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Vital Signs in the Ambulatory Setting: An Evidence-Based Approach Cecelia L. Crawford, RN, MSN

Vital Signs in the Ambulatory Setting: An Evidence-Based Approach Cecelia L. Crawford, RN, MSN. How to Measure Respirations. Respiration Measurement - An Overview. Equipment for accurate respiratory measurement Watch or clock with second hand or digital second counter Stethoscope

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Vital Signs in the Ambulatory Setting: An Evidence-Based Approach Cecelia L. Crawford, RN, MSN

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  1. Vital Signs in the Ambulatory Setting:An Evidence-Based ApproachCecelia 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. Respirations – It’s All About The Numbers! 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)

  4. Respiratory Rate Procedure • Wash hands & put on gloves, if appropriate • Provide privacy • 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 (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

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