Vitals

Radial Pulse: Are you palpating for the radial pulse on the inside of the wrist towards the thumb side? Are you pressing too hard? Try varying your position, and how hard you palpate for it.

Respirations: When palpating the radial pulse, try raising the pts hand to sit up across their chest--then you will feel the respirations. Or, place your hand on the patients back, or listen with your stethoscope.

Watch: Try getting a non-digital watch...ie one with a second hand. Then you watch the hand move, not watch the numbers change which could be why you're messing up your numbers.

Make sure you palpate on the thumb side and don't press too hard. Radial vein is off center. I always get pulses first and continue to act like I'm getting a pulse while I'm really getting respirations. If pt's know you're counting their respirations they get nervous and don't breathe as much or breathe too much. Remember to count for a whole minute and not 15 secs or 30 secs. HR isn't always regular. If respirations are hard to see because of too many blankets, put the pt's hand on their stomach. Each rise is a respiration.

This is excellent advice. In our school of nursing, we have the students determine the heart rate by auscultating the apical pulse for a full minute using the stethoscope at the PMI (point of maximal impulse - usually 5th intercostal space, midclavicular line). We consider this a much more accurate assessment of heart rate than the radial pulse, as the radial pulse may not always correspond accurately to the actual heart beats.

In terms of counting respirations, the suggestion for a watch with second-hand is great. I personally cannot use a digital watch for counting respirations. There are watches available with minute "timers" - You can set to "beep off" in exactly sixty seconds. This is a very helpful innovation also. For respirations, we also have our students count (in a nonconspicuous manner) for a full sixty seconds. This is done immediately after counting heart rate. I leave the stethoscope in place, so as not to alert the patient that I am counting his or her respirations. Placing the hand lightly on the chest will help determine when the person is actually taking in breaths, and this is better than observation alone.