Measuring respiration: Clinical skills notes





Measuring Respiration

Breathing, also known as respiration, is how the air moves into and out of the lungs. It consists of repetitive cycles of inspiration, which is when air full of oxygen flows into the lungs, and expiration, when the air along with carbon dioxide leaves the lungs. In order for this cycle to happen, there are respiratory centers within the brain that control breathing. These centers receive information from a group of receptors, known as chemoreceptors, which detect any changes regarding the oxygen and carbon dioxide concentration in the body. As a nurse, you need to be able to measure your clients' respiration and determine its characteristics, including the respiratory rate and rhythm, depth of respiration, and level of noisiness and strenuousness.
Respiratory rate refers to the number of breaths a client takes in one minute. Normal respiratory rate varies among different age groups.
  • Adults: 12–20 breaths per minute (bpm)
  • Adolescents (12–20 years old): 15–20 bpm
  • School-aged children (5–12 years old): 15–25 bpm
  • Preschoolers (3–5 years old): 22–34 bpm
  • Toddlers (1–3 years old): 24–40 bpm
  • Infants (< 1 year old): 30–60 bpm

Besides age, the respiratory rate can also be influenced by many factors, including physical activity; body temperature; emotions, like anger, fear, or stress; medications; smoking; certain diseases of the heart or lungs; or even the weather! A client can also voluntarily choose to increase their respiratory rate or hold their breath and, thus, decrease their respiratory rate.

Tachypnea is when the respiratory rate is faster than normal, and this can occur in response to strenuous exercise, fever, pain, anxiety, or specific medications. In contrast, bradypnea means that the respiratory rate is too slow and can be due to respiratory problems or various medications.
Figure 1: Respiratory rate factors.  
Another important characteristic is the respiratory rhythm, which is normally regular, meaning that the intervals between the breaths are approximately equal. In an irregular rhythm, the breaths do not follow an even tempo and some of them might even be skipped. This can be a result of lung problems or a complication of a stroke or brain damage. 
During respiration, oxygen is exchanged for carbon dioxide in the lungs; this process is called ventilation. Normal ventilation keeps the body in balance because the amount of carbon dioxide removed by the lungs is equal to the amount the body produces.

Hypoventilation, or breathing that is too shallow or too slow to meet the needs of the body, means that the lungs can't keep up with the carbon dioxide the body produces, so the level of carbon dioxide in the body rises, and there is not enough oxygen. Hypoventilation can be caused by prolonged bed rest, if a client is reluctant to breathe normally when breathing causes pain, or by an overdose of certain drugs. 

On the other hand, during hyperventilation, which is breathing that is too fast or deep, carbon dioxide is removed faster than the body produces it. Hyperventilation happens normally during exercise but also can be caused by extreme fear or anxiety or when a diabetic client's blood sugar gets too high.
Figure 2: Hypoventilation vs. hyperventilation. A. Hypoventilation leads to accumulation of CO. B. Hyperventilation leads to loss of CO2
All this can be also accompanied by dyspnea, or shortness of breath, where breathing gets difficult, uncomfortable, or even painful.
  • You can count the number of respirations by looking at the client’s chest rising as they take a breath in and falling as they breathe out. 
  • Some clients, particularly young children and the elderly, use the muscles of the abdomen predominantly to help them with breathing. For these clients, you can look at the movements of the abdominal wall. In any case, one rise or inhalation plus one fall or exhalation equals one breath.
  • It may help to bend down a little bit so that you can position yourself at the level of the client's chest or abdomen.
  • Another thing you can do, especially with clients whose respiratory movements are subtle, is to position your hand over their chest or abdomen so that you can feel it rise and fall.
  • The client should not be aware that you're counting their respirations until after you're done so that they don't modify their respiratory rate. The best way to do that is to measure the respiration right after you've measured pulse rate and while you still keep your finger on their radial artery. In this way, they'll think you're still counting their pulses. Another good idea would be to count respirations while they're asleep.
Figure 3: Measuring respiratory rate procedure. 
Gather the supplies you’ll need, including a watch that can count seconds. Remember to also practice hand hygiene.
  1. Assist the client into a comfortable position. Make sure that their chest or abdomen is visible. You can then look or place your palm on their chest or abdomen and feel for the rises and falls. 
  2. Count the first breath, or full cycle of breathing in and out, as zero. The second breath is one, the third breath is two, and so on. 
  3. Measure the number of breaths in a full minute. A full minute of respiration needs to be counted in infants, too. While you count, notice whether respirations seem shallow or deep. 
  4. When you’re done, assist the client back into a comfortable position. 
  5. Practice hand hygiene.
When measuring a client’s respiration, you should report abnormal breath sounds or any signs and symptoms of respiratory distress to the healthcare provider.

Remember to document:
  • the date and time 
  • the respiratory rate, rhythm, and depth 
  • your observations

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