25. CCA Study Notes: Measuring, Assessing, and Reporting Respirations

The Big Picture

Breathing brings oxygen into the lungs and moves carbon dioxide out. One complete breath in and out counts as one respiration.

When measuring respirations, you look at more than the number of breaths. You also pay attention to the breathing pattern, depth, chest movement, discomfort, and unusual sounds.

A client might change how they breathe if they know you are counting. For this reason, respirations are counted without telling the client what you are doing.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

What Is Respiration?

Respiration means breathing air into the lungs and breathing air out of the lungs.

Breathing in is called inhalation. During inhalation, oxygen enters the lungs and the chest rises.

Breathing out is called exhalation. During exhalation, carbon dioxide leaves the lungs and the chest falls.

Key fact: One inhalation plus one exhalation equals one respiration.

What Normal Respirations Look Like

Normal respirations are:

• quiet
• effortless
• regular
• even on both sides of the chest

Both sides of the chest should rise and fall uniformly.

Shallow and Deep Breathing

The amount the chest moves helps describe the depth of breathing.

Shallow breathing: The chest moves only a small amount.

Deep breathing: The chest rises and falls a large amount with each breath.

Depth is one of the observations recorded after respirations are counted.

Normal Respiratory Rates by Age

Respiratory rates change with age. Infants and children have higher respiratory rates than adults.

Age	Respirations per Minute
Newborn	30-60
Infant	30-50
Toddler	25-32
Child and preadolescent, 3-12 years	20-30
Adolescent, 13-18 years	16-19
Adult, older than 18 years	12-20

Number to remember: A healthy adult normally has 12 to 20 respirations per minute.

Count an infant’s respiratory rate for 1 full minute.

Factors That Affect Respiratory Rate

Respiratory rate is affected by the same factors that affect temperature and pulse.

Infections, heart disease, and respiratory diseases usually increase the respiratory rate.

Count Respirations While the Client Is at Rest

Count respirations while the client rests.

Position the client so you have a clear view of the chest rising and falling.

A client has some control over breathing rate and depth. Knowing that someone is counting respirations might change the client’s breathing pattern.

For this reason, do not tell the client that you are counting respirations.

Count Respirations After Taking the Pulse

Respirations are counted right after the pulse.

Keep your fingers over the pulse site with the same pressure. The client then believes you are still checking the pulse while you watch the chest.

This approach helps reduce the chance that the client changes their breathing pattern while you count.

How to Count One Respiration

Watch the chest rise and fall.

Start the count as the chest rises. Finish that respiration when the chest falls.

One rise and one fall together equal one respiration.

Do not count the breath in and breath out as two separate respirations. That gives a false count.

When to Count for 30 Seconds

For regular respirations:

1. Count the respirations for 30 seconds.
2. Multiply the number by two.
3. Follow your employer’s policy.

Regular respirations do not change after 30 seconds.

When to Count for 1 Full Minute

Count respirations for 1 full minute when they are:

• abnormal
• irregular

A full-minute count gives a more accurate reading when the breathing pattern is abnormal or irregular.

What to Observe While Counting

While watching the client’s breathing, note:

• whether respirations are regular
• whether both sides of the chest rise uniformly
• the depth of breathing
• whether the client has pain or difficulty breathing

After counting, also report and record:

• respiratory rate
• depth, described as shallow, normal, or deep
• respiratory rhythm, regular or irregular
• pain or difficulty breathing
• respiratory noises
• abnormal respiratory patterns

What to Report

Report: Irregular findings must be reported immediately to your supervisor.

Irregular findings raise concern for illness or other health problems.

What to Record

Record the respiratory rate and your other observations and basic assessments on your notepad or assignment sheet.

After the procedure, report and record:

• your actions
• the time of day
• your observations
• your basic assessments

Follow employer policy.

Recording and reporting keep the health care team informed and serve legal purposes.

Counting Respirations: Procedure Order

The order matters.

1. Continue holding the client’s wrist after taking the radial pulse.
2. Do not tell the client that you are counting respirations.
3. Watch one complete rise and fall of the chest as one respiration.
4. Observe regularity, whether both sides of the chest rise uniformly, the depth of respirations, and whether the client has pain or difficulty breathing. Report any irregularities in these observations and basic assessments immediately to your supervisor.
5. For regular respirations, count for 30 seconds and multiply by two. Follow employer policy.
6. Count for 1 full minute when respirations are abnormal or irregular.
7. Record the respiratory rate and other observations and basic assessments on your notepad or assignment sheet.
8. Provide for the client’s safety and comfort.
9. Place the call bell within reach.
10. Perform hand hygiene.

After the procedure, report and record your actions, the time of day, and your observations and basic assessments according to employer policy.

The call-bell step does not apply in every community setting.

Supporting the Client During the Procedure

The procedure includes promoting:

• dignity
• independence
• individualized care
• preferences
• privacy
• safety

These remain part of providing quality care while measuring respirations.

Common Mix-Ups

Wrong Idea	Better Idea
One inhalation counts as one respiration.	One inhalation plus one exhalation counts as one respiration.
Count every respiration for 30 seconds.	Count abnormal or irregular respirations for 1 full minute.
Shallow breathing means the chest moves a lot.	Shallow breathing means the chest moves only a small amount.
Deep breathing means little chest movement.	Deep breathing produces greater chest rise and fall.
Tell the client before counting respirations.	Do not tell the client, because awareness might change the breathing pattern.
Respiratory rate is the only observation needed.	Also observe rhythm, depth, chest movement, discomfort, noises, and abnormal patterns.