Oh sure, it sounds easy enough. You just need to know how to count and how to look at someone’s chest rise, right? WRONG. Respirations are tricky mainly due to the fact you can’t let the patient know you are counting their breaths, otherwise their respirations will change (ie, they get nervous and breath faster). Many techs and nurses I’ve worked with make up their respirations. You can tell this is the case because mysteriously all the patients on that floor have respirations of 18, and miraculously these respirations don’t change every 4 hours or between shifts. It’s a miracle. Not to mention, I’ve been told to “just chart 18” without having even seen the patient. I refuse to do this. It’s irresponsible.
My charting consistently reflects respirations of 12, 14, 15; the nurses go crazy, as if the patient is about to code. They tell me it’s not the patient’s normal. I’d like to tell them the patient’s normal was made up in the first place so we should establish a new baseline. Instead, I calmly nod and suggest the patient was most likely very relaxed when I saw them (and of course I chart whatever I counted regardless). But it took me a long time to even figure out the best way to count respirations. I am determined to find a non-awkward way of accurately counting a patient’s breathing pattern without them knowing it. It’s almost become a game for me. I have tried all kinds of techniques:
The most effective technique I’ve found so far involves the Dynamap (automatic blood pressure machine). If you’re not familiar with the machine yet, don’t worry; you will be soon enough! It takes the BP, pulse, O2 saturation, and temperature of the patient. Looks like this: This is the most efficient way I’ve found to do vitals thus far:
- Turn the machine on.
- Connect the pulse ox probe to the patient’s finger. Wrap the BP cuff around the patient’s arm (make sure it’s the correct size/positioning) and attach the BP inflator cord to the cuff.
- Take the temperature first. While the temp is taking, the pulse ox and pulse should be calculating.
- After those numbers have calculated, inflate the BP cuff. Dynamap takes just about 30 seconds for a BP (sometimes 20 seconds). As the BP is being taken, count the respirations. Nine times out of 10 you’ll have enough time to count for 30 seconds, then double it. Voila! You have your vitals.
Some may argue counting respirations while taking BP will give you an inaccurate figure because the body reacts during BP readings (sometimes tensing up, person gets nervous, etc.). By that logic, however, then the BP reading is inaccurate too. There’s no perfect answer to a human problem but I know one thing: my technique is better than “just charting 18” any day of the week.