CNA Skill: Counts & Records Respiration Rate

Respiration rate is measured to determine the number of times per minute a person breathes.  Changes in the respiration rate may indicate a more serious condition, or can indicate when a patient is experiencing too much stress.  A patient who is told that you will be measuring his/her breathing will often unknowingly change the pattern of their breathing causing irregular or shallow breathing to occur.  The best time to check the respiration rate is right after taking the patient’s pulse.  To determine the respiration rate, follow these steps:

  • Observe the patient as they breathe, and count each rise and fall of the chest as one respiration.  Count the breaths for one minute, paying attention to how deeply the person breathes.
  • Look for any use of accessory muscles for breathing, or signs of labored breaths.  If you see any signs that the patient is having difficulty achieving regular, deep breaths, notify the nurse.
  • Record the respiration rate on the patient’s chart as directed.
  • Wash your hands properly.

There are several causes of abnormal respiration rates.  For most adults, the respiration rate is between twelve and eighteen breaths per minute.  A patient who is resting or laying on his/her back may breathe more slowly.  Use of certain narcotic drugs can depress the respiration rate, resulting in fewer breaths per minute.  An unusually fast respiration rate may indicate pain or stress, or may result from strenuous activity or stress.  If the patient has a high temperature (fever) as the result of an infection, they may also breathe more rapidly.  Patients who are having a heart attack will also breathe more quickly.  Other conditions including respiratory distress, increased fluid levels, or asthma may also cause rapid respiration.  Breathing is a fundamental requirement for life, and by paying attention to a patient’s respiration rate, you will be able to spot early signs of distress and may be able to provide vital care more quickly.

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Examiners Checklist For This Skill

1) Positioned hand on wrist as if taking the pulse as appropriate.
2) Determined whether to count for 30 seconds or 60 seconds.
3) Counted respirations for 30 seconds and multiplied the count by 2; or for one minute if irregular. Student must tell when to start and end count.
4) Recorded the respiratory rate within + or – two respirations per minute of respiratory rate recorded by evaluator.
5) Performed completion tasks.

Expert Tip By Tanya Glover, CNA

Breathing is obviously very important and we want to make sure that our patients are doing it properly! This is why ensuring that respiration counts are done properly and recorded. If something is incorrect it must be reported to the hall nurse immediately. Though it is told to you in your training class that you should do this skill by counts of 30 multiplied by 2, in the workplace it is typically acceptable to use counts of 15 multiplied by 4.

Counting respirations can be a challenge since you do not want to have to put your hand on the patient’s chest every time. However, for some this is the only way to get an accurate count. So, there are two options when you are working:

  1. Watch their chest as it rises and falls
  2. Place your hand on their chest or abdomen and count this way

How you do it depends on your own skill and what condition the patient is in.

When performing this skill on your exam, make sure that you really do a good count. Know what the proper numbers are before beginning because if you give an outrageous number, your instructor will come behind you and do their own count. When it comes to vitals, nothing can be faked because you can be proven wrong in a shake of a lamb’s tail! If you are having trouble getting a right count, tell your instructor that you are having a problem. Maybe you are just nervous. If so, take your own deep breath and begin counting again. Do not make the mistake of guessing the number or you will fail this skill and possibly the entire exam.

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