Respiration is the exchange of oxygen and carbon dioxide between the atmosphere and the body. External respiration, or breathing, occurs through the work of the diaphragm and chest muscles and delivers oxygen to the lower respiratory tract and alveoli.
Respiration can be measured according to rate, rhythm, depth, and sound. These measurements reflect the body's metabolic state, diaphragm and chest muscle condition, and airway patency.
Respiratory rate is recorded as the number of cycles per minute, with inspiration and expiration making up one cycle. Rhythm is the regularity of these cycles. Depth is recorded as the volume of air inhaled and exhaled with each respiration and sound as the audible digression from normal, effortless breathing.
The best time to assess your patient's respirations is immediately after taking his pulse rate. Keep your fingertips over his radial artery and don't tell him that you're counting respirations; otherwise, he'll become conscious of them and the rate may change.
Watch the movement
Count respirations by observing the rise and fall of the patient's chest as he breathes. Alternatively, position the patient's opposite arm across his chest and count respirations by feeling its rise and fall. Consider one rise and one fall one respiration.
Count respirations for 30 seconds and multiply by 2 or count for 60 seconds if respirations are irregular to account for variations in respiratory rate and pattern.
Observe chest movements for depth of respirations. If the patient inhales a small volume of air, record the depth as shallow; if he inhales a large volume, deep.
Observe the patient for use of accessory muscles, such as the scalene, sternocleidomastoid, trapezius, and latissimus dorsi. Such use indicates weakness of the diaphragm and the external intercostal muscles—the major muscles of respiration.
Adults with COPD will often lean forward and rest their hands on the bed or chair to improve their breathing (tripod position). This helps increase lung expansion.
Listen to the sounds
As you count respirations, watch for and record such breath sounds as stertor, stridor, wheezing, and expiratory grunting.
Stertor is a snoring sound resulting from secretions in the trachea and large bronchi. Listen for it in comatose patients and in patients with a neurologic disorder.
Stridor is an inspiratory crowing sound that occurs in patients with laryngitis, croup, or upper respiratory tract obstruction with a foreign body. (See How age affects respiration.)
Wheezing is caused by partial obstruction in the smaller bronchi and bronchioles. This high-pitched, musical sound is common in patients with emphysema or asthma.
To detect other breath sounds—such as crackles and rhonchi—or the lack of them, you'll need a stethoscope.
Watch the patient's chest movements and listen to breathing to determine the rhythm and sound of respirations. (See Identifying respiratory patterns.)
Respiratory rates of less than 8 breaths/minute or more than 40 breaths/minute are usually considered abnormal and should be reported promptly.
Observe the patient for signs of dyspnea, such as an anxious facial expression, flaring nostrils, a heaving chest wall, and cyanosis. To detect cyanosis, look for the characteristic bluish discoloration of the nail beds and lips, under the tongue, in the buccal mucosa, and in the conjunctiva.
When assessing a patient's respiratory status, consider personal and family history. Ask if he smokes and, if he does, the number of years and the number of packs per day. (See Documenting respirations.)
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