You are assessing breathing. Which of these signs is just as important as the respiratory rate?

Author

Gail P. Mooney is a Lecturer at School of Health Science, University of Wales, Swansea.

The function of the respiratory system is to supply adequate oxygen to the tissues and to remove the waste product carbon dioxide. This is achieved with the inspiration and expiration of air. With each breath there is a pause after expiration.

Normal/ideal values

The rate of respiration will vary with age and gender. A respiratory rate of 12-18 breaths per minute in a healthy adult is considered normal (Blows, 2001).

Tachypnoea: the rate is regular but over 20 breaths per minute.

Bradypnoea: the rate is regular but less than 12 breaths per minute.

Apnoea: there is an absence of respiration for several seconds - this can lead to respiratory arrest.

Dyspnoea: difficulty in breathing, the patient gasps for air.

Cheyne-Stokes: respiration the breathing is shallow, very slow and laboured with periods of apnoea. This type of breathing is often seen in the dying patient.

Hyperventilation: patients may breathe rapidly due to a physical or psychological cause, for example if they are in pain or panicking. Hyperventilation reduces the carbon dioxide levels in the blood, causing tingling and numbness in the hands; this may cause further distress. In adults, more than 20 breaths a minute is considered moderate, more than 30 breaths is severe (Mallett and Dougherty, 2004).

Recording respirations

Respirations are recorded for a number of reasons:

To acquire a baseline;To monitor a patient with breathing problems;To aid in the diagnosis of disease;To evaluate the response to medication that affects the respiratory system.

When measuring and recording respirations the rate, depth and pattern of breathing should be recorded.

The depth (volume) of the breath is known as the tidal volume, this should be around 500ml (Blows, 2001).

The rate should be regular with equal pause between each breath. The rate can be irregular with disease of the respiratory system. Any irregularities should be noted and reported to the medical team.

When observing the respiratory rate, it is important to note the colour of the patient’s lips. They may be cyanosed (blue) or discoloured if the patient has respiratory problems. Cyanosis can also be observed in the nail bed, tip of the nose and ear lobes (Woodrow, 2005).

The patient’s oxygen saturation (SaO2) may be recorded using a pulse oximeter. This will provide an accurate reading of oxygenation in the red blood cells. Using a pulse oximeter may require the patient to have less arterial blood gases performed, by providing the medical team with a guide to the patients oxygenation level.

Observe the breathing: is the patient mouth breathing, pursing the lips on expiration, using the abdominal muscles or flaring the nostrils?

Nostril flaring in children and babies is indicative of acute respiratory distress (Field, 2000).

The respiratory rate is recorded along with other vital observation: pulse, blood pressure and temperature.

ProcedureExplain to the patient what you are about to do - even if the patient is unconscious;Ensure the patient is comfortable;Make sure the patient is as relaxed as possible;Observe if the patient is distressed in any way;It is best to monitor and record the respirations immediately after taking the pulse; this will aid in a more accurate recording, as the patient will not be aware that you are observing respirations. Awareness that

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alrighty thx

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