Definition
Respiration is the process of breathing and consists of inspiration and expiration. Assessing respiration involves monitoring inspiration and expiration in a patient.
Purposes
- To assess rate, rhythm, and volume of respiration.
- To assess for any change in condition and health status.
- To monitor the effectiveness of therapy related to respiratory system.
Articles
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Procedure
| Nursing Action | Rationale | |
| 1 | Before Procedure Ensure that patient is relaxed and assess other vital signs, such as pulse or temperature prior to counting respirations. | Awareness of the procedure may alter the rate of respiration. Conscious patients when relaxed and unaware of procedure tend to have accurate respiratory rate. |
| 2 | Assess for factors that may alter respiration. | Allows nurse to accurately assess for presence and significance of respiratory alteration. |
| 3 | Wait for 5-10 min before assessing respiration if patient had been active. | Activity may increase rate and depth of respiration. |
| 4 | During Procedure Position patient in sitting or supine with head elevated at 45-60° | Ensures proper assessment |
| 5 | Keep your fingers over the wrist as if checking pulse, and position patient’s hand over his lower chest or abdomen. | Makes the patient less aware of his respiration. Keeping hand chest or abdomen makes the movement of chest more visible |
| 6 | Observe one complete respiratory cycle-inspiration and expiration. | |
| 7 | Assess rate, depth, rhythm, and character of respiration. | Depth of respiration reveals volume of air moving in and out lungs, Abnormalities of rhythm and character reveals specific disease condition. |
| 8 | Count respiration for one whole minute. | |
| 9 | After Procedure Wash hands. | |
| 10 | Record the findings and report any abnormal findings |
Paediatric Variations
- In infants, observe abdominal movements because respirations are diaphragmatic
- Due to irregular movements in infants, count respirations for one full minute for accuracy
Normal Respiratory Rate-Age wise
| AGE | RATE (BREATHS PER MINUTE |
| Newborn | 36-40 |
| 1-12 months | 28-32 |
| 2-4 years | 22-26 |
| 5-10 years | 18-24 |
| 11-18 years | 16-22 |
Pediatric Considerations for Respiratory Assessment
| Aspect | Special Consideration |
|---|---|
| Age-specific norms | Respiratory rates vary significantly by age—infants breathe faster than older children. |
| Observation first | Begin with a “hands-off” approach—observe chest rise, nasal flaring, and retractions. |
| Breathing pattern | Look for irregular rhythms in infants (normal), but flag grunting, stridor, or wheezing. |
| Effort of breathing | Use of accessory muscles, head bobbing, or nasal flaring may indicate distress. |
| Positioning | Allow the child to sit in a position of comfort (e.g., tripod) to reduce anxiety. |
| Silent chest | A “silent chest” in a distressed child is a red flag—may indicate severe airway obstruction. |
| Behavioral cues | Irritability, lethargy, or inability to speak may reflect respiratory compromise. |
| Parental input | Ask caregivers about baseline breathing and any recent changes. |
Best Practices for Accurate Measurement
- Count respirations for a full 60 seconds, especially in infants with irregular patterns.
- Observe abdominal movement in infants and thoracic movement in older children.
- Avoid assessment when the child is crying or agitated—wait for calm moments.
- Document respiratory rate, effort, sounds, and oxygen saturation together for context.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
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