CNA Charting What Nurse Tells Her

[Anxiousandafraid]

I admittedly have anxiety and struggle with respirations. One night my respirations were 21 and I kept counting until it reached 24. I told my nurse in case she wanted to verify. I don’t think she actually counted but I can’t prove it. I asked her were things okay she said “yes you can just put 22” I charted 22 and said “nurse reported “. Is this okay ? What IF she didn’t count. Was I wrong to write her answer down and then leave the note that this number is the number the nurse gave me? 

[JKL33]

Hello:

First, you didn't falsify any documentation, you charted the nurse's assessment of the respirations and correctly noted as such (that it was nurse reported).

Where are your troubles with counting respirations?

You mention this and I'm not sure what you mean by it:

1 hour ago, Anxiousandafraid said:

One night my respirations were 21 and I kept counting until it reached 24.

You stop counting at the end of the time frame. So if you are counting for 30 seconds, you stop counting at the end of the 30 seconds--then multiply by 2 which will give you a reasonable estimation of the number of breaths per minute. You can also just count for 60 seconds instead. Many people count for 15 seconds (then multiply by 4), this is quicker but generally less accurate.

Or are you having trouble seeing the chest rise/fall?

[Anxiousandafraid]

1 hour ago, JKL33 said:

Hello:

First, you didn't falsify any documentation, you charted the nurse's assessment of the respirations and correctly noted as such (that it was nurse reported).

Where are your troubles with counting respirations?

You mention this and I'm not sure what you mean by it:

You stop counting at the end of the time frame. So if you are counting for 30 seconds, you stop counting at the end of the 30 seconds--then multiply by 2 which will give you a reasonable estimation of the number of breaths per minute. You can also just count for 60 seconds instead. Many people count for 15 seconds (then multiply by 4), this is quicker but generally less accurate.

Or are you having trouble seeing the chest rise/fall?

Thank you.  Sometimes I overthink. Like I can be in mid breath or the patient rather then I’ll be stuck with “what number is it really ? “ or the patient will move a little and I lose count. But mostly like tonight I’ll be counting and say I count 6 inhalations but only 5 full exhales because my timer starts buzzing in the MIDST of the 6th fall (exhale of the chest ) do I count this as a full respiration meaning 12 or do I count it as 11 respirations since the patient was technically still exhaling as the timer went off ? What about when I began my timer and the patient is already exhaling. Do I wait for them to inhale to begin my count ? 

[subee, MSN, CRNA]

11 hours ago, Anxiousandafraid said:

Thank you.  Sometimes I overthink. Like I can be in mid breath or the patient rather then I’ll be stuck with “what number is it really ? “ or the patient will move a little and I lose count. But mostly like tonight I’ll be counting and say I count 6 inhalations but only 5 full exhales because my timer starts buzzing in the MIDST of the 6th fall (exhale of the chest ) do I count this as a full respiration meaning 12 or do I count it as 11 respirations since the patient was technically still exhaling as the timer went off ? What about when I began my timer and the patient is already exhaling. Do I wait for them to inhale to begin my count ? 

Change your screenname to something more optimistic:)  Yes! You are anxious and afraid and it is interfering with your common sense.  There's  no need to belabor whether the rate is 22 or 24.  The important thing is how far the rate you are counting deviates from normal.  Is the patient experiencing any distress?  What is the patient's normal resting respiratory rate?  When you concentrate on a strict number, you're avoiding using your own judgement.  There just is NO WAY you can injure a patient by putting down 22 vs. 24.  Take a deep breath (what is your own respiratory rate while you are so anxious?), take a good hard look at the patient and pick a number within the range of 2.  You are good here!

[Anxiousandafraid]

Thank you so much… I’ll admit the anxiety does at times cause me to not use my common sense. I take no offense at all to your comment. I appreciate the response so much ?❤️❤️

[subee, MSN, CRNA]

4 hours ago, Anxiousandafraid said:

Thank you so much… I’ll admit the anxiety does at times cause me to not use my common sense. I take no offense at all to your comment. I appreciate the response so much ?❤️❤️

You didn't say how long you've been doing this.  If you are brand new, this fearfulness may go away when you get experience.  If it doesn't then it's time to speak with someone .  

[Anxiousandafraid]

3 hours ago, subee said:

You didn't say how long you've been doing this.  If you are brand new, this fearfulness may go away when you get experience.  If it doesn't then it's time to speak with someone .  

I’ve been doing this for almost 10 years. Caregiving I mean. I’m on the search to find a professional now. 

[JKL33]

Agree with all the above. You are likely doing just fine.

The important thing is that you make a reasonable estimation--as oppposed to the type of people who write 16 without remotely trying to count, and maybe the patient's respirations are closer to 44. THAT's the kind of thing that is a problem.

Take care ~

[Simba&NalasMom, LPN]

On 4/16/2022 at 8:34 AM, subee said:

Change your screenname to something more optimistic:)  Yes! You are anxious and afraid and it is interfering with your common sense.  There's  no need to belabor whether the rate is 22 or 24.  The important thing is how far the rate you are counting deviates from normal.  Is the patient experiencing any distress?  What is the patient's normal resting respiratory rate?  When you concentrate on a strict number, you're avoiding using your own judgement.  There just is NO WAY you can injure a patient by putting down 22 vs. 24.  Take a deep breath (what is your own respiratory rate while you are so anxious?), take a good hard look at the patient and pick a number within the range of 2.  You are good here!

Great answer. 

[hppygr8ful, ASN, RN, EMT-I]

On 4/15/2022 at 7:43 PM, Anxiousandafraid said:

Thank you.  Sometimes I overthink. Like I can be in mid breath or the patient rather then I’ll be stuck with “what number is it really ? “ or the patient will move a little and I lose count. But mostly like tonight I’ll be counting and say I count 6 inhalations but only 5 full exhales because my timer starts buzzing in the MIDST of the 6th fall (exhale of the chest ) do I count this as a full respiration meaning 12 or do I count it as 11 respirations since the patient was technically still exhaling as the timer went off ? What about when I began my timer and the patient is already exhaling. Do I wait for them to inhale to begin my count ? 

The correct number for what you describe is 6 as a full respiration included both the inhale and the exhale. You might find it easier to take respirations using a watch with a second hand rather than a timer. I agree sometimes patients hold their breath or try to manipulate their respiratory rate so try this. If the patient is awake start you vitals by machine and place a hand on their shoulder or watch their upper abdomen. Using the watches second hand time that rise and fall for a full minute. The trick here is that the patient doesn’t know you are counting respirations and since the machine does all the work for both BP and pulse so you can fully focus on the respirations.

hppy