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4-5. HOW DO I ASSESS A PATIENT'S BREATHING RATE AND QUALITY?

You normally assess the patient's breathing when you are taking his pulse. Take his pulse in such a manner that you do not need to move in order to observe his breathing also. The best position is the position shown in figure 3-3 A. If you are not to take his pulse also, observe his breathing when he is at rest (usually lying down) and not aware that you are observing his breathing.

a. Counting Breaths. When you finish counting the patient's pulse rate, count the patient's breaths (the rising and falling of his chest) before recording his pulse rate. Continue to hold his wrist as though you were still counting his pulse rate.

(1) Count the number of complete breaths (the sequence of inhalation and exhalation is one breath) that occur during a 60-second period.

(2) After you have practice, you can count the number of breaths that occur during 30 seconds and multiply that number by two. This procedure, however, can only be used if the patient's breathing is regular. If his breathing is irregular, count for the full 60 seconds.

b. Note Abnormalities. As you count the patient's breaths, look and listen for abnormalities (rapid or slow breathing, shallow or deep breathing, irregular breathing, noises, indications of pain, coughing, and so forth).

c. Record Breathing Rate and Quality. Record the number of complete breathing cycles per minute on your form or sheet of paper. The number can be either even or odd. Suppose your 60-second period began as the patient started to inhale. Also suppose that he had 15 complete breaths plus one full inhalation (no exhalation) when the 60 seconds expired. You would record his rate as "15" since only complete cycles (inhalation and exhalation) are to be counted.

d. Record Any Abnormalities. Record any abnormalities noted while assessing the patient's breathing.

4-6. WHY SHOULD THE PATIENT BE UNAWARE THAT I AM ASSESSING HIS BREATHING RATE AND QUALITY?

Your brain controls your breathing and will do so automatically (without conscious order). This means you will continue to breathe even when you are not thinking about breathing, such as when you are asleep. However, breathing can also be under the conscious (voluntary) control of the brain. You can breathe faster, breathe deeper, breathe shallower, or breathe slower if you want to do so. You can even stop breathing altogether, at least for a short time. Thus, you can swim underwater and you can hold your breath while putting on your protective mask during a chemical attack. Unfortunately, this voluntary control of breathing can create a problem when you are assessing the patient's breathing rate and quality. If the patient knows that you are paying attention to his breathing, then he will probably start paying attention to his breathing also. In doing so, his brain switches from automatic control of breathing (which you want to observe) to voluntary control (which does not give you a true picture of his normal breathing). In order to get a true picture of the patient's breathing rate and quality, the patient should be at rest (lying down) and should not beware that you are observing his breathing process.

David L. Heiserman, Editor

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Revised: June 06, 2015