Measuring Respirations

1Step-by-Step Procedure

1. 1

   Wash hands.

2. 2

   Identify the resident and explain that you are continuing to monitor vital signs (do not announce you are counting breaths).

3. 3

   Keep your fingers on the resident's wrist as if still counting the pulse — this prevents the resident from becoming aware and altering their breathing pattern.

4. 4

   Observe the rise and fall of the chest; one complete rise-and-fall cycle equals one respiration.

5. 5

   Count respirations for a full 60 seconds.

6. 6

   Note the rate, depth (shallow, normal, or deep), and rhythm (regular or irregular).

7. 7

   Also note any abnormal sounds such as wheezing, gurgling, or stridor.

8. 8

   Lower the resident's arm and ensure comfort.

9. 9

   Wash hands.

10. 10

    Record the respiratory rate, depth, rhythm, and any abnormal sounds immediately.

11. 11

    Report abnormal findings to the nurse right away.

What the Examiner Is Watching For

• ✓

  Fingers remain on the wrist to avoid alerting the resident.

• ✓

  One full chest rise-and-fall is counted as one respiration.

• ✓

  Respirations are counted for a full 60 seconds.

• ✓

  Rate, depth, and rhythm are all assessed and recorded.

Common Mistakes That Cause Failure

• ⚠

  Announcing you are counting respirations — this makes people breathe differently.

• ⚠

  Counting each chest movement (up and down) as a separate respiration instead of a cycle.

• ⚠

  Counting for only 30 seconds and doubling.

• ⚠

  Not noting the depth and rhythm, only the rate.

• ⚠

  Forgetting to report abnormal sounds like wheezing.

Tips for Exam Day

• →

  Keep your fingers on the wrist — it looks like you are still counting the pulse.

• →

  One rise + one fall = one breath. Count complete cycles.

• →

  Normal adult respiratory rate is 12–20 breaths per minute.

• →

  Immediately after counting the pulse is the ideal time — transition smoothly.