Assessing and accurately describing a patient's breathing pattern is a cornerstone of nursing practice. Respiratory changes can be an early warning sign of clinical deterioration, making this skill essential for patient safety. A thorough respiratory assessment provides valuable information about a patient's overall respiratory function and helps guide interventions. For nurses, this involves a methodical evaluation of the key characteristics of respiration, moving beyond just a simple count of breaths per minute.
The Core Elements of Respiratory Assessment
To effectively describe a patient's breathing pattern, nurses must assess four primary components during their clinical evaluation.
Rate
The respiratory rate, or the number of breaths per minute, is a fundamental metric. It is best to count for a full minute, especially if the rhythm is irregular or falls outside the normal range, without the patient being aware. Key terms for documentation include:
- Eupnea: Normal, relaxed, unlabored breathing. The normal range for an adult is 12 to 20 breaths per minute.
- Tachypnea: A rapid respiratory rate, typically over 20 breaths per minute in an adult. This can be shallow.
- Bradypnea: A slower than normal respiratory rate, usually fewer than 12 breaths per minute in an adult.
- Apnea: A temporary absence or cessation of breathing.
Rhythm
The rhythm of breathing refers to the regularity of the respiratory cycle. A healthy pattern is regular and uninterrupted. An irregular pattern, with inconsistent timing between breaths or pauses, may indicate an underlying issue. Abnormal rhythms often signal neurological problems or respiratory distress. Examples include Cheyne-Stokes and Biot's respirations.
Depth
The depth of a patient's respirations is observed by the degree of chest wall movement. This is described as shallow, normal, or deep. Extremely deep breathing can be a sign of the body's compensatory mechanisms, such as in diabetic ketoacidosis.
Effort
Observing the patient's breathing effort is critical for identifying respiratory distress. Effortless breathing, or unlabored respiration, is the norm. Signs of labored breathing include visible use of accessory muscles in the neck and shoulders, nasal flaring, or pursed-lip breathing. The tripod position, where the patient leans forward and supports themselves with their hands on their knees, is another key sign of respiratory distress.
Normal vs. Abnormal Breathing Patterns
Recognizing deviations from normal is a key nursing skill. The following table compares standard breathing (eupnea) with several clinically significant abnormal patterns.
| Assessment Category | Eupnea (Normal) | Tachypnea | Bradypnea | Kussmaul Respirations | Cheyne-Stokes Respirations | Labored Breathing Signs |
|---|---|---|---|---|---|---|
| Rate | 12-20 breaths/min (adult) | >20 breaths/min | <12 breaths/min | Varies, often rapid | Cyclical, periods of apnea | Varies, often increased |
| Rhythm | Regular, uninterrupted | Regular or irregular | Regular or irregular | Regular | Regular increases and decreases followed by apnea | Can be regular or irregular |
| Depth | Normal, full lung expansion | Shallow | Shallow or deep | Deep and rapid | Gradual increase and decrease | Varies, often shallow or deep to compensate |
| Effort | Unlabored | Varies, may be labored | May be minimal | Labored | Varies, often labored after apnea | Labored (accessory muscle use, nasal flaring, retractions) |
| Associated Condition | Healthy state | Fever, pain, anxiety | Opioid overdose, sedation | Metabolic acidosis (DKA) | Heart failure, stroke, brain injury | Asthma exacerbation, COPD |
Nursing Interventions Based on Breathing Patterns
After a thorough assessment, the nurse implements appropriate interventions to manage the patient's breathing difficulties. The actions taken depend on the specific abnormal pattern identified. Common interventions include:
- Patient Positioning: Elevating the head of the bed to a high Fowler's position can maximize chest expansion and reduce the work of breathing, especially for those experiencing dyspnea. The tripod position may be assumed instinctively by a distressed patient and can be encouraged.
- Oxygen Therapy: Administering supplemental oxygen, as prescribed, can correct hypoxemia. The nurse must ensure proper flow rates and patient comfort while monitoring the patient's response.
- Breathing Techniques: Teaching patients techniques such as pursed-lip breathing helps slow their respiratory rate and control their breathing.
- Airway Clearance: For patients with increased secretions, interventions may include suctioning, administering expectorants, or encouraging the use of an incentive spirometer to promote lung expansion.
- Managing Underlying Cause: Interventions often address the root cause, such as administering bronchodilators for asthma or managing pain and anxiety to reduce respiratory effort.
Documenting the Respiratory Assessment
Precise and detailed documentation of the respiratory assessment is critical for continuity of care and accurate communication among the healthcare team. The documentation should be specific about the location of any abnormal findings, the patient's overall respiratory status, and the response to interventions. For a normal assessment, a nurse might write: “Chest wall symmetric, with equal chest expansion. Respiratory rate 16, unlabored, regular rhythm, and normal depth. Lungs clear to auscultation bilaterally.”
When documenting abnormal findings, more detail is required. For example: “Patient presents with tachypnea, respirations 28/minute. Labored breathing noted with use of accessory muscles and nasal flaring. Lungs auscultated with bilateral expiratory wheezes. O2 saturation 93% on room air. Positioned patient in High Fowler's position and initiated supplemental O2 via nasal cannula at 2L/min.”
Conclusion
Knowing how to describe breathing pattern in nursing is an indispensable skill that allows for the timely identification of patient deterioration and the implementation of appropriate interventions. By systematically assessing and documenting the rate, rhythm, depth, and effort of respiration, nurses can provide comprehensive and responsive care. This foundation in respiratory assessment and documentation ultimately contributes to improved patient outcomes and reinforces the nurse's role as a vigilant advocate for patient health. The ability to identify subtle changes and respond effectively is what differentiates excellent nursing care and ensures patient safety. For further information, the National Institutes of Health provides extensive resources on abnormal respirations.
