Vital signs - Respirations: Nursing skills

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. Now, as a nurse, you need to be able to measure your client’s respirations and determine its characteristics, including the respiratory rate, rhythm, and depth of respiration and whether the respirations are quiet or noisy as well as easy or difficult.

Okay, respiratory rate refers to the number of breaths a client takes in one minute. Normal respiratory rate varies among different age groups. So, for adults, it’s typically between 12 and 20. For adolescents between 12 and 20 years old, normal respiratory rate is 15 to 20. For school-aged children between 5 and 12 years old, it’s from 15 to 25. For preschoolers from 3 to 5, it’s 22 to 34, while toddlers from 1 to 3 have a normal respiratory rate of 24 to 40. Finally, infants under 1 year of age normally have the fastest respiratory rate, which ranges from 30 to 60 breaths per minute.

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. So, 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.

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.

Now, during respiration, oxygen is exchanged for carbon dioxide in the lungs: a process 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 glucose gets too high.

All this can be also accompanied by dyspnea, or shortness of breath, where breathing gets difficult, uncomfortable, or even painful.

Now, when measuring a client's respirations, there are some common care tips you need to remember. First of all, 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.