Assessing respiration: Rate, Rhythm, and Effort

Hand Hygiene and Patient Privacy

  • Perform hand hygiene before any patient interaction.

  • Ensure patient privacy throughout the assessment.

Introduction to the Patient

  • Introduce yourself to the patient, e.g., "Alright, Leonard."

  • Identify the patient using two identifiers.

    • Request the patient to show their ID band.

    • Ask for the patient's first name, last name, and date of birth.

Example Interaction

  • Patient: "Michael Williams. January 23, 1961."

Factors Affecting Respiration

  • Assess factors that may affect respiration:

    • Exercise

    • Anxiety

    • Acute pain

    • Smoking

    • Medications

Positioning the Patient

  • Raise the bed and the head of the bed to an elevated position (45 to 60 degrees).

  • Ensure the patient's chest is visible by adjusting bed, linen, or gown as needed.

  • Help the patient relax and lay on their back.

  • Position the patient’s arm:

    • Across the lower chest or upper abdomen for assessment.

    • Alternatively, place your hand directly over the chest area.

Assessing Respiratory Rate

  • Observe a complete respiratory cycle (1 inspiration + 1 expiration).

  • Note the start time when the second hand reaches a number or when the digital display shows a round number.

  • Count the respiratory rate:

    • If the rhythm is regular: Count for 30 seconds, then multiply by 2.

    • A normal respiratory rate ranges from 12 to 20 breaths per minute.

    • If irregular or outside the normal range, count for a full 60 seconds.

Note Respiratory Characteristics

  • As you count:

    • Observe the depth of respiration based on chest wall movement.

    • Alternatively, palpate the chest wall or auscultate the posterior thorax after counting.

  • Describe the depth:

    • Shallow

    • Normal

    • Deep

  • Note the respiratory rhythm:

    • Should be regular and uninterrupted except for occasional sighs.

  • Look for signs of dyspnea and ask about any shortness of breath:

    • Have you had any breathing problems?

Example Response

  • Patient: "No."

  • Assessment: "Your respiratory rate was 16, which is within the normal range."

  • Ensure the patient is comfortable after assessment.

Follow-Up Assessment

  • Compare the patient’s current respiration with their previous baseline.

  • Examine the rate, depth, and rhythm against their usual patterns.

  • Correlate respiratory values with:

    • Pulse oximetry readings.

    • Arterial blood gas measurements (if available).