Vital Signs, Height, and Weight 361 It is best to count respiration rate with no warning immediately after pulse is taken. This way, the resident is breathing as he or she normally would. After taking the pulse, switch to counting respirations without mentioning the change to the resident. A resident who knows his or her respirations are being counted may subconsciously change his or her breathing, giving an inaccurate result. Observing how well a resident is breathing is just as important as determining the number of breaths. When counting respirations, also observe the following: • Is the breathing regular or irregular? • Is the resident experiencing hyperventilation (deep, rapid breathing) or hypoventilation (slow, shallow breathing)? • Is the breathing rapid (called tachypnea), deep and labored (called dyspnea), or unusually slow (called bradypnea)? • Is the breathing noisy like snoring (called stertorous breathing)? • Are there periods of no breathing at all (called apnea)? What Is the Rate of Respiration? The rate of respiration is the measurement of a resident’s breathing cycle (inhalation followed by exhalation). Respiration rate helps determine a resident’s level of blood oxygenation, or how well oxygen is supplied to body cells. Respiration rate also provides information about conditions such as asthma, heart disease, and even infections. A normal adult respiration rate is 12–20 breaths per minute. To determine the rate of respiration, document the number of full breaths (each rise and fall of the chest) taken in one minute. Typically, this involves counting respirations for 15 seconds and multiplying the result by four. Some healthcare facilities require nursing assistants to count respirations for 30 seconds and then multiply the result by two. If respirations are irregular, the nursing assistant should count the number of full breaths for one full minute using a watch with a second hand. Procedure Counting Respirations Rationale Counting respirations involves measuring the number of inhalations and exhalations in one minute. A respiration rate that is outside the normal range may be a sign of 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 easy-to-reach place: • a watch or clock with a second hand (not a digital watch) • a pen and pad, form, or digital device for documenting 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. Maintain safety during the procedure. If the resident is in a bed with side rails, raise and lock 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. (continued) Copyright Goodheart-Willcox Co., Inc.