Respiration Rate

[ecmb]

Will this be the dumbest question ever posted?

When I go to the doctor, they take blood pressure and pulse. I know they are not checking my pulse for the full 60 seconds like we were taught to do for the skills test. They do the 15 seconds and multiply by 4 probably. Also, I can never recall them checking my respiration rate but if they are they aren't doing that for a full 60 seconds either.

When taking the skills test, do we actually feel the radial pulse for a full 60 seconds and then write that down?

And then do we take the respiration rate for another 60 seconds and write that down? And what do we actually do while watching the patient breathe? I've been looking at the patient's clothing and watching for folds of fabric in their shirts or tops to move. Doesn't just staring at someone for a full minute bother them? If I tell them what I'm doing, they might alter their breathing pattern. If I don't tell them, what are they thinking? If I hold their wrist like I'm taking their pulse (again) wouldn't that seem odd?

[EricJRN, MSN, RN]

Best way is to hold the wrist with their arm against their chest so you can feel the rise and fall of the chest. Take the pulse for the first 15-30 seconds (or whatever your school/facility protocol is) then count the rise and fall for the next 15-30 seconds.

If you mention anything about breathing, you are likely to get an inaccurate respiratory rate. Staring is also not the way to go.

[NurseCubanitaRN2b, BSN, RN]

That's a good question, and I have an answer for that as a CNA and a VN student.....It is hard to take ones respirations, and most likely, they are taking your respiration a the doctors office....Some people are good at watching you while doing something else....I'm not one of them LOL....

Well anyway, as a CNA I can tell you that it depends on the situation on why you would take a full minute or or do the short cut 12 seconds X 4....For your patient is on respiration q1h, then take it for the full minute (mostly post operative patients) because most likely they have had medication that alters respiration pattern....What you might want to do is to also (this is more of a nursing procedure) see if their respirations are deep, shallow or whatever....They can be on medication that can't be given if their respiration rate goes below a certain number...Also a doctor might want the nurse to call him/her if the respiration rate is below that certain amount...

Now if you have a regular patient who's not under respirations q1h or there really is no concern for respirations, then take it for the 15 sec X 4.....You can still watch to see if it's deep or shallow, and if you see something that doesn't look right then double check yourself and do the full minute.

[casi, ASN, RN]

I always take respirations for a full 30seconds and multiply by two. If I get an abnormal number or notice and abnormal breathing pattern I always take the respirations for a full minute.

To me 15 seconds seems to short of a time to properly observe the patient's breathing pattern.

Also instead of looking, a lot of times I listen for respirations. I've also learned that if I throw an automatic BP cuff on a patient and a thermometer in their mouth I'm less likely to be staring creeply at the patient.

[ecmb]

We were told that when we are doing vitals DURING THE SKILLS TEST, we have to do pulse and respiration for full sixty seconds EACH - we can't do 30 and multiply by 2 or 15 and multiply by 4 for either pulse or respiration.

It just seems awkward to do it that way especially when it's a new skill and we aren't comfortable about it. I guess during the test I'll just stare at the "pretend patient" and do it anyway; awkward or not.

[shouldhavebeenanunRN]

and that my friends is the difference between IDEAL nursing and REAL nursing; as I was taught that CNAs cannot even take vitals for RNs. However, as a RN if I am counting someones apical pulse with a stethescope I count a full 60 seconds, esp., if giving a cardiac medication such as Digoxin. However, when taking q8h vitals as first member stated I do radial 15s x4 as do I take resp. rate. Note: If someone is struggling for breath and has 40-60 bpms YOU WILL NOTICE.. AS will you notice someone who has apnea (i.e. holds breath for extended period of time say 30s and then dramatically inhales, snores or otherwise struggles for intake), it isn't rocket science but I like the hand on chest after taking pulse to count respirations but another method is to put hand on upper back or watch for rise of stomach as you count if it helps... good topic for all beginning practitioners... nurses & aides!!

[rancelumsden]

See, not a dumb question!

You won't be doing this -----

[cjcsoon2bnp, MSN, RN, NP]

I actually asked this same question in my CNA class and here is what I was told. For state certification you have to introduce yourself and explain the procedure when your taking pulse and respirations. The pulse and respirations must each be done for the full 60 seconds and if you don't tell the patient that your doing them then you may fail the skill and thus fail the test. In real life you don't tell your patient your going to take their respirations because it will automatically make them change their breaking patterns. In real life you can take a 30 second respiration (multiplying by 2) and a 15 second pulse (multiplying by 4), this will not work on every patient but on many it will and it will be ok, but in the skills test everything must be done by the book. Good luck!

!Chris

[MochaRN424, ASN]

Thank you for asking this question...I also wondered how you are really supposed to count. I see the experienced nurses don't even look at their watches and come up with a count. I have learned to hold the wrist as if I am checking their pulse...but I still see at times the patient is looking at me for whatever reason lol while I am trying to watch the chest rise and fall. It is funny when the patient and other family members are looking to see what I am looking at. When I am done I tell the patient what I was doing...a lot of times everyone just laughs. Definitely not a dumb question