Tips for counting respirations as a nursing student!
Counting respirations seems like a fairly easy skill, right? Well, it can actually be tricky, especially when you’re first learning the skill. In addition, you will find out quickly that for some patients it’s really easy to take their respiratory rate while others not so much. Therefore, this skill definitely takes practice.
First let’s quickly review how to count a respiratory rate in an adult:
Points to remember about counting respirations:
A normal respiratory rate in an adult is 12-20 breaths per minute.- When counting respirations we are not only counting the rate but we’re assessing if the patient’s breathing rate is regular/irregular and labored or unlabored.
- To count a respiratory rate, you want the patient to be unaware that you’re counting their breathing rate until after you are done. This is because if they know you’re counting their breathing rate they will alter it. It’s like if someone told you that they were going to count how many times you blink…you would alter your blinking pattern because you’re aware of it.
- Remember one rise (inspiration) and one fall (expiration) of the chest equals one breath.
- Count the rise and fall for 30 seconds, and if the breathing rate is REGULAR, multiple by 2. If breathing rate is irregular, count for one full minute.
- Remember it’s always best to count the respiratory rate rather than documenting the number given by the monitor. The respiratory rate number on a monitor is usually inaccurate…so always double check it.
- It’s best to count the respiratory rate after counting the radial pulse rate.
- Use fingers to assess radial pulse side and count for either 30 seconds (if regular) or one full minute (if irregular).
- Once you’re done counting the pulse rate, keep your fingers on the radial site and count the respiration rate…but this is the part that can be complicated. So, here are three tricks I’ve found helpful.
It’s important to note that one trick may work for one patient while another may not. You will find that you will have to sometimes think outside the box or switch up techniques for different patients. This is because patients are different in their size, clothing worn, breathing patterns, and disease process.
Counting Respirations Tips
Tip 1
Get at the right level!
When counting the respiratory rate, be sure you position yourself at the patient’s chest level. This will allow you to easily see the rise and fall of the chest.
Therefore, right before you count the pulse rate slightly bend down so you can see the patient’s chest/abdomen clearly. Watch for the rise and fall of the chest, shoulders, or abdominal muscles…it is also helpful to watch the movement of the patient’s gown or clothing. Note: some patients breath in and out with their shoulders, while some with their abdominal muscles (especially if they have some type of respiratory disorder because these areas have accessory muscles that help with airflow). So it’s important to look at these areas along with the chest movement.
Tip 2
Feel for the rise and fall!
Sometimes placing a hand on the patient’s back or shoulder area, can be helpful in determining the rise and fall of the chest. To do this, get in position when you BEGIN to take the pulse (count pulse and then feel for the rise and fall). However, this tip should be used with discretion and is not an option for all patients because some patients may not like being touched. It may actually change their breathing rate.
Tip 3
Group it together during your physical assessment (nurses like multi-tasking)!
Count the breathing rate while assessing the patient’s chest. Tell the patient you’re going to be listening to their heart sounds for one minute. You can start by listening and counting the normal breath rate. Be sure to find a spot where there isn’t a lot of adipose tissue. This is “usually” around the 2nd-4th intercostal space anteriorly. After counting the rate, then listen to heart sounds.
You may be interested in: “Collecting Vital Signs“