› Respirations

Respirations

As a CNA, this is a pretty easy skill to master. Count the breaths, get a number and document it.  

As a nurse, you have more responsibility. You need to recognize some basic abnormal breathing. But first watch this short nursing video for review.

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Obviously, in this video, the CNA is saying “start” and “stop” for the sake of the evaluator and her being tested which is not to be done in a real clinical setting!

Begin by counting for one full minute. As you get comfortable with your practice, if the breathing is quiet and regular, many nurses take the respiration for only 30 seconds and multiply by 2 to get the rate per minute. 

The alcohol wipe trick seems a bit dorky to me. Not to mention that you have to watch the chest rise and fall. When a patient is in bed, it is easy to bend the patient’s arm and place it on their chest while you grasp their wrist to take a radial pulse. That way you can look at your wrist watch for timing and feel the rise and fall of the chest.

Similarly, if you are doing an apical pulse, with the stethoscope on their chest, count the apical pulse then the number of breaths while looking at your wrist watch. 

Sometimes just the simple act of putting a stethoscope on the chest makes the patient think you want him to breathe deep. (and noisy sometimes!)

If that occurs, simply tell the patient you are listening to his or her heart and they can breathe normally. That brings them back to a normal rate.

The hard part is remembering both numbers, pulse and respirations until you get to write it down.  

Occasionally you will have a patient who breathes with their abdomen expanding and contracting instead of the chest. Check before you actually start attempting to count by feel alone.

I would certainly hope you are practicing these simple skills until it is no big deal to walk into a real patient’s room and perform vital signs seamlessly. You are, aren’t you? 

nurse listening to apical pulse

Recognizing Abnormal Respirations

The trick is to remember a variety of abnormal sounds and rhythms  that as a nurse, you must recognize and report.

Understand that abnormal respirations are what you see and hear externally. Lung sounds, which will be covered on another page are what you hear through your stethoscope.

Some abnormal patterns are:

  • Cheyne Stokes: (how to pronounce). Usually seen in patients at “end of life” it is a gradual increase from shallow breathing deeper and deeper with each breathe then nothing. No breathing for 30 seconds to sometimes up to 2 minutes. You think the patient is gone but they aren’t. Here are two examples:

Sometimes the pattern, while consistent in all patients, is not as pronounced.


  • Paroxysmal Nocturnal Dyspnea: (how to pronounce paroxysmal, nocturnal and dyspnea) When a patient wakes up out of a sound sleep and has to sit up to catch their breath.
  •  Kussmaul Breathing: deep regular breathing of a patient in diabetic ketoacidosis 

  • Obstructive Sleep Apnea: (how to pronounce apnea) interrupted breathing  due to intermittant collapse of tissue in the throat.
  • Agonal breathing: (how to pronounce) shallow breathing pattern associated with cardiac arrest and  death. Mistaken often for normal breathing in an unconscious patient.

Terminology

  • Respirations: the act of breathing in and out.
  • Inspiration: the act of breathing in
  • Expiration: the act of breathing out
  • Dyspnea: (how to pronounce) difficulty breathing Dys = difficulty  -pnea = breathing
  • Labored Breathing: difficulty with breathing usually with use of accessory muscles of respiration in the chest wall, stridor, grunting, or nasal flaring.
  • Apnea: (how to pronounce)  absence of breath. A = absence  -pnea = breathing
  • Nasal Flaring: When the nostrils open during inspiration

Normal Rates

Anywhere  between 12 and 20 is considered normal at rest for the general population. As an interesting side note, when someone is meditating, the rate can go down to about 8 respirations per minute and be perfectly fine.

Lung sounds will be discussed on another page.

OK, you can take a deep breath now, we're done :) 

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