher than their own, they panic. Therefore, in this article we propose to figure out what the normal respiratory rate is for children. The table will help us with this.

Features of the child's respiratory system

The first thing you've been waiting for so long future mom- the baby's first cry. It is with this sound that his first breath occurs. By the time of birth, the organs that ensure the child’s breathing are not yet fully developed, and only with the growth of the body itself do they mature (both functionally and morphologically).

The nasal passages (which are the upper respiratory tract) in newborns have their own characteristics:
. They are quite narrow.
. Relatively short.
. Their inner surface is delicate, with a huge number of vessels (blood, lymphatic).

Therefore, even with minor symptoms, the child’s nasal mucosa quickly swells, the already small lumen decreases, and as a result, breathing becomes difficult and shortness of breath develops: small children cannot yet breathe through their mouths. How younger child, the more dangerous the consequences can be, and the faster it is necessary to eliminate the pathological condition.

Lung tissue in young children also has its own characteristics. They, unlike adults, have poorly developed lung tissue, and the lungs themselves have a small volume at a huge number blood vessels.

Rules for counting breathing rate

Measuring respiratory rate does not require any special skills or equipment. All you need is a stopwatch (or a watch with a second hand) and following simple rules.

The person must be in a calm state and in comfortable position. If we're talking about For children, especially young children, it is better to count respiratory movements during sleep. If this is not possible, the subject should be distracted from the manipulation as much as possible. To do this, just grab your wrist (where the pulse is usually detected) and meanwhile count your breathing rate. It should be noted that the pulse in children under one year old (about 130-125 beats per minute) should not cause concern - this is the norm.

In infants, it is strongly recommended to count the respiratory rate during sleep, since crying can significantly affect the result and give deliberately false numbers. By placing your hand on the anterior abdominal wall (or just visually), you can easily carry out this study.

Considering that breathing has its own rhythmic cycle, it is necessary to observe the duration of its counting. Be sure to measure your respiratory rate over the course of a full minute, rather than multiplying the result obtained in just 15 seconds by four. It is recommended to carry out three counts and calculate the average.

Normal respiratory rate in children

The table shows the normal respiratory rate. Data are presented for children of different age groups.

As we can see from the table, the frequency of respiratory movements per minute is higher, the younger the child. Gradually, as they grow older, their number decreases, and by puberty when a child turns 14-15 years old, the respiratory rate becomes equal to that of an adult healthy person. No differences by gender are observed.

Types of breathing

There are three main types of breathing in both adults and children: chest, abdominal and mixed.

The breast type is more typical for females. With it, inhalation/exhalation is ensured to a greater extent due to movements of the chest. The disadvantage of this type of breathing movement is poor ventilation of the lower sections lung tissue. Whereas with the abdominal type, when the diaphragm is more involved (and the anterior one visually moves when breathing abdominal wall), lack of ventilation upper sections lungs. This type respiratory movements are more common for men.

But when mixed type breathing occurs uniform (identical) expansion of the chest with an increase in the volume of its cavity in all four directions (upper-lower, lateral). This is the most correct one, which ensures optimal ventilation of the entire lung tissue.

Normally, the respiratory rate in a healthy adult is 16-21 per minute, in newborns - up to 60 per minute. Above, the norm of respiratory rate in children is given in more detail (table with age norms).

Rapid breathing

The first sign of respiratory damage, especially when infectious diseases, is In this case, there will definitely be other signs of a cold (cough, runny nose, wheezing, etc.). Quite often, when body temperature rises, the respiratory rate increases and the pulse quickens in children.

Holding your breath during sleep

Quite often, young children (especially infants) experience short-term pauses in breathing during sleep. This is a physiological feature. But if you notice that such episodes become more frequent, their duration becomes longer, or other symptoms occur, such as blue lips or loss of consciousness, you should immediately call " Ambulance"to prevent irreversible consequences.

Conclusion

The respiratory organs have a number of features that contribute to their frequent defeat and rapid decompensation of the condition. This is primarily due to their immaturity at the time of birth, certain anatomical and physiological characteristics, incomplete differentiation of the structures of the central nervous system and their direct effect on the respiratory center and respiratory organs.
The younger the child, the less lung capacity he has, and therefore the more he will need to do large quantity respiratory movements (inhalation/exhalation) to provide the body with the necessary amount of oxygen.

Summing up

It should be remembered that respiratory arrhythmia is quite common in children in the first months of life. Most often this is not pathological condition, but only indicates age-related characteristics.

So, now you know what the normal respiratory rate is for children. The table of averages should be taken into account, but small deviations should not panic. And be sure to consult your doctor before jumping to conclusions!

Ellipses

Creating ellipses and elliptical arcs is done using the ELLIPSE command.

Ellipse axis end point or [Arc/Center]: (Specify axis endpoint of ellipse or :)

Second axis end point: (Specify other endpoini of axis:)

If you select the option Turn(Rotation), then the ellipse will be constructed as a projection of a circle rotated in space relative to the XY plane (more precisely, relative to the main axis) by the angle you specify. Allowable angle range: 0-89.4 (if the angle equal to zero, then the result is an ordinary circle).

Option Center(Center)

Ellipse center: (Specify center of ellipse:)

Axis end point: (Specify endpoint of axis:)

After this, a final question is issued, as in the case we considered above (Length of other axis or [Rotation]: (Specify distance to other axis or :)).

To build an elliptical arc you need to select the option Arc(Arc).

Elliptical arc axis end point or [Center]:

(Specify axis endpoint of elliptical arc or :) Further:

Second axis end point: (Specify other endpoint of axis:) Next request:

Length of other axis or [Rotation]: (Specify distance to other axis or :)

Starting angle or [Option]: (Specify start angle or :)

The starting angle is set by a number or using the mouse relative to the first axis (counting counterclockwise, starting from the first point of the axis). Further:

End corner or [Option/Inside corner]:

(Specify end angle or :)

Heart is hollow muscular organ, the “pump” of our body that pumps blood through blood vessels: arteries and veins.

Through arteries, blood flows from the heart to organs and tissues, while it is rich in oxygen and is called arterial. Blood flows through the veins to the heart, while it has already given oxygen to each cell of the body and taken carbon dioxide from the cells, therefore this blood is darker and is called venous.

Arterial called pressure, which is formed in the arterial system of the body during contractions of the heart and depends on complex neurohumoral regulation, the magnitude and speed of cardiac output, the frequency and rhythm of heart contractions and vascular tone.

There are systolic (SD) and diastolic pressure (DD). Blood pressure is recorded in millimeters of mercury (mmHg). Systolic is the pressure that occurs in the arteries at the moment of maximum rise of the pulse wave after ventricular systole. Normally, in a healthy adult, DM is 100–140 mmHg. Art. The pressure maintained in the arterial vessels during ventricular diastole is called diastolic; normally in a healthy adult it is 60–90 mmHg. Art. Thus, human blood pressure consists of two values ​​- systolic and diastolic. SD (larger indicator) is written first, DD (smaller indicator) is written second, separated by a fraction. An increase in blood pressure above normal is called hypertension or hypertension. The difference between SD and DD is called pulse pressure(PD), the normal values ​​of which are 40 – 50 mmHg. Blood pressure below normal is called hypotension or hypotension.

In the morning, blood pressure is lower by 5-10 mmHg than in the evening. Art.. A sharp drop in blood pressure is life-threatening! It is accompanied by pallor, severe weakness, and loss of consciousness. Low blood pressure disrupts the normal course of many vital important processes. So, when falling systolic pressure below 50 mm Hg. Art. urine production ceases and renal failure develops.

Blood pressure is measured using the indirect sound method, proposed in 1905 by the Russian surgeon N.S. Korotkov. Devices for measuring pressure have the following names: Riva-Rocci apparatus, or tonometer, or sphygmomanometer.

Currently, electronic devices are also used that make it possible to determine blood pressure using a non-sound method.

To study blood pressure, it is important to consider the following factors: the size of the cuff, the condition of the membrane and tubes of the phonendoscope, which may be damaged.

Pulse- these are rhythmic vibrations of the arterial wall caused by the release of blood into arterial system during one heartbeat. There are central (on the aorta, carotid arteries) and peripheral (on the radial, dorsal artery of the foot and some other arteries) pulse.

For diagnostic purposes, the pulse is determined in the temporal, femoral, brachial, popliteal, posterior tibial and other arteries.

More often, the pulse is examined in adults on the radial artery, which is located superficially between the styloid process. radius and the tendon of the internal radial muscle.

When examining the pulse, it is important to determine its frequency, rhythm, filling, tension and other characteristics. The nature of the pulse also depends on the elasticity of the artery wall.

Frequency is the number of pulse waves per minute. Normally, a healthy adult has a pulse of 60-80 beats per minute. An increased heart rate of more than 85-90 beats per minute is called tachycardia. A heart rate rate of less than 60 beats per minute is called bradycardia. The absence of a pulse is called asystole. With an increase in body temperature at HS, the pulse increases in adults by 8-10 beats per minute.

The pulse rhythm is determined by the intervals between pulse waves. If they are the same, the pulse is rhythmic (correct); if they are different, the pulse is arrhythmic (incorrect). In a healthy person, the contraction of the heart and the pulse wave follow each other at regular intervals.

Pulse filling is determined by the height of the pulse wave and depends on the systolic volume of the heart. If the height is normal or increased, then a normal pulse (full) is felt; if not, then the pulse is empty. Pulse voltage depends on the magnitude blood pressure and is determined by the force that must be applied until the pulse disappears. At normal pressure, the artery is compressed with moderate force, so the normal pulse is of moderate (satisfactory) tension. At high blood pressure the artery is compressed by strong pressure - such a pulse is called tense. It is important not to make a mistake, since the artery itself can be sclerotic. In this case, it is necessary to measure the pressure and verify the assumption that has arisen.

With low blood pressure, the artery is easily compressed, and the tension of the pulse is called soft (relaxed).

An empty, relaxed pulse is called a small filamentous pulse.

Pulse study data is recorded in two ways: digital - in medical documentation, magazines, and graphically - in the temperature sheet with a red pencil in the “P” (pulse) column. It is important to determine the division value on the temperature sheet.

The respiratory system provides the gas exchange necessary to maintain life and also functions as a vocal apparatus. Function respiratory system comes down to supplying blood sufficient quantity oxygen and remove carbon dioxide from it. Life without oxygen is not possible for humans. The exchange of oxygen and carbon dioxide between the body and the environment is called respiration.

Breathing is a single process consisting of 3 parts:

1. External respiration - gas exchange between external environment and blood of the pulmonary capillaries.

2. Transfer of gases (using blood hemoglobin).

3. Internal tissue respiration - gas exchange between blood and cells, as a result of which the cells consume oxygen and release carbon dioxide. Watching breathing, Special attention should be given to color change skin, determining the frequency, rhythm, depth of respiratory movements and assessing the type of breathing.

The respiratory movement is carried out by alternating inhalation and exhalation. The number of breaths in 1 minute is called the respiratory rate (RR).

In a healthy adult, the rate of respiratory movements at rest is 16-20 per minute; in women it is 2-4 breaths more than in men. NPV depends not only on gender, but also on body position, state of the nervous system, age, body temperature, etc.

Observation of breathing should be carried out unnoticed by the patient, since he can arbitrarily change the frequency, rhythm, and depth of breathing. NPV is related to heart rate on average as 1:4. When body temperature increases by 1°C, breathing becomes more frequent by an average of 4 respiratory movements.

Possible changes breathing pattern

There is a distinction between shallow and deep breathing. Shallow breathing may not be audible from a distance. Deep breathing, audible from a distance, is most often associated with a pathological decrease in breathing.

Physiological types of breathing include thoracic, abdominal and mixed type. In women, thoracic breathing is more common; in men, abdominal breathing is more common. With a mixed type of breathing, a uniform expansion of the chest of all parts of the lung occurs in all directions. Types of breathing are developed depending on the influence of both external and internal environment body. When the rhythm and depth of breathing is disturbed, shortness of breath occurs. There is inspiratory dyspnea - this is breathing with difficulty inhaling; expiratory - breathing with difficulty exhaling; and mixed - breathing with difficulty inhaling and exhaling. Rapidly developing severe shortness of breath is called suffocation.

2. Mechanisms of heat generation and heat transfer pathways

In an adult healthy person, body temperature is constant and when measured in the armpit, it ranges from 36.4-36.9°.

Heat is generated in all cells and tissues of the body as a result of the metabolism occurring in them, i.e. oxidative processes, decay nutrients, mainly carbohydrates and fats. The constancy of body temperature is regulated by the relationship between the formation of heat and its release: the more heat is generated in the body, the more it is released. If at muscle work The amount of heat in the body increases significantly, and its excess is released into the environment.

With increased heat production or increased heat transfer, skin capillaries expand and then sweating begins.

Due to the expansion of skin capillaries, a rush of blood occurs to the surface of the skin, it turns red, becomes warmer, “hotter”, and due to the increased temperature difference between the skin and the surrounding air, heat transfer increases. When sweating, heat transfer increases because a lot of heat is lost when sweat evaporates from the surface of the body. That is why, if a person works hard, especially when high temperature air (in hot workshops, a bathhouse, under the scorching rays of the sun, etc.) he turns red, he becomes hot, and then he begins to sweat.

Heat transfer, although to a lesser extent, also occurs from the surface of the lungs - the pulmonary alveoli.

A person exhales warm air saturated with water vapor. When a person is hot, he breathes more deeply and frequently.

A small amount of heat is lost in urine and feces.

With increased heat generation and reduced heat transfer, body temperature rises, a person gets tired faster, his movements become slower, sluggish, which somewhat reduces heat generation.

A decrease in heat generation or a decrease in heat transfer, on the contrary, is characterized by a narrowing of the skin blood vessels, paleness and coldness of the skin, due to which heat transfer decreases. When a person is cold, he involuntarily begins to tremble, that is, his muscles begin to contract, both embedded in the thickness of the skin (“skin tremors”) and skeletal ones, as a result of which heat generation increases. For the same reason, he begins to make rapid movements and rub the skin to increase heat generation and cause hyperemia of the skin.

Heat generation and heat transfer are regulated by the central nervous system.

The centers that regulate heat exchange are located in the interstitial brain, in the subthalamic region under the controlling influence of the brain, from where the corresponding impulses spread to the periphery through the autonomic nervous system.

Physiological adaptability to changes in external temperature, like any reaction, can only occur to certain limits.

If the body overheats excessively, when the body temperature reaches 42-43°, a so-called heat stroke occurs, from which a person can die if appropriate measures are not taken.

With excessive and prolonged cooling of the body, the body temperature begins to gradually decrease and death from freezing may occur.

Body temperature is not a constant value. The temperature value depends on:

- time of day. The minimum temperature occurs in the morning (3-6 hours), the maximum in the afternoon (14-16 and 18-22 hours). Night workers may have the opposite relationship. The difference between morning and evening temperatures in healthy people does not exceed 1 0 C;

- motor activity. Rest and sleep help lower the temperature. Immediately after eating there is also slight increase body temperature. Significant physical and emotional stress may cause an increase in temperature by 1 degree;

Hormonal background. In women during pregnancy and menstrual period the body rises slightly.

Age. In children it is higher on average by 0.3-0.4°C than in adults; in old age it may be slightly lower.

Breathing (respiration) is a set of processes that ensure the entry of atmospheric oxygen into the body, its use in biological oxidation reactions, and the removal from the body of carbon dioxide formed during metabolism. Reflex irritation of the respiratory center occurs when the level of carbon dioxide in the blood increases.

There are several stages of respiration: 1. External respiration - exchange of gases between the atmosphere and alveoli. 2. Exchange of gases between the alveoli and the blood of the pulmonary capillaries. 3. Transport of gases by blood - the process of transferring O2 from the lungs to the tissues and CO2 from the tissues to the lungs. 4. Exchange of O2 and CO2 between capillary blood and body tissue cells. 5. Internal, or tissue, respiration - biological oxidation in the mitochondria of the cell. There are several stages of respiration: 1. External respiration - exchange of gases between the atmosphere and alveoli. 2. Exchange of gases between the alveoli and the blood of the pulmonary capillaries. 3. Transport of gases by blood - the process of transferring O2 from the lungs to the tissues and CO2 from the tissues to the lungs. 4. Exchange of O2 and CO2 between capillary blood and body tissue cells. 5. Internal, or tissue, respiration - biological oxidation in the mitochondria of the cell.

In a healthy adult, the normal respiratory rate at rest is 1620 per minute. RR (Respiratory rate) depends: 1. On gender: Women have 2-4 breaths more than men; 2. From body position; 3. From the state of the nervous system; 4. From age; 5. From body temperature; When body temperature increases by 1 °C, breathing becomes more frequent by an average of 4 respiratory movements. 1. From the floor: Women have 2-4 more breaths than men; 2. From body position; 3. From the state of the nervous system; 4. From age; 5. From body temperature; When body temperature increases by 1 °C, breathing becomes more frequent by an average of 4 respiratory movements. Observation of breathing must be carried out unnoticed by the patient, since he can involuntarily change the respiratory rate, rhythm, and depth of breathing. ATTENTION!

There is a distinction between shallow and deep breathing. Shallow breathing may be inaudible at a distance or slightly audible. It is often combined with a pathological increase in breathing. Deep breathing, audible from a distance, is most often associated with a pathological decrease in breathing.

Physiological types of breathing include thoracic, abdominal and mixed type. In women, thoracic breathing is more common, while in men, abdominal breathing is more common. With a mixed type of breathing, a uniform expansion of the chest and all parts of the lung occurs in all directions.

It is advisable that the ward before the test should not be agitated by anything, should not eat, or be exposed to physical activity. Inhalation and exhalation are considered “one breath”. The calculation is carried out without informing the patient about the respiratory rate study in order to prevent voluntary changes in breathing. It is advisable that the ward before the test should not be agitated by anything, should not eat, or be exposed to physical activity. Inhalation and exhalation are considered “one breath”. The calculation is carried out without informing the patient about the respiratory rate study in order to prevent voluntary changes in breathing. It is convenient to calculate the respiratory rate when the patient lies on his back and the upper part of his chest or epigastric region is visible (with abdominal breathing) Take the patient’s hand as for examining the pulse, count the number of breaths per minute, using a stopwatch, simulating pulse examinations Estimate the frequency of the patient’s respiratory movements . Watch the movements (rising and lowering) of the chest or abdominal wall: how high the chest rises, whether the inhalations and exhalations are equal, whether the pauses between them are equal. At the end of the procedure, record data to ensure continuity of work and control over the NPV. It is convenient to calculate the respiratory rate when the patient lies on his back and the upper part of his chest or epigastric region is visible (with abdominal breathing) Take the patient’s hand as for examining the pulse, count the number of breaths per minute, using a stopwatch, simulating pulse examinations Estimate the frequency of the patient’s respiratory movements . Watch the movements (rising and lowering) of the chest or abdominal wall: how high the chest rises, whether the inhalations and exhalations are equal, whether the pauses between them are equal. At the end of the procedure, record data to ensure continuity of work and control over the NPV.

Pathological types of breathing. For a patient with a heart or pulmonary disease, a sharp increase in breathing is a sign of a complication or worsening of the condition. Rare breathing (less than 12 breath per minute) is a sign of a threat to life. If shallow and excessively frequent breathing occurs with noise, sometimes bubbling, this indicates improper gas exchange in the lungs. With asthma, breathing is wheezing, with bronchitis with wheezing. For a patient with a heart or pulmonary disease, a sharp increase in breathing is a sign of a complication or worsening of the condition. Rare breathing (less than 12 breath per minute) is a sign of a threat to life. If shallow and excessively frequent breathing occurs with noise, sometimes bubbling, this indicates improper gas exchange in the lungs. With asthma, breathing is wheezing, with bronchitis with wheezing.

Big Kussmaul breathing is rare, deep breathing with a loud noise, observed in deep coma (prolonged loss of consciousness); Biotte breathing is periodic breathing, in which there is a correct alternation of periods of shallow respiratory movements and pauses of equal duration (from several seconds to a minute);

Cheyne-Stokes breathing is characterized by a period of increasing frequency and depth of breathing, which reaches a maximum at the 57th breath, followed by a period of decreasing frequency and depth of breathing and another long pause of equal duration (from several seconds to 1 minute). During a pause, patients are poorly oriented environment or lose consciousness, which is restored when breathing movements are resumed (with severe damage to the brain, kidneys, and heart vessels).

“The art of medicine consists of the amount of knowledge necessary to understand the causes and pathophysiological mechanisms of diseases, from clinical experience, intuition and a set of qualities, which together constitute the so-called “clinical thinking.”

1. Create a trusting relationship with the patient.

2. Explain to the patient the need to count the pulse and obtain consent.

3. Take the patient's hand as for examining the pulse.

4. Place your and the patient’s hands on chest(for thoracic breathing) or the epigastric region (for abdominal breathing) of the patient, simulating a pulse examination.

6. Assess the frequency, depth, rhythm and type of breathing movements.

7. Explain to the patient that his respiratory rate has been counted.

8. Wash and dry your hands.

9. Record the data in the temperature sheet.

Note: NPV calculation is carried out without informing the patient about the respiratory rate study.

5. Conducting anthropometry (measurement of height)

Execution sequence:

Place a replaceable napkin on the stadiometer platform (under the patient’s feet).

Raise the stadiometer bar and invite the patient to stand (without shoes!) on the stadiometer platform.

Place the patient on the stadiometer platform; the back of the head, spine in the area of ​​the shoulder blades, sacrum and heels of the patient should fit tightly to the vertical bar of the stadiometer; the head should be in such a position that the tragus of the ear and the outer corner of the orbit are on the same horizontal line.

Lower the stadiometer bar onto the patient's head and determine the height on the scale along the lower edge of the bar.

Help the patient leave the stadiometer platform and remove the napkin.

6. Conducting anthropometry (determining body weight)

Execution sequence:

If possible, establish a trusting relationship with the patient. Explain the purpose and progress of the procedure, obtain consent to carry out it.

Place a replaceable napkin on the scale platform (under the patient’s feet).

Open the shutter of the scales and adjust them: the level of the balance beam, at which all the weights are in the “zero position”, must coincide with the control mark - the “nose” of the scales on the right side.

Close the shutter of the scale and invite the patient to stand (without shoes!) in the center of the scale platform.

Open the shutter and determine the patient’s weight by moving the weights on the two bars of the rocker arm until the rocker arm is level with the reference mark of the medical scale.

Close the shutter.

Help the patient get off the scale and remove the napkin.

Record measurement data.

7.Assessing the risk of development and severity of pressure ulcers

Execution sequence:

I. Preparation for the examination

1. Introduce yourself to the patient, explain the purpose and course of the examination (if the patient is conscious). II. Performing the examination The risk of developing pressure ulcers is assessed using the Waterlow scale, which is applicable to all categories of patients. In this case, the points are summed up according to 10 parameters: 1. physique; 2. body weight, relative to height; 3. skin type; 4. gender, age; 5. special risk factors; 6. retention of urine and feces; 7. mobility; 8. appetite; 9. neurological disorders; 10. surgical interventions or injury. III. End of the procedure 1. Inform the patient(s) of the examination result 2. Make an appropriate entry about the results in the medical documentation

SEVERITY ASSESSMENTS

Execution Sequence I. Preparation for the procedure 2.. If possible, establish a trusting relationship with the patient. Explain the purpose and progress of the procedure, obtain consent to carry out it. 3.. Adjust the height of the bed. 4. Treat hands hygienically and dry. Wear gloves. II. Performing the procedure 1. Help the patient lie on his stomach or side. 2. Inspect the places where bedsores form: sacrum, heels, ankles, shoulder blades, elbows, back of the head, greater trochanter femur, internal surfaces knee joints. 3. Assess: location, color of the skin, presence of odor and pain, depth and size of the lesion, presence and nature of discharged fluid, swelling of the edges of the wound, presence of a cavity in which tendons and/or bone formations may be visible. 4. If necessary, use sterile tweezers and sterile gloves. III. End of the procedure 1. Inform the patient the result of the study 2. Disinfect the used material and gloves. 3. Treat hands hygienically and dry. 4. Make an appropriate entry about the results of the implementation in the medical documentation

Respiratory rate

Respiratory frequency- the number of respiratory movements (inhalation-exhalation cycles) per unit of time (usually a minute). It is one of the main and oldest biomarkers.

The number of respiratory movements is calculated by the number of movements of the chest and anterior abdominal wall. Usually, during an objective study, the pulse is first determined and counted, and then the number of respiratory movements in one minute, the type of breathing (thoracic, abdominal or mixed), depth and its rhythm are determined.

Human breathing rate

In adults

A healthy adult in a state of physiological rest makes an average of 16 to 20 respiratory movements per minute, a newborn - 40-45 respiratory movements, the frequency of which gradually decreases with age. During sleep, breathing slows down to 12-14 per minute, and during physical activity, emotional excitement or after plenty of intake food - naturally increases in frequency.

Pathological increased breathing ( tachypnea) develops as a result of the presence of certain pathological conditions:

1. narrowing of the lumen of the small bronchi due to their spasm or diffuse inflammation of their mucous membrane ( bronchiolitis), which prevent the normal flow of air into the alveoli;
2. reduction of the respiratory surface of the lungs (pneumonia - lobar or viral pneumonia, pulmonary tuberculosis, collapsed lung (atelectasis); as a result of compression of the lung - exudative pleurisy, hydrothorax, pneumothorax, mediastinal tumor; with obstruction or compression of the main bronchus by a tumor; in case of pulmonary infarction as a result of blockage of a branch of the pulmonary trunk by a thrombus or embolus; with severe emphysema of the lungs and their overflow with blood due to edema against the background of pathology of the cardiovascular system);
3. insufficient depth of breathing (shallow breathing) with sharp pain in the chest (dry pleurisy, diaphragmatitis, acute myositis, intercostal neuralgia, rib fracture, or the development of metastases in them malignant tumor); at sharp increase intra-abdominal pressure and high level standing of the diaphragm (ascites, flatulence, late dates pregnancy) and hysteria.

Pathological decrease in breathing ( bradypnea) may be caused by:

1. increase intracranial pressure(brain tumor, meningitis, cerebral hemorrhage, cerebral edema);
2. the impact on the respiratory center of toxic metabolic products accumulated in significant quantities in the blood (uremia, hepatic or diabetic coma, some acute infectious diseases and poisoning).

In children

In a healthy child, synchronous participation in the act of breathing of both halves of the chest is visually noted. To determine the degree of mobility (excursion) of the chest, use a centimeter tape to measure the circumference of the chest at the level of the nipples in front, and at the back at the angles of the shoulder blades. During examination, pay attention to the type of breathing. The number of respiratory movements is counted for a minute when the child is calm or sleeping. In newborns and young children, you can use a soft stethoscope, the bell of which is held near the nose of the child being examined. This method allows you to count the number of respiratory movements without undressing the child. Sometimes using this method it is possible to listen to wheezing characteristic of bronchitis, bronchiolitis or pneumonia.

Newborns may experience periodic breathing - alternating regular breathing with irregular breathing. This is considered normal for this age.

Respiratory rate and basic hemodynamic parameters in children are normal Age Respiratory rate (/min) Pulse (beats/min) Systolic blood pressure(mm Hg)

Respiration rate in animals

Normal respiratory rate in children: table. Respiratory rate

One of the actions carried out during examination by a pediatrician is counting respiratory movements. This seemingly simple indicator carries important information about the state of health in general and about the functioning of the respiratory organs and cardiovascular system in particular.

How to correctly calculate the respiratory rate (RR) per minute? This is not particularly difficult. But certain difficulties arise with the interpretation of the data. This is more true for young parents, because, having received a result from a child that is several times higher than their own, they panic. Therefore, in this article we propose to figure out what the normal respiratory rate is for children. The table will help us with this.

Features of the child's respiratory system

The first thing an expectant mother has been waiting for for so long is the baby's first cry. It is with this sound that his first breath occurs. By the time of birth, the organs that ensure the child’s breathing are not yet fully developed, and only with the growth of the body itself do they mature (both functionally and morphologically).

The nasal passages (which are the upper respiratory tract) in newborns have their own characteristics:
They are quite narrow.
Relatively short.
Their inner surface is delicate, with a huge number of vessels (blood, lymphatic).

Therefore, even with minor catarrhal symptoms, the child’s nasal mucosa quickly swells, the already small lumen decreases, and as a result, breathing becomes difficult and shortness of breath develops: small children cannot yet breathe through their mouths. The younger the child, the more dangerous the consequences can be, and the faster it is necessary to eliminate the pathological condition.

Lung tissue in young children also has its own characteristics. Unlike adults, their lung tissue is poorly developed, and the lungs themselves have a small volume with a huge number of blood vessels.

Rules for counting breathing rate

Measuring respiratory rate does not require any special skills or equipment. All you need is a stopwatch (or a watch with a second hand) and following simple rules.

The person should be calm and in a comfortable position. If we are talking about children, especially young children, then it is better to count respiratory movements during sleep. If this is not possible, the subject should be distracted from the manipulation as much as possible. To do this, just grab your wrist (where the pulse is usually detected) and meanwhile count your breathing rate. It should be noted that the pulse in children under one year old (about 130-125 beats per minute) should not cause concern - this is the norm.

In infants, it is strongly recommended to count the respiratory rate during sleep, since crying can significantly affect the result and give deliberately false numbers. By placing your hand on the anterior abdominal wall (or just visually), you can easily carry out this study.

Considering that breathing has its own rhythmic cycle, it is necessary to observe the duration of its counting. Be sure to measure your respiratory rate over the course of a full minute, rather than multiplying the result obtained in just 15 seconds by four. It is recommended to carry out three counts and calculate the average.

Normal respiratory rate in children

The table shows the normal respiratory rate. Data are presented for children of different age groups.

As we can see from the table, the frequency of respiratory movements per minute is higher, the younger the child. Gradually, as they grow older, their number decreases, and by puberty, when the child turns 14-15 years old, the respiratory rate becomes equal to that of a healthy adult. No differences by gender are observed.

Types of breathing

There are three main types of breathing in both adults and children: chest, abdominal and mixed.

The breast type is more typical for females. With it, inhalation/exhalation is ensured to a greater extent due to movements of the chest. The disadvantage of this type of breathing movement is poor ventilation of the lower parts of the lung tissue. Whereas in the abdominal type, when the diaphragm is more involved (and the anterior abdominal wall visually moves during breathing), the upper sections of the lungs experience a lack of ventilation. This type of breathing movement is more common for men.

But with a mixed type of breathing, a uniform (identical) expansion of the chest occurs with an increase in the volume of its cavity in all four directions (upper-lower, lateral). This is the most correct type of breathing, which ensures optimal ventilation of the entire lung tissue.

Normally, the respiratory rate in a healthy adult is 16-21 per minute, in newborns - up to 60 per minute. Above, the norm of respiratory rate in children is given in more detail (table with age norms).

Rapid breathing

The first sign of damage to the respiratory system, especially in infectious diseases, is increased breathing. In this case, there will definitely be other signs of a cold (cough, runny nose, wheezing, etc.). Quite often, when body temperature rises, the respiratory rate increases and the pulse quickens in children.

Holding your breath during sleep

Quite often, young children (especially infants) experience short-term pauses in breathing during sleep. This is a physiological feature. But if you notice that such episodes become more frequent, their duration becomes longer, or other symptoms arise, such as blue lips or nasolabial triangle, loss of consciousness, you must immediately call an ambulance to prevent irreversible consequences.

Conclusion

The respiratory organs of young children have a number of features that contribute to their frequent damage and rapid decompensation of the condition. This is primarily due to their immaturity at the time of birth, certain anatomical and physiological characteristics, incomplete differentiation of the structures of the central nervous system and their direct influence on the respiratory center and respiratory organs.
The younger the child, the less lung capacity he has, and therefore he will need to make a greater number of respiratory movements (inhalation/exhalation) to provide the body with the necessary volume of oxygen.

Summing up

It should be remembered that respiratory arrhythmia is quite common in children in the first months of life. Most often, this is not a pathological condition, but only indicates age-related characteristics.

So, now you know what the normal respiratory rate is for children. The table of averages should be taken into account, but small deviations should not panic. And be sure to consult your doctor before jumping to conclusions!

Manipulation No. 40 “Calculating the number of respiratory movements (RR).”

Target: determine the main characteristics of breathing.

Indications: diseases of the respiratory system and cardiovascular system.

Contraindications: No.

Equipment: clock (stopwatch), temperature sheet or sheet nursing supervision, pen paper.

Algorithm:

Manipulation No. 41 “Filling out the temperature sheet.”

Target: rules for filling out medical documentation.

Indications: registration of patient examination results.

Contraindications: No.

Equipment: temperature sheet, pens (or pencils) with red and blue paste.

Algorithm:

Age norms for respiratory rate.

The ratio of respiratory rate and heart rate in healthy children in the first year of life is 3-3.5, i.e. for one breathing movement there are 3-3.5 heartbeats, in older children - 5 heartbeats.

Palpation.

To palpate the chest, both palms are applied symmetrically to the areas being examined. By squeezing the chest from front to back and from the sides, its resistance is determined. How younger age child, the more pliable the chest is. Increased resistance of the chest is called rigidity.

Voice tremors– resonant vibration chest wall the patient when he pronounces sounds (preferably low-frequency), felt by the hand during palpation. To assess vocal tremor, the palms are also placed symmetrically. Then the child is asked to pronounce words that cause maximum vibration of the vocal cords and resonating structures (for example, “thirty-three,” “forty-four,” etc.). In young children, vocal tremors can be examined during screaming or crying.

Percussion.

When percussing the lungs, it is important that the child’s position is correct, ensuring the symmetry of the location of both halves of the chest. At incorrect position the percussion sound in symmetrical areas will be different, which may give rise to an erroneous assessment of the data obtained. When percussing the back, it is advisable to invite the child to cross his arms over his chest and at the same time bend slightly forward; when percussing the anterior surface of the chest, the child lowers his arms along the body. It is more convenient to percuss the anterior surface of the chest in young children when the child lies on his back. For percussion of the child's back, the child is seated, and small children must be supported by someone. If the child does not yet know how to hold his head up, he can be percussed by placing his stomach on a horizontal surface or his left hand.

There are direct and indirect percussion.

Direct percussion – percussion with tapping with a bent finger (usually the middle or index finger) directly on the surface of the patient’s body. Direct percussion is more often used when examining young children.

Indirect percussion - percussion with a finger on the finger of the other hand (usually along the phalanx of the middle finger of the left hand), tightly applied with the palmar surface to the area of ​​the patient’s body surface being examined. Traditionally, percussion is done with the middle finger of the right hand.

Percussion in young children should be carried out with weak blows, since due to the elasticity of the chest and its small size, percussion shocks are too easily transmitted to distant areas.

Because intercostal spaces in children they are narrow (compared to adults), the pessimeter finger should be placed perpendicular to the ribs.

When percussing healthy lungs, a clear pulmonary sound is obtained. At the height of inhalation, this sound becomes even clearer; at the peak of exhalation, it shortens somewhat. On different areas the percussion sound is not the same. Right in lower parts due to the proximity of the liver, the sound is shortened; on the left, due to the proximity of the stomach, it takes on a tympanic hue (the so-called Traube space).

Auscultation.

During auscultation, the position of the child is the same as during percussion. Listen to symmetrical areas of both lungs. Normally, in children under 6 months of age, they listen weakened vesicular breathing, from 6 months to 6 years – puerile(breath sounds are louder and longer during both phases of breathing).

The structural features of the respiratory organs in children that determine the presence of puerile breathing are listed below.

Greater elasticity and thin thickness of the chest wall, increasing its vibration.

Significant development of interstitial tissue, reducing the airiness of lung tissue.

After 6 years of age, breathing in children gradually acquires the character of a vesicular, adult type.

Bronchophony – carrying out sound wave from the bronchi to the chest, determined by auscultation. The patient whispers the pronunciation of words containing the sounds “sh” and “ch” (for example, “cup of tea”). Bronchophony must be examined over symmetrical areas of the lungs.

Instrumental and laboratory studies.

Clinical analysis blood allows you to clarify the degree of activity of inflammation, anemia, and the level of eosinophilia (an indirect sign of allergic inflammation).

Sputum culture from tracheal aspirate, bronchial lavage waters (throat smears reflect the microflora of only the upper respiratory tract) allows you to identify the causative agent of a respiratory disease (diagnostic titer with a semi-quantitative research method is 105 - 106), determine sensitivity to antibiotics.

Cytomorphological examination of sputum , obtained by collecting tracheal aspirate or by performing bronchoalveolar lavage allows you to clarify the nature of inflammation (infectious, allergic), the degree of activity inflammatory process, carry out microbiological, biochemical and immunological study the received material.

Puncture of the pleural cavity carried out at exudative pleurisy and other significant accumulations of fluid in the pleural cavity; allows for biochemical, bacteriological and serological test material obtained during puncture.

X-ray method:

Radiography is the main method of x-ray diagnostics in pediatrics; a photograph is taken in a direct projection while inhaling; according to indications, a photograph is taken in a lateral projection;

Fluoroscopy - gives a large radiation dose and therefore should be carried out only according to strict indications: determining the mobility of the mediastinum during breathing (suspicion of a foreign body), assessing the movement of the domes of the diaphragm (paresis, diaphragmatic hernia) and for a number of other conditions and diseases;

Tomography - allows you to see small or merging details of lung lesions and The lymph nodes; with a higher radiation dose, it is inferior in resolution to computed tomography;

Computed tomography (mainly cross-sections are used) provides rich information and is now increasingly replacing tomography and bronchography.

Bronchoscopy - visual assessment method inner surface trachea and bronchi. It is carried out with a rigid bronchoscope (under anesthesia) and a fiberoptic bronchoscope with fiber optics (under local anesthesia).

Bronchoscopy is an invasive method and should be performed only if there is an undeniable indication .

- SHOWINGS for diagnostic bronchoscopy are:

Suspicion of congenital defects;

Aspiration of a foreign body or suspicion of it;

Suspicion of chronic aspiration of food (lavage to determine the presence of fat in alveolar macrophages);

The need to visualize the nature of endobronchial changes in chronic diseases of the bronchi and lungs;

Carrying out a biopsy of the bronchial mucosa or transbronchial lung biopsy.

In addition to diagnostic, bronchoscopy, according to indications, is used with therapeutic purpose: sanitation of the bronchi with the introduction of antibiotics and mucolytics, drainage of the abscess.

During bronchoscopy, it is possible to perform bronchoal volar lavage (BAL) - flushing the peripheral parts of the bronchi with a large volume isotonic solution sodium chloride, which provides important information if alveolitis, sarcoidosis, pulmonary hemosiderosis and some other rare lung diseases are suspected.

Bronchography - contrasting the bronchi to determine their structure and contours. Bronchography is not primary diagnostic study. Currently used mainly to assess the extent of bronchial lesions and the possibility surgical treatment, clarification of the form and localization of the congenital defect.

Pneumoscintigraphy - used to assess capillary blood flow in the pulmonary circulation.

Study of respiratory organ functions. In clinical practice, the ventilation function of the lungs is most widely used, which is methodologically more accessible. Violation of the ventilation function of the lungs can be obstructive (impaired passage of air through the bronchial tree), restrictive (reduced gas exchange area, decreased extensibility of lung tissue) and combined type. Functional research allows differentiating types of insufficiency external respiration, forms of ventilation failure; detect disorders not detected clinically; evaluate the effectiveness of the treatment.

To study the ventilation function of the lungs, spirography and pneumotachometry are used.

Spirography gives an idea of ​​ventilation disturbances, the degree and form of these disturbances.

Pneumochymetry gives an FVC exhalation curve, from which about 20 parameters are calculated both in absolute values ​​and as a percentage of the required values.

Functional tests for bronchial reactivity. Inhalation pharmacological tests are carried out with β 2 -adrenergic agonists to determine latent bronchospasm or select adequate antispasmodic therapy. FVD study carried out before and 20 minutes after inhalation of 1 dose of the drug.

Allergy tests.

Skin (application, scarification), intradermal and provocative tests with allergens are used. Define general content IgE and the presence of specific immunoglobulins to various allergens.

Determination of blood gas composition.

Ra O and pa CO 2 are determined, as well as the pH of capillary blood. If long-term continuous monitoring of the blood gas composition is necessary, transcutaneous determination of blood oxygen saturation (S 2 O 2) is carried out in the dynamics of respiratory failure.

Software tests