Assess the Respiratory Rate and Pattern

When assessing respiratory rate, never ask the patient to breathe ''normally.'' Individuals voluntarily change their breathing patterns and rates once they are aware that respiration is being assessed. A better way is, after taking the radial pulse, to direct your eyes to the patient's chest and evaluate respirations while still holding the patient's wrist. The patient is unaware that you are no longer taking the pulse, and voluntary changes in breathing rate will not occur. Counting the number of respirations in a 30-second period and multiplying that number by two provides an accurate respiratory rate.

The normal adult takes about 10 to 14 breaths a minute. Bradypnea is an abnormal slowing of respiration; tachypnea is an abnormal increase. Apnea is the temporary cessation of breathing. Hyperpnea is an increased depth of breathing, usually associated with metabolic acidosis. It is also known as Kussmaul's breathing. There are many types of abnormal breathing patterns. Figure 13-10 illustrates and lists the more common types of abnormal breathing.

Normal

"Barrel chest''

Kyphosis

Normal

"Barrel chest''

Kyphosis

Pectus excavatum

Pectus carinatum

Figure 13-9 Common chest configurations.

Pattern

Characteristic

Cause

Apnea

Absence of breathing

Cardiac arrest

Biot's respiration

Irregular breathing with long periods of apnea

Increased intracranial pressure Drug-induced respiratory depression Brain damage (usually at the medullary level)

Cheyne-Stokes respiration

Irregular breathing with intermittent periods of increased and decreased rates and depths of breaths alternating with periods of apnea

Drug-induced respiratory depression

Congestive heart failure

Brain damage (usually at the cerebral level)

Kussmaul's respiration

Fast and deep

Metabolic acidosis

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Apnea Biot's Cheyne-Stokes Kussmaul's

Figure 13-10 Patterns of abnormal breathing.

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