Counting Respirations

Cuddleswithpuddles · Mar 24, 2012

I am not in my first semester, but I'm still having trouble counting respirations while having distractions. I still have to act like I'm counting the pulse "for a full minute" and count respirations for the second half of that time. Anyone have any tips on how to do this another way? Whenever I try to do it while I'm using the Vitals machine, I find I don't have a full 30 seconds to observe for respirations and so I can never make it work out. Any other time I try it, I find myself getting distracted. I have a hard time looking natural while counting respirations/doing something else for a full 30 seconds. Thanks.

Some things I do:

Count while the automated BP cuff is doing its thing. Unless your VS machine is some magic light speed one I would like to get a hold of, this should give you enough time.

Count after you auscultate lungs and heart. Leave your stethoscope there and use lung sounds and chest rise to help you keep track.

As for getting distracted, well, I have no other advice other than focus! LOL! Think of it this way: You wouldn't be distracted if your teacher was announcing whether you passed nursing school or not, if your significant other had you in the most passionate, loving kiss or if your child was about to get run over by a car. It's all about motivation. You have to find that motivation to get an accurate respiratory count. It could mean the difference between catching respiratory distress at its very early stages or not.

Hope this helped :)

1969 · Mar 24, 2012

while taking the radial pulse, place pts hand on his chest, then after counting the pulse for 15 or 30, then count the resps for the 15 or 30. That way, the pt thinks your doing pulse, but you really are doing both. Make sense? we count ea of the above for 15 seconds then multiply by 4 or 30 x 2, but if the resps are off or wierd in any way, then the full minute.

emptyboxcars · Mar 24, 2012

Cuddleswithpuddles...Do you count respirations for a full 30 seconds? Or are you doing it for 15? I'm required to do it the full 30 seconds...

Cuddleswithpuddles · Mar 24, 2012

emptyboxcars,

I usually do 30 seconds if respirations are regular. If they are irregular and/or if there are any unusual characteristics to their breathing, I go for the full minute.

Double-Helix, BSN, RN · Mar 24, 2012

In addition to the above suggestions:

If you go in to the patient's room and they are sleeping or resting with their eyes closed, take that moment to count their respirations. Watch for chest rise for 30 seconds while they are unaware that you are in the room. It's the best way to get an accurate respiratory count.

Also, when you are taking the patient's pulse or listening to their heart and lungs, tell them that you are going to do so for a full minute. Then they know what you're doing and that something it's wrong because you're taking awhile. Then you have plenty of time to count everything because your patient knows you are taking a minute to do it all.

gallatea · Mar 24, 2012

if you can't chew gum and walk, you're in trouble in the real world..counting respirations should not be this difficult that we need a page dedicated to it.

nurseprnRN, BSN, RN · Mar 24, 2012

these are all going to get you resting respiratory rate, sure, but be sure you are also able to count accurately when the patient is up and walking, in pain, etc.

do not fall into the trap of the ward with synchronous ventilation :jester: . this is when the cna takes all the vital signs and everyone is, magically, breathing at 20 (or maybe in your establishment it's 18). this is a classic right out of the wonderful little book called "ritualistic practices in nursing," and is shorthand for "respirations normal and unlabored." you will also see on the patient's graphic chart that resps are remarkably stable over 24 hours. :clown:

once when i was a nursing aide i floated to a floor where the "normal" was not 18 but 20. i didn't know that, so all my patients were at 18. all hell broke loose. it was really ludicrous, and made me start thinking about why we didn't really count and chart what we found. other aides told me it was just because it took too long. really, a minute is too long?

think 20 resps per minute is ok? fine. take out your watch and make yourself breathe every three seconds for a full minute. fingers and toes tingly yet? can you say, "respiratory alkalosis"? people who are really breathing that fast are in trouble, generally.

if you want to cause a stir some peaceable afternoon, count actual resting resps (which are often in the 12-14 range, or less) and chart them. people get into a major tizzy. you can really make them crazy if you report resps of 10, because that seems to be the level when everyone panics about opioids. i am here to tell you that my perfectly healthy dh, age >65, has a resting resp rate of around 10 all the time. when i do my meditation, i count slow fifty breaths and then check the clock for how long it takes me. it's usually between 10 and 12 minutes, so that's about 4-5 bpm, and i am no model of physical fitness and do not pass out at this rate.

moral of the story: do the right thing. really count them. teach the aides to really count them.

nguyency77, CNA · Mar 24, 2012

if you can't chew gum and walk, you're in trouble in the real world..counting respirations should not be this difficult that we need a page dedicated to it.

Hey now... Let's not be discouraging. It's better that the OP is trying to learn, right? You wouldn't want to work with an NA that just makes up random vitals. If you are an RN and one of your patients dies/suffers a serious sudden change in their condition, and it's found that vitals were fabricated... Who's in trouble? We CNA typically aren't held as accountable as the RN is.

I try not to get the nurses I work with in trouble. I'm a nice CNA.

Cuddleswithpuddles · Mar 24, 2012

Ah, yes. That magical 20 respirations a minute. All the cool dudes are doing it. Why aren't you?

Another common trap that people make is to look at the set breath rate on ventilators. Not every ventilator seems to display the actual breath rate as prominently as the set breath rate. Also, they are machines and they make mistakes. Just recently, I had a patient on a ventilator who was struggling. I counted his breath rate in the 30s but the ventilator still had a big "12" on the screen for whatever reason. I called the RT, got the pt back to normal and replaced the vent and tubings. The aide took VS somewhere at this point. Her sheet still said 12 breaths per minute.

GitanoRN, BSN, MSN, RN · Mar 24, 2012

i always do the 30, unless i'm press for time the 15, needless to say, if the pt. is hyperventilating or the pt. is a copd i count the full minute. in addition, i never place my full trust on the bp machine when it comes to respiration's.

BostonTerrierLover, BSN, RN · Mar 25, 2012

Sounds like your undiagnosed and untreated ADHD like me:jester:That ADD Comercial came on (about the ADD brain being like a T.V. flipping channels to represent the ADD thought process), and my wife said:

"Wow, Baby that's just like you, huh?"

Me: "What?, . . .Huh?, ah baby I missed it.

Wife: "Nevernind."