Respiratory Rate – Vital Signs (Nursing)

00:00 Let's talk about respiratory rate in our vital signs series. So if you remember the normal range here is 12-20 breaths per minute, so let's take a look. So taking a look at this image, we've got to think our movements during breathing. Now, the normal amount of inhaled air is about 500 ml. So when you're talking about a breathing pattern, there are 2 pieces.

00:27 Right? We've got inspiration where we have that big chest expansion and the diaphragm moving up and of course expiration where our diaphragm relaxes. So, when we're counting a respiratory rate, we've got to count the inspiration and expiration as one. So when we're looking at normal respiratory rate, this is going to range depending on the patient's age.

00:53 So if you take a look at this chart, look at how fast that newborn to 6 weeks breathe, 30-60 breaths per minute. And as you move down the chart and with the older adult, we're going to breathe about 12-20 breaths per minute. So you can see there's a wide variance here. So it is indeed important to know based on age and your population you take care of what's the normal respiratory rate range. So when we talk about ventilation, we're going to assess 3 things. We're going to assess the respiratory rate, how many breaths per minute. And this can be influenced by if we're running for example, our age, if we're ill, or there's injury or disease. We're also going to assess the depth; how deep we breathe, is this normal, or is it very very shallow. That could indicate there's an issue with the patient's breathing. Also the rhythm. There should be a regular ventilation rhythm when the patient's breathing and not irregular. Let's take a look at some factors that can influence the characteristics of respiration. Well, exercise of course is one. If the patient has experienced acute pain or anxiety. Also if there's a smoking history with your patient and even body position. So let's talk about this. So of course when you're thinking about exercise and you're exerting yourself, there is an increase in respiratory rate, how fast we're breathing, and the depth to meet that body's need for additional oxygen. Also if a patient's in acute pain, this can actually alter the rate and the rhythm of the respirations and they can even have some shallow breathing. Now, if a patient or if someone's experiencing anxiety, we can have an increase in respiratory rate and depth. Now if a patient has a past medical history of smoke or they currently smoke, you can have an increase in the respiratory rate at rest when they're not smoking. So now let's talk about body positions and this is important in nursing care because this is a non-invasive way to help improve respiratory system rate and oxygenation. So, if a patient's in erect, upright posture, we can promote full chest expansion which is ideal. Now if the patient is slumped over in their bed, this can impair some of their ventilator movement and that's not ideal. And occasionally a patient lying flat, sometimes that's indicated by the doctor but this does prevent full chest expansion. So keep these body positions in mind when you're talking about the patient's quality of breathing. So let's talk about some other factors that can affect respirations. Of course, medications is one. One that comes to mind is maybe opioids or some sort of pain medications. It can reduce our patient's respiratory effort.

03:49 Neurological injury can also affect our respirations. If certain areas of our brain are injured, it could indeed affect our respiratory control center and affect the patient's breathing.

04:01 And also, think about our hemoglobin function. If there's not a lot of oxygen in our blood, this can indeed affect our respirations as well. Let's look at this very long list of some alterations in breathing pattern. This is actually important to note for you as a nurse because this may indicate how we chart. So we have a normal breathing pattern which is what we hope to see in our patients. This is a 12-20 breaths per minute, it's regular and the patient has comfortable breathing. Now, you may see bradypnea which is less than 12 breaths per minute, meaning this is slow. You could have a patient with tachypnea, meaning it's fast and greater than 20 breaths per minute. Now, a patient could have indeed hyperpnea which is greater than 20 breaths per minute but what the difference is here we have labored breath and we have an increased in rate and depth. So that's different than just your typical tachypnea. Now, there are periods of apnea which is what we don't like as a nurse. This is where we have no respirations for several seconds. You may see this in a patient with maybe a sleep apnea, for example. That's where you may hear that word.

05:16 Sometimes a patient could do what we call hyperventilation where we have increased rate and depth of respiration. I know sometimes when I exert energy I may hyperventilate.

05:28 Hypoventilation is the opposite here. We have a decreased rate and depth of respiration.

05:34 You may also see some other critical things to key in as a nurse. One of this is what we call Cheyne-Stokes. This is an alternating pattern of depth separated with periods of apnea and hyperventilation. So the period may stop breathing for several seconds and then have a hyperventilation moment. This is called Cheyne-Stokes. Or, you may see a patient have Kussmaul's respiration where there are deep, labored, and there's an increase in rate.

06:03 And lastly, Biot's respiration is something else you may see where you have a couple abnormally shallow breath followed by irregular periods of apnea where there's no respiration for several seconds. So let's talk about how we assess a patient's respiratory rate. if you recall, a complete breath includes one inhalation and one exhalation. That is one.

06:28 So that's how we count. So we want to watch our client's chest rise inhale and fall exhale and count that as one breath. Now, as you're watching the client's chest note the quality, the depth, and the regularity of the patient's breath. Now to measure this rate, we want to count the number of breaths for an entire minute or 30 seconds and multiply that by 2.

06:55 Now, if the patient has abnormally regular rate or rhythm, we can usually count for 30 seconds and times by 2. But if a patient has some abnormal breathing patterns, I would count for a full minute. And of course, document the client's respiratory rate and their other vital signs. Here's one tip also I would like to talk about when you're talking about assessing a respiratory rate. It's really a good idea to maybe act like you're taking a patient's pulse and then watch the patient's chest. Sometimes if they know you're counting a respiratory rate, they may breathe differently. So if you can do this trick, that works straight as well.

07:39 Let's talk about how we assess a patient's respiratory rate. So we talked about completing a breath. If you remember, of course, it means one inhalation and one exhalation. So remember when you are counting a respiratory rate, we are watching our client's chest rise, inhale and exhale. And that is counted as one. So, as you're watching our client breathe, we are watching the client's quality and the depth and the regularity of breath. It should be unlabored and natural like Brandon's breathing here. And again, we're going to watch the chest rise and fall. Now, every time we see Brandon's chest rise and fall, we count that as one. Now here's just a little tip for you that I like to do with the patient. I will tell my patient, "Brandon, let me go ahead and take your radial pulse." So, what this does is have your patient relax. If your patient thinks that you're watching their breathing, sometimes they don't breathe very naturally so I will tell him "Hey Brandon I'm going to check your radial pulse here." And then while I'm doing a pulse, I'll watch their breath naturally rise and fall in their chest. And every inhalation/exhalation is counted as one. I'm going to do this for 30 seconds and then multiply by 2. Now, if the patient again has some irregular breathing, you're going to want to do this for a full minute. And then of course document the client's respiratory rate and their other vital signs in the electronic health record.