472 The Nursing Assistant Copyright Goodheart-Willcox Co., Inc. Rationale Counting respirations involves measuring the number of inhalations and exhalations in one minute. A respiration rate that falls outside the normal range may indicate a health issue, medical disease, or condition. Preparation 1. Ask the licensed nursing staff how this procedure fits into the plan of care, if there are doctor’s orders for the procedure, if there are any special instructions or precautions, and if the resident can be moved into the positions required for this procedure. 2. Wash your hands or use hand sanitizer before entering the room. 3. Knock before entering the room. 4. Introduce yourself using your full name and title. Explain that you work with the licensed nursing staff and will be providing care. 5. Greet the resident and ask the resident to state his or her full name, if able. Then check the resident’s identification bracelet. 6. Use Mr., Mrs., or Ms. and the last name when conversing. 7. Explain the procedure in simple terms, even if the resident is not able to communicate or is disoriented. Ask permission to perform the procedure. 8. Bring the necessary equipment into the room. Place the following items in an accessible location: • a watch or clock with a second hand (not a digital watch) • a pen and pad, form, or digital device for recording the respiration rate The Procedure 9. Provide privacy by closing the curtains, using a screen, or closing the door to the room. 10. If the resident is in bed, lock the bed wheels and then raise the bed to hip level. 11. Ensure safety during the procedure. If the resident is in a bed with side rails, raise and secure the rails on the opposite side of the bed from where you will be working. Lower the rail on the side you are working. 12. Have the resident sit or lie down. 13. The best time to count respirations is immediately after counting pulse rate. It is best not to tell residents you are counting respirations. When residents know their breathing is being observed, they may alter their breathing patterns. Best Practice Depending on which pulse was taken, keep your fingers on the wrist or keep the stethoscope on the chest while counting respirations. 14. Begin counting respirations when the chest rises. Each rise and fall of the chest counts as one respiration. Note the regularity and depth of respirations, the expansion of the chest, and any pain or difficulty breathing. 15. Note the position of the second hand on your watch and count respirations for one full minute. Some facilities allow nursing assistants to count respirations for 15 seconds and multiply the result by four or count respirations for 30 seconds and multiply the result by two. Follow the facility policy. Counting respirations for one full minute should be done if the respiration is irregular. 16. Notify the licensed nursing staff immediately if the resident complains of pain or difficulty breathing. 17. Record the respiration rate on a pad, on a form, or in the electronic record. 18. If the resident is in bed, check to be sure the bed wheels are locked. Then reposition the resident and lower the bed. 19. Follow the plan of care to determine if the side rails should be raised or lowered. Follow-Up 20. Wash your hands to ensure infection control. 21. Make sure the resident is comfortable and place the call light and personal items within reach. 22. Conduct a safety check before leaving the room. The room should be clean and free from clutter or spills. 23. Wash your hands or use hand sanitizer before leaving the room. Reporting and Documentation 24. Communicate any specific observations, complications, or unusual responses to the licensed nursing staff. Counting Respirations Procedure