1. Presentation title SUB TITLE HERE Vital Signs in the Ambulatory Setting: An Evidence-Based Approach Cecelia L. Crawford, RN, MSN How to Measure Respirations

2. Respiration Measurement - An Overview Equipment for accurate respiratory measurement  Watch or clock with second hand or digital second counter  Stethoscope  Pen or pencil  Flowsheet, chart, or medical record  Clean hands and fingers! Patient in a comfortable & relaxed position Waited 5 minutes if patient was active Enough time to count the respiratory rate

3. Terminal Digit Preference Some people may show a preference for certain numbers in respiratory rate readings*  Zeros, even numbers, odd numbers Be aware you might “like” certain numbers more than others! (*Roubsanthisuk, W., Wongsurin, U., Saravich, S., & Buranakitjaroen, P., 2007) Respirations – It’s All About The Numbers!

4. Respiratory Rate Procedure 1.Wash hands & put on gloves, if appropriate 2.Provide privacy 3.Assist patient to a comfortable & relaxed position

5. Respiratory Rate Procedure 4. Position patient for clear view of chest movement 5. Place patient’s arm or your own hand in a relaxed position across stomach or lower chest 6. Observe a complete respiratory cycle  An inhale and an exhale http://www.lane.k12.or.us/CSD/CAM/level1/ASSESS

6. Respiratory Rate Procedure 7. Count for 60 sec  Full minute count for:  Children  Irregular respirations  Very fast or very slow respirations 8. Count for 30 sec and multiply X2  Shorter time counts = inaccurate data

7. Normal Respiratory Rates AGEBREATHS/MIN Newborn to 6 weeks30 - 60 Infant (6 weeks to 6 months)25 - 40 Toddler ( 1 to 3 years)20 - 30 Young Children ( 3 to 6 years)20 - 25 Older Children (10 to 14 years)15 - 20 Adults12 - 20 (Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter, 2006)

8. Respiratory Rate 9. Pediatric patients  If panting, use stethoscope to count  Agitation can result in inaccurate RR

9. Respiratory Rate Procedure Respiratory rates are NOT a reliable way to determine low oxygen levels!  RN and MD assessment is needed

10. Respiratory Rate Procedure 10. Inform the RN or MD for:  Difficult to count respirations  Very fast or very slow breathing  Irregular breathing  If patient seems to be having trouble breathing

11. Respiratory Rate Procedure 11. Discuss respiratory rate with patient or parent 12. Remove gloves & wash hands

12. Respiratory Rate Procedure 13. Document the Results  Flowsheet, clinic record, or clinic chart 14. Communicate the Results  RN  MD

13. Respiratory Measurement in the Clinic YOU can make the difference:  Welcoming presence  Decrease any anxieties & fears  Reassure patients & family  Accurate vital signs