Vital Signs in the Ambulatory Setting: An Evidence-Based Approach Cecelia L. Crawford, RN, MSN

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Vital Signs in the Ambulatory SettingAn
Evidence-Based ApproachCecelia L. Crawford, RN,
MSN

• How to Measure Respirations

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Respiration Measurement - An Overview

• Equipment for accurate respiratory measurement
• Watch or clock with second hand or digital second
  counter
• Stethoscope
• Pen or pencil
• Flowsheet, chart, or medical record
• Clean hands and fingers!
• Patient in a comfortable relaxed position
• Waited 5 minutes if patient was active
• Enough time to count the respiratory rate

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Respirations Its All About The Numbers!

• Terminal Digit Preference
• Some people may show a preference for certain
  numbers in respiratory rate readings
• Zeros, even numbers, odd numbers
• Be aware you might like certain numbers more
  than others!

(Roubsanthisuk, W., Wongsurin, U., Saravich, S.,
Buranakitjaroen, P., 2007)
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Respiratory Rate Procedure

1. Wash hands put on gloves, if appropriate
2. Provide privacy
3. Assist patient to a comfortable relaxed position

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Respiratory Rate Procedure

• 4. Position patient for clear view of chest
  movement
• 5. Place patients arm or your own hand in a
  relaxed position across stomach or lower chest
• 6. Observe a complete respiratory cycle
• An inhale and an exhale

http//www.lane.k12.or.us/CSD/CAM/level1/ASSESS
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Respiratory Rate Procedure

• 7. Count for 60 sec
• Full minute count for
• Children
• Irregular respirations
• Very fast or very slow respirations
• 8. Count for 30 sec and multiply X2
• Shorter time counts inaccurate data

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Normal Respiratory Rates
AGE BREATHS/MIN
Newborn to 6 weeks 30 - 60
Infant (6 weeks to 6 months) 25 - 40
Toddler ( 1 to 3 years) 20 - 30
Young Children ( 3 to 6 years) 20 - 25
Older Children (10 to 14 years) 15 - 20
Adults 12 - 20
(Mosbys Critical Care Nursing Reference, 2002
Perry Potter, 2006)
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Respiratory Rate

• 9. Pediatric patients
• If panting, use stethoscope to count
• Agitation can result in inaccurate RR

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Respiratory Rate Procedure

• Respiratory rates are NOT a reliable way to
  determine low oxygen levels!
• RN and MD assessment is needed

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Respiratory Rate Procedure

• 10. Inform the RN or MD for
• Difficult to count respirations
• Very fast or very slow breathing
• Irregular breathing
• If patient seems to be having trouble breathing

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Respiratory Rate Procedure

• 11. Discuss respiratory rate with patient or
  parent
• 12. Remove gloves wash hands

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Respiratory Rate Procedure

• 13. Document the Results
• Flowsheet, clinic record, or clinic chart
• 14. Communicate the Results
• RN
• MD

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Respiratory Measurement in the Clinic

• YOU can make the difference
• Welcoming presence
• Decrease any anxieties fears
• Reassure patients family
• Accurate vital signs