Key Takeaways
- Normal adult respirations are 12-20 breaths per minute
- Do not tell patient you are counting respirations (they can control breathing)
- One breath = one inhalation + one exhalation
- Report tachypnea (>24), bradypnea (<10), labored breathing, or cyanosis immediately
- Normal oxygen saturation (SpO2) is 95-100%
Respirations Measurement
Respirations refer to the act of breathing—taking air into the lungs (inhalation) and releasing it (exhalation). CNAs count respirations and observe breathing quality to assess respiratory function.
What to Assess
| Characteristic | What to Note |
|---|---|
| Rate | Number of breaths per minute (normal: 12-20) |
| Depth | Shallow, normal, or deep |
| Rhythm | Regular or irregular pattern |
| Quality/Effort | Easy, labored, noisy |
One respiration = one inhalation + one exhalation
Normal Respiratory Rates
| Age Group | Normal Rate (breaths/minute) |
|---|---|
| Newborn | 30-60 |
| Infant (1-12 months) | 30-40 |
| Toddler (1-3 years) | 24-30 |
| Preschool (3-6 years) | 22-24 |
| School age (6-12 years) | 18-22 |
| Adolescent (12-18 years) | 12-20 |
| Adult | 12-20 |
| Elderly | May be slightly higher |
Measuring Respirations
Key Point: Do NOT tell the patient you are counting respirations. People can consciously control their breathing, which will affect the count.
Technique:
- Keep fingers on radial pulse site (patient thinks you're still counting pulse)
- Count each rise and fall of chest as ONE breath
- Count for 60 seconds (or 30 seconds × 2 if regular)
- Note depth, rhythm, and quality
- Record findings
What to Watch:
- Rise and fall of chest
- Rise and fall of abdomen
- Sound of breathing
- Use of accessory muscles (shoulders, neck)
Abnormal Breathing Patterns
| Term | Description | Possible Cause |
|---|---|---|
| Tachypnea | Fast breathing (>24/min) | Fever, pain, anxiety, respiratory disease |
| Bradypnea | Slow breathing (<10/min) | Overdose, brain injury, sleep |
| Apnea | No breathing | Emergency—call for help immediately |
| Dyspnea | Difficulty breathing | Heart failure, asthma, COPD |
| Orthopnea | Difficulty breathing lying flat | Heart failure, severe COPD |
| Cheyne-Stokes | Cycles of deep/shallow breathing with apnea | Brain injury, heart failure, approaching death |
Signs of Respiratory Distress
Report these signs IMMEDIATELY:
Visual Signs:
- Flared nostrils
- Pursed lip breathing
- Using neck/shoulder muscles to breathe
- Retractions (skin pulling between ribs)
- Cyanosis (blue color to lips, nailbeds)
- Sitting up and leaning forward
Sounds:
- Wheezing (whistling sound)
- Stridor (harsh, high-pitched sound on inhalation)
- Gurgling (fluid in airway)
- Gasping
Patient Complaints:
- "I can't breathe"
- "I feel like I'm suffocating"
- "I can't catch my breath"
Factors Affecting Respirations
| Increases Rate | Decreases Rate |
|---|---|
| Exercise | Sleep |
| Fever | Some medications (opioids) |
| Anxiety/fear | Brain injury |
| Pain | Deep relaxation |
| Respiratory disease | |
| Heart disease | |
| High altitude |
Oxygen Saturation (SpO2)
Pulse oximetry measures oxygen saturation in the blood using a small sensor clipped to the finger or earlobe.
Normal SpO2: 95-100%
| SpO2 Level | Interpretation |
|---|---|
| 95-100% | Normal |
| 91-94% | Mild hypoxemia—report |
| 86-90% | Moderate hypoxemia—report immediately |
| Below 85% | Severe hypoxemia—emergency |
Factors Affecting Accuracy:
- Cold hands (poor circulation)
- Nail polish (dark colors)
- Artificial nails
- Movement
- Poor perfusion (low blood pressure)
Documentation Examples
Normal: "Respirations 16, regular, unlabored" Abnormal: "Respirations 28, shallow, labored with accessory muscle use. SpO2 92%. Nurse notified immediately." Emergency: "Patient reports difficulty breathing. Respirations 32, labored. Lips appear dusky. Nurse called STAT."
Why should you NOT tell the patient you are counting respirations?
What is the normal respiratory rate for an adult?
A patient has a respiratory rate of 28 and is using neck muscles to breathe. What should you do?