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.
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?
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:
Sometimes the pattern, while consistent in all patients, is not as pronounced.
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.
OK, you can take a deep breath now, we're done :)