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by Rhonda V

Hi Everyone...I have a question on what is the best way to count a patient's respiratory rate. I've always been taught that you continue to hold the patient's wrist after taking their pulse while you observe them breathing. When I used to do it this way, the patient would usually interrupt me and say, "What's the matter, don't I have one?" (thinking I'm still taking the pulse).
I also feel kind of silly watching their stomach or chest rise. They look down wondering what I'm staring at.

Then I tried another trick which seems to work...I take my stethoscope and tell the patient that I'm going to listen to his heart when I'm actually listening to him breathe. This works because I not only hear the respirations, but I can feel the chest rise with my stethoscope. The disadvantage to this, however, is that I've found that some patients will tend to breathe very lightly or will try to hold their breath thinking it will help me hear their heart better.

Another question I have is concerning respiratory rates. I understand that the normal respiratory rate for an adult is between 12 and 20/minute. I usually count respirations for 30 seconds. Is it just me, or have any of you run across some patients who breathe less than 12 times/minute? I literally counted one patient who was around 9 or 10/minute (and he was otherwise alert and stable). I'll count for a full minute if the respiratory rate seems slow, though I don't feel right about charting a respiratory rate below 12 if the patient is otherwise coherant and stable...I work in an urgent care clinic, not a hospital where narcotic pain meds or sedative might be to blame. Is it possible that some people can REALLY breathe that slow and have it be OK? Thank You for all responses on this!

[Faeriewand]

Re: Taking Respirations

Right now I"m in nursing school and was concerned with the same thing but my clinical instructor told me that 10/min is ok. Let's see what others have to say about this.

[Marie_LPN, RN]

Re: Taking Respirations

I'l tell the pt. that i'm "counting" for 2 minutes. Which is the half truth. One minute i'm counting the pulse, the other i'm counting respirations.

Slowest respirations i've seen was 8, on a healthy pt. too. And this was normal for them.

[Mommy TeleRN]

Re: Taking Respirations

I will usually try the wrist method first. If I can't see their chest or whatever then I'll use my steth and say "Now just breath normally for me, I'm not listening to your lungs right now" so they know they don't have to do the deep breaths (but I still don't tell them I'm counting respirations)
My teacher had a trick, to sort of fold their arm across their stomach as you are counting, so you could FEEL the rise of the chest.

What's hard for me is when I"m using the dynamap - because you aren't counting the pulse then. But usually then I tell them I need to "listen" for a minute and use the steth.

I'm getting better but it can still be tricky.

[mced]

Re: Taking Respirations

I think you are putting too much thought into this. If the patient is in distress, you will know.

[RN-Cardiac]

Re: Taking Respirations

in urgent care setting your probably more intersted in those w/respers of 35 and they will be in obvious distress.

[TriageRN_34]

Re: Taking Respirations

Well, I have learned to assess patients without them knowing it most of the time. I get people into conversation while I am checking facial movements, hand movements, seeing if they are moving their legs in bed, and so on.

How I count resps are either when I am talking with them, or doing something they typically do...cause even if you tell them you are listening to their heart or what not...they tend to change the rate automatically. This is a learned skill...and keep on practicing till you can do this accurately.

I really don't like resps below 12, and don't like them above 24 unless there is an underlying condition..then I look it up and see their trends to see if this is their baseline or are they having trouble.

[ginger58]

Re: Taking Respirations

I know what you mean about standing there counting. I usually count when I'm listening to the chest/heart. Since I work inpt on days I go by their room in the morning and they're usually resting so I take them standing in the doorway (private rooms). If they're nice and regular I usually stop at 30 seconds but if they're irregular I count the full minute.
I normally breathe 6-8 breaths per minute and so did my dad. I've talked to my docs about this and they just say it's normal for me. If someone's breathing that slowly you'll know if they're in trouble or oversedated.

[earle58]

Re: Taking Respirations

i'll place the pt's arm across their stomach and proceed to take a radial pulse.
before i start, i ask for a couple minutes of quiet so i can confirm the regularity/irregularity of any rhythms.
if the rates are reg, i do pulsex30 and rrx30sec.
any deviations= pulsex60, rrx60.
meanwhile, i also assess for symmetry, accessory usage, color, audible sounds.
never have had any problems.

leslie

[RunnerRN]

Re: Taking Respirations

I work ER and also do PRN shifts in urgent care. I think the above answer about "you'll know if they're in distress" was pretty accurate. I always chart "Resp even/unlabored" and "Pt speaks w ease" on my urgent care pts. I just tell people I'm going to count for a minute and hold my fingers on their pulse for the next 30 seconds.
When I'm feeling really "on" I can count pulse and RR at the same time (count HR in my head, and use my fingers for RR...like I said, when I'm really on!)