Hi guys welcome back to NurseMinder. This is Tammy your host and today we're
talking about the respiratory rate, especially the tricky part - counting it
in your patients, because once they become aware that can be a little bit
harder to get a true response respiratory rate. So we're gonna talk about that right
after this. Welcome back my name is Tammy and this is NurseMinder and on this
channel we do everything nursing so if you're new here consider subscribing
below so that you get the next video and its released. Welcome back today we're
talking about the respiratory rate and how to gather that information from your
patient without them really knowing that you're watching for it. Now let me know
in the comments below if this sounds like something you've done before. You
maybe have noticed a family member sleeping on the couch or your spouse and
you're like oh my god are they even breathing? And you stare at them and you
try to see the rise in the fall of their chest or to hear the inhale, inhalation
exhalation. And it's a real panicked moment. Well we do that with our patients
too but we don't want to stare at them in fact we want to make sure they are
breathing. And so we might come in and do an assessment on them which would
include their vital signs and part of that vital sign assessment is doing a
respiratory rate. Now a normal respiratory rate is 10 to 20 breaths per
minute or 12 to 20 breaths per minute depending on the textbook that you are
using and the resource that you are using. And those numbers include a complete
rise and fall of the chest. Now in some patients this is super easy to identify.
They have a visible rise and a visible fall of the chest or you can hear that
sound. In other patients this can be quite tricky and it may require a few
different tricks so I'm going to show you some strategies later in the video.
Now the respiratory rate is one part of your respiratory system assessment and
when we're looking at the rate we're also looking
to see if it is a regular rhythm and that it's a predictable pattern, or an
irregular rhythm in that maybe we've got some fast, fast, fast, slow, absent, periods
of apnea maybe where there is no breathing - you want to count those
seconds if there is - and then all of sudden there's a big gasp and then fast,
fast, slow. So that would be like an irregular rhythm that we want to identify the
difference between regular and irregular. And the second piece to that is we want
to know how much effort are they having to utilize in order to get that breath
in. So labored breathing would look something like this.
What you're noticing there is hiking of the shoulders, mouth breathing, really heavy
rise of the chest and a fast pattern so there might be some labored work to it. Other pieces you
would be looking forward in the trachea you'd want to notice that there's any in
drawings, like that they're trying to work so hard that you see these
indrawing, nasal flaring, you'll see some shoulder hiking potentially and maybe
some in drawing of the muscles in the neck by the trachea, in the ribs-
intercostal spaces, or under the diaphragm under here. Now counting the
respiratory rate does become tricky when the patient is aware because once
somebody knows they're being watched they tend to focus on their breathing
and it becomes um not a regular rate for them, and so the tricky part is, as a
health care providers to get it when they don't know you're watching. Now when
it comes to the female patient there tends to be a little bit of awkwardness
around that because you feel like you're staring at the chest - but you don't have
to stare at the chest. Right? Now if your patients in bed, one of
the things you can do is take their pulse and you can either hold their hand
across their belly so you can palpate the pulse for 30 seconds and then feel
the respirations for the next 30; or you can keep their hand up in the air and as
you're doing that you're visualizing past. So you would be holding my pulse at
this point and after 30 seconds you just shift your gaze from the pulse just past
the hand and then you would watch the rise in the fall of the chest. And your
patient will think that your vision is still on the pulse because you only have
to look ever so slightly beyond it.
Time to practice
Now if you counted six breaths in 30 seconds you would be correct. Multiply
that by two and you can have 12 breaths per minute as your rate because this was
a regular unlaboured rhythm. Now tip number two is you may actually physically have
to put your hand on their chest to feel. Some of our patients that are sedated,
maybe they've got too much medication, they're sleeping really heavily, they've
got a disease process where they're not as alert and so maybe they're just
breathing shallow normally - put your hand on their chest to see if you can feel
the slight rise and fall and then count those. Now if the chest is too obvious
for your patient you can then maybe put your hand on their shoulder or the back
and just feel. And tip number three, if neither of those work, is to do it while
you auscultate the heart. So you just tell the patient you're going to listen
to their heart for a while - breathe normal - relax, and then while you're there
you can hear the inhalation and exhalation and count those cycles as
well. Now the respiratory rate is an important element of the respiratory
system assessment. It tells us whether or not the patient is breathing in the
normal parameter which is between 12 and 20 and that would be an expected rate
and with a normal volume in order to meet the needs of the body. Now I have
talked about lung volumes before in a previous video so I'll pop up a little
link here for you there so you can understand the importance of that volume.
And then we've also talked about measuring oxygen in an oxygen sat probe
video- so I'll pop that card up here as well for you - so you can identify if the
saturation is matching what you're seeing clinically. Now we always, always,
always treat the patient not the number. Now sometimes those machines on the wall
there will be some vibrations and it might be giving you an irregular number
on the machine, so you always want to check your patient first and assess them
manually. So there you have it the respiratory rate can be very tricky but
with these tips I think you're going to find greater success! :)