The weirdness of taking Vitals Signs.

130tobe · Jul 7, 2013

Just take their wrist, tell them you are taking a pulse, look at your watch and watch their chest. If resps are normal and even, you should only have to count for 10 to 15 seconds. Hope that helps!

StanleyNickels, BSN · Jul 7, 2013

oh wow I didnt know that. I usually counted for a whole minute. thanks

akulahawkRN, ADN, RN, EMT-P · Jul 7, 2013

You don't necessarily have to look directly at the patient's chest either. Keep it in your relatively close peripheral vision and you'll be able to see it rise/fall easily. You can do other things than just "taking a pulse" but just make sure it's something that you can easily explain away and doesn't alert the patient to the fact that you're counting their breathing rate.

Another thing you can do is put their arm/hand on their chest or abdomen and "take the pulse" so that you can feel the chest rise/fall while you're looking at your watch which is conveniently located where you can watch that and see that rise/fall, if not feel it too.. and don't forget to actually take the pulse too.

Just make sure that the patient is not engaged in conversation with someone because that changes their breathing pattern. If they are, why not count number of words they speak before they take a breath? It's not something that directly measures breathing like a respiratory rate does, but if the patient starts becoming short of breath, it's additional information that your nurse may want to know/have.

There's lots of little tricks that you can use... just as long as you're doing things right, following policy, and results in the patient not realizing what you're doing. Heck, if you're standing back from the patient, you might be able to appear to do something in the room for a minute while you're counting respirations from 10 feet away.

blwilliams10 · Jul 8, 2013

You don't want your PT to know you are taking a resp rate because they can change it. What I do is act like I'm filling in my charts while actually using peripheral vision to count. Also you only need to count for 15 seconds and multiply by 4 unless it is an abnormal pattern then you will have to count a full minute. Eventually you become a master of this technique and it is really easy. Just experiment and find what works best for you.

fuzzywuzzy, CNA · Jul 16, 2013

I do it while "writing things down." You can also count them while taking the pulse if you're good at multitasking. Count the pulse in your head and and every time you see them breathe in press one of your fingers down a little. Then when you're done make a mental note of how many fingers you pressed down (my CNA instructor taught us that one).

SaoirseRN · Jul 16, 2013

Although really, if a patient is breathing well enough to notice you counting and change their rate because of it, chances are they are not having any difficulties with their breathing. Same with someone who is laughing or talking animatedly with you or a visitor and is not short of breath.

funtimes · Jul 17, 2013

You can check their pulse first, for say 15 seconds, then while you still have their wrist check their respirations. Of course you may be checking their pulse with the pulse ox, then you could just pretend to check their pulse while checking their resps.

Sometimes If need be I'll just tell them I'm going to check your pulse and breathing for a bit, so they don't feel creeped out. Yeah I know if you tell them your checking their respirations it might affect it, but sometimes its best to tell them if, for instance the person is bundled with blankets and you cant see their respirations and you want to explain why your pulling their blankets down, or you have a younger female patient and youre a male and they might get weirded out if they realize you're peeking at their chest while checking their pulse.

TheNoviceNurse16 · Jul 17, 2013

While I'm recording the vitals, I look at the pts chest in my peripheral view.. I only count for 15 seconds then multiply that by 4.

green34 · Jul 27, 2013

Through triaging, I found one of the most effective ways is when I am taking their temps. I just make them keep the thermometer in for 20 to 30 seconds. The patient will not feel the need to talk during this time and 90% of patients do not hold their breath when taking their temp. Some do in which case the pulse method works better for them, but then they may be talking to you the entire time.

IEDave, ASN, CNA, LVN · Jul 28, 2013

Me - I do the BP first, and depending on whether the cuff has a pulse sensor or not determines what comes next. If there's a pulse sensor I do the respiration count while the cuff's doing it's thing; if no pulse sensor I do the respiration count while I'm doing the radial pulse. Last thing I do is temp/pain, 'cause we use non-contact thermometers where I work.

When I'm dialed in & have the gadgetry to help I can get an accurate set of VS in about 20 secs; if it's all manual, probably 40-45 secs. I try to get the numbers as fast as I can to minimize pt. discomfort - keeps the other CNA's off my back as well.

One thing I saw last week while I was at a local "Doc in the Box" - pulse oximeter that did everything but make me a sandwich. BP, Temp, Pulse, Resp. - only thing the MA did was ask about my pain. No idea how accurate the gadget was, but she had full VS on me in about 10 secs. Sweet!

----- Dave

SweetCorn · Jul 29, 2013

I found that after some practice you get to recognizing what a patient who is 12-20 (most common range for me) looks and acts like and if a patient doesn't fall into that range, more time is spent analyzing the breathing patterns. It's those that don't fit into normal ranges that you want to catch and they usually present in a different way that stands out and many times their chief complaint (in the ER) matches breathing difficulties.

If they are having no difficulty breathing, then 15 seconds of assessment should be sufficient, * 4.