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

This article provides an evidence-based approach to measuring respiratory rates in the ambulatory setting. It includes the necessary equipment, proper procedure steps, and considerations for accurate measurements. It also highlights the importance of communicating and documenting the results.

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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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