4-5. HOW DO I ASSESS A PATIENT'S BREATHING RATE AND QUALITY?

You normally assess the patient's breathing when you are taking his pulse. Take his pulse in such a manner that you do not need to move in order to observe his breathing also. The best position is the position shown in figure 3-3 A. If you are not to take his pulse also, observe his breathing when he is at rest (usually lying down) and not aware that you are observing his breathing.

a. Counting Breaths. When you finish counting the patient's pulse rate, count the patient's breaths (the rising and falling of his chest) before recording his pulse rate. Continue to hold his wrist as though you were still counting his pulse rate.

(1) Count the number of complete breaths (the sequence of inhalation and exhalation is one breath) that occur during a 60-second period.

(2) After you have practice, you can count the number of breaths that occur during 30 seconds and multiply that number by two. This procedure, however, can only be used if the patient's breathing is regular. If his breathing is irregular, count for the full 60 seconds.

b. Note Abnormalities. As you count the patient's breaths, look and listen for abnormalities (rapid or slow breathing, shallow or deep breathing, irregular breathing, noises, indications of pain, coughing, and so forth).

c. Record Breathing Rate and Quality. Record the number of complete breathing cycles per minute on your form or sheet of paper. The number can be either even or odd. Suppose your 60-second period began as the patient started to inhale. Also suppose that he had 15 complete breaths plus one full inhalation (no exhalation) when the 60 seconds expired. You would record his rate as "15" since only complete cycles (inhalation and exhalation) are to be counted.

d. Record Any Abnormalities. Record any abnormalities noted while assessing the patient's breathing.