Tachypnea without dyspnea, interventions

[cloudtalk]

Hi all. I'm hoping you can help me out and tell me what you'd do in this situation. Sometimes I count a patient's respirations and arrive at a high number, like 30-40 breaths/minute at rest. But when I ask the patient they deny any shortness of breath or trouble breathing, they can talk just fine, and their spO2 is 100%. I feel odd recording the vital signs without any intervention, but I'm not sure if any intervention is needed, or why the respiratory rate is so high.

Also, my documentation ends up contradicting the data recorded by my coworkers, many of whom seem to record the respiratory rate as 18 every time. Part of me starts to doubt myself, like I'm counting wrong, but what could I be doing wrong? I look at the clock and watch the rise and fall of their chest. I also sometimes get a number that is a little low, like 10, with no other concerning signs, and again, I'm not sure what to do.

Should I put on oxygen, notify the MD, write "will continue to monitor", or what?

Any help or advice would be appreciated :)

[Here.I.Stand, BSN, RN]

Should I put on oxygen, notify the MD, write "will continue to monitor", or what?

Had the pt been up and moving before you came in? If so I'd reassess. If not, I'd give the doc a heads up and see if they want an xray and/or an ABG. I'd be concerned that 1) either he may be becoming alkalotic from that high rate or respiratory system attempting to compensate for a metabolic acidosis, or 2) he's starting to develop a pneumonia and just not feeling rotten yet.

No supplemental O2 needed for SpO2 >94%.

If all checks out ok, or if the MD just wants you to watch it, you can document that in your nursing notes.

[cloudtalk]

Thank you!! That actually might explain it - I work with dialysis patients, so they do tend to be a little acidotic before treatment. I was thinking maybe fluid overload might be a contributing factor as well. It just bugs me that I seem to be the only one who notices the elevated respiratory rates :/

[KatieMI, BSN, MSN, RN]

For dialysis guys:

1) metabolic acidosis they periodically live with

2) slight fluid overload (if they have even trace of basal crackles heard, it means 25% of lungs is out of the game)

3) COPD with emphysema and low ex/in/tidal volumes ("fish-on-the-shore" type of breathing)

4) and most important: 80+% of them are on b-blockers. Which will block tachycardia, if it is there.

And

5) anyone above age of 70, even totally healthy otherwise, has 30% of lungs out of the game due to age-related changes. Your guys are not healthy and have to make do with less, so they work harder.