The Foundation of Respiratory Assessment in Nursing
Assessing a patient's respirations is a fundamental nursing skill, providing crucial insight into their overall health status. Unlike heart rate, which is an involuntary action, respiration is both involuntary and voluntary, meaning a patient can unconsciously alter their breathing if they know it is being observed. This is why nurses must perform the assessment discreetly, often immediately after checking the pulse, to obtain the most accurate reading of the patient's normal breathing pattern. A thorough respiratory assessment involves a systematic approach that includes inspection, palpation, and auscultation to gather both objective and subjective data.
Key Components of a Respiratory Assessment
To effectively describe respirations in nursing, clinicians focus on several key characteristics. Recording these observations accurately in the patient's chart is essential for continuity of care and for tracking any changes in condition over time.
Rate: The respiratory rate is the number of breaths a person takes per minute. A normal rate for a resting adult is typically 12 to 20 breaths per minute.
- Tachypnea: A rate greater than 20 breaths per minute.
- Bradypnea: A rate less than 12 breaths per minute.
- Apnea: The complete cessation of breathing.
Rhythm: This refers to the consistency of the breathing pattern. A normal rhythm is regular and uninterrupted. An irregular rhythm, with pauses or varying patterns, can indicate underlying health issues.
Depth: The depth of respiration is determined by the degree of chest and abdominal wall movement.
- Shallow: Minimal chest wall movement, often seen with pain or fatigue.
- Normal: Adequate chest excursion with each breath.
- Deep: Full lung expansion, seen during exertion or in conditions like metabolic acidosis.
Effort: The effort involved in breathing is a critical indicator of respiratory distress. Normal breathing is quiet and effortless. Signs of increased effort, also known as labored breathing, include:
- Use of accessory muscles (neck and shoulder muscles).
- Nasal flaring.
- Pursed-lip breathing.
- Tripod position (leaning forward to aid breathing).
Auscultating for Breath Sounds
Using a stethoscope to listen to the lungs (auscultation) is a vital part of a respiratory assessment. Normal breath sounds are soft, rustling vesicular sounds heard over most of the lung fields. However, the presence of adventitious (abnormal) sounds can signal a problem.
- Wheezes: High-pitched whistling sounds produced by narrowed airways, often heard during exhalation in patients with asthma or COPD.
- Crackles (Rales): Small, bubbling, or rattling sounds heard during inhalation, suggesting air moving through fluid-filled airways. Can be fine or coarse.
- Rhonchi: A low-pitched, continuous snoring sound caused by air moving through blocked or coarse airways, which may clear with coughing.
- Stridor: A high-pitched, sharp, inspiratory sound that indicates an upper airway obstruction and is a medical emergency.
Documenting Respiratory Findings
Accurate documentation ensures that all members of the healthcare team are aware of the patient's respiratory status. A typical notation might include the rate, rhythm, and quality. For example: “RR 18, regular, unlabored, and inaudible. Lungs clear to auscultation bilaterally”. In cases of abnormal findings, detailed descriptions are necessary: “RR 28, irregular, shallow, with mild intercostal retractions and bilateral inspiratory wheezes”.
Comparison of Normal and Abnormal Respiratory Patterns
| Assessment Category | Expected (Normal) Findings | Unexpected (Abnormal) Findings |
|---|---|---|
| Rate | 12-20 breaths per minute (Adult) | Tachypnea: >20 breaths/min; Bradypnea: <12 breaths/min |
| Rhythm | Regular, with consistent, uninterrupted cycles | Irregular (e.g., periods of apnea, Cheyne-Stokes) |
| Depth | Normal chest and abdominal excursion | Shallow: Decreased chest movement; Deep: Increased tidal volume (Kussmaul) |
| Effort | Quiet, effortless, and non-labored | Labored breathing, use of accessory muscles, nasal flaring |
| Symmetry | Bilateral, equal chest rise and fall | Asymmetrical chest expansion |
| Sounds | Clear to auscultation; vesicular sounds | Adventitious sounds like wheezes, crackles, rhonchi, or stridor |
| Skin Color | Pink lips, face, hands, and feet | Cyanosis (bluish tint), pallor |
Conclusion
Proficiency in knowing how to describe respirations in nursing is a core skill that directly impacts patient outcomes. A thorough and timely respiratory assessment, including evaluating the rate, rhythm, depth, and effort of breathing, provides the critical data needed to identify respiratory distress early. By documenting observations accurately and comparing them against a patient's baseline, nurses can effectively communicate changes to the healthcare team, ensuring appropriate interventions are initiated. Recognizing subtle changes in a patient's breathing can be the difference between a minor issue and a life-threatening emergency. Continuous learning and practice are essential to maintaining this crucial skill. For further resources, the National Institutes of Health (NIH) offers extensive information on vital sign assessment and respiratory care.
Note: It's crucial to remember that interpreting these findings requires clinical judgment, considering the patient's unique health history and baseline.
References
National Institutes of Health (NIH) | (.gov). (2023). Chapter 10 Respiratory Assessment - Nursing Skills - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK593192/
