Counting resps in a neonate

psychonaut · Dec 28, 2009

Is there anywhere in particular that you look while you are counting??

The monitor? I kid, I kid.

Getting a resting RR in a heavily swaddled kid may be tough...I've lightly laid my hand on their trunk to feel the resps through the swaddle.

Honestly, I usually go ahead and open them up, let them fuss, change them, and settle them with a paci to get a count watching chest/belly movement. Counting during auscultation is even better.

prmenrs, RN · Dec 28, 2009

I put my hand on the baby, outside the blankets. The baby may squirm, but will usually settle down, wait til I can discern the resps, start counting, go for 30 secs. If they really wake up, you're toast. Just wait til later. After the feeding, diaper change, hold the baby til s/he goes to sleep, then get your RR.

Sometimes, you can sneak your hand in the blankets closer to the baby's body, that makes it easier.

In any case, it gets easier w/practice.

TakingCareOfBabies · Dec 29, 2009

I gently slip my hand in and rest it on their trunk and count for 60 seconds. If they are restless or upset, I do my cares first, get them settled and do the resps at the end when they are rested and comfortable. Hope this helps!

NJNICUCCRN · Dec 29, 2009

I agree with all the above. Sounds like we are all doin it the same.

AussieTina · Dec 29, 2009

Thankyou for your replies.

That is what I was doing as well, or I was counting after I auscultated the heartbeat.

Older more experienced neonatal nurses however were telling me to do the resps before I touched the babe, so I got a bit confused. I can't really ask them for advice as they have been rather unaproachable when I asked for help in the beginning of my working here.

Love_2_Learn · Dec 29, 2009

I usually lay my hand gently on the wrapped baby as the others have mentioned and then count for a full minute.

Another option that I have used is to place the stethoscope just under the baby's nose and you can hear each respiration as they breathe out. You don't have to touch the baby at all to do this. I learned this from a nurse practitioner years ago.

I agree it is best to count the respirations before laying the stethoscope on the baby to do their heart rate. It's more accurate of their rate when at complete rest.

I remember in nursing school learning that before I touch any patient I should first use my eyes, ears and nose to assess the room and patient. Nose to sniff for odd smells, ears to listen for odd sounds, eyes to look for position, signs of pain on their face or guarding, and for looking at their color, etc. before actually touching the patient. Seems to have been a helpful routine for me over the years whether caring for babies or adults.

I also like to know the respiratory rate is less than 60-70 before feeding a baby so I really try hard to get accurate respiratory rate before beginning the feeding.

Hope this helps in some way.

TiffyRN, BSN, PhD · Dec 31, 2009

When our NICU infants are rooming in to go home they most likely are not on monitors. I like to loosen enough covering to slip a warmed stethescope onto the infant's chest then auscultate the lungs, heart and count HR & RR. I can't tell you how many times I've caught a heart murmur that is subtle or intermittent by auscultating for a full minute or more, which I can't say I typically do with regular NICU patients. Keeping the infant calm can sometimes be challenging but pacifiers are very useful.