Breathing

Why does the patient’s/client’s breathing (respirations) need to be checked?

The rate and character of the respirations gives us important insights into people’s general health status. In addition, breathlessness is a very distressing symptom for many people, and it’s important that we are skilled in assessing breathing (respiration) to identify problems early and deal with them. More dramatically, absence of breathing is often the most obvious sign that  a patient has had a collapse and requires immediate basic life support.

When should I check it?

The frequency of checking will vary according to the person’s health state. People with known lung disease may require their respirations to be assessed more frequently than others. Also, those who are perhaps more susceptible to developing chest infections – people with long-term lung conditions, those who smoke tobacco regularly and people who have physical disabilities that inhibit their breathing or who are inactive or bed-bound – will benefit from having their respirations assessed regularly as a means of identifying early signs of problems. The times to check the respirations will be set out in the patient’s/client’s care plan.

How do I check it?

Have a look at our animation on how to assess respiration. It is helpful to assess this when the person is not concentrating on their breathing. It may be useful to observe the breathing rate after taking the pulse while your fingers are still in position.

What do my findings mean?

There are many factors that affect the respiratory rate: age, gender, size and weight, exercise, anxiety, pain, the effect of some medicines, smoking habits and excitement level are among them. A ‘normal’ respiratory rate for a man is about 14 to 18 breaths per minute and for a woman 16 to 20 breaths per minute, but it’s more important to know what is ‘normal’ for the individual, and to assess changes from that level.

Some possible findings are:

  • deep and rapid breathing, which may suggest anxiety
  • shallow breathing, which can be brought on by some medicines
  • minimal chest movement, sometimes seen in asthma
  • the person struggling for breath, characteristic of long-term lung disease or the sudden onset of a new lung or heart problem
  • mouth breathing, which might indicate a blocked nose
  • pain on breathing, which could indicate a cracked rib, chest infection or a tumour in the lung
  • noises on breathing: normal breathing is practically soundless, so noisy breathing – whether it is wheeze, crackles or gasps – can indicate a problem
  • delayed breaths, where the time span between breaths varies: this can be a normal sign in older people, but could also indicate problems with the heart or brain.

Normal and abnormal breathing

The patient’s/client’s skin colour is also important as an indicator of how well their respirations are working. Patients/clients who are not getting enough oxygen can develop a bluish tinge called ‘cyanosis’ which can be seen in their skin, nail beds, earlobes and the lining of the mouth (in people with dark skin, it’s most noticeable in the lips and nail beds, which become dusky). Some people who’ve been living with lung disease for a long time may have this appearance almost as a ‘normal’ state, but the sudden appearance of cyanosis should be reported immediately as an emergency.

Where should I record and report my findings?

The patient/client will have a chart on which your respiration observations can be recorded. You should make sure you record your findings clearly and accurately so that they can be readily seen and understood. Always follow your organisation’s policies and procedures on recording and reporting.

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