Inaccurate respiratory rates

1 Do you trust the respiratory rates the CNA's chart?

I notice that some of the CNA's on my unit always chart the same number for respiratory rate. The other day I had 5 patients and all had vitals Q4 and each time their respiratory rate was 18, for 15 sets of vitals that seems astonishing and improbable. When I was doing my assessment some had RR of 11 to 25. It frustrates me since respiratory rate will be one of the first things to indicate a problem. Last edit by MattNurse on May 11, '12 : Reason: should say someone else's charted respiratory rate
im a PCA on an ortho med/surg floor. i am almost certain the other PCAs are making up their RRs.. its so weird that EVERY patients RR is either 18 or 20. i feel like i look strange for putting in numbers like 12, 15, 24.. to my knowledge, no one calls them out on it either.

I never understood it. It's the easiest vital sign to obtain. Why fake it?The PCT's and BHA's take our vitals and I know for a fact who actually counts and who doesn't. I know because I used to be a PCT on that very same floor.We do our vitals in pairs, if possible because our pts are very unpredictable.So one would actually take the vitals and the other would write them down.When I wrote, I counted the resps because I knew the other tech wasn't doing it, but they would always tell me the resps were "18" or whatever.One time the resps were "33"...Big difference.So, no, I do not trust what is written and have also been quite irritated to find a blood pressure, that was waaaaaaay out of parameters, that no one was going to bother telling me about right away!

I get 16, 18, and 20 a lot. I usually count for 30 seconds, not a whole minute, so I never get an odd number. I hope my nurses don't think I'm faking.

Quote from fuzzywuzzyI get 16, 18, and 20 a lot. I usually count for 30 seconds, not a whole minute, so I never get an odd number. I hope my nurses don't think I'm faking.

Quote from fuzzywuzzyI get 16, 18, and 20 a lot. I usually count for 30 seconds, not a whole minute, so I never get an odd number. I hope my nurses don't think I'm faking.

I did my LPN clinicals on a sub-acute rehab floor @ a nursing home. One pt I had towards the end of my Med-Surg II rotation had CHF. He was dyspneic, and had +2 edema on his extremeties. I did his RR and it was 10. I wrote it down & handed it to my instructor. I also auscultated his lungs , and checked his other vitals. He was receiving oxygen but kept pulling it out. I also tried to obtain his O2 sat, but the pulse oximeter was missing :-/ Later on when I was charting, one of the aides came to my clinical instructor & said "Omg what kind of vital sign is this?!?" very loudly & pointing at the RR I obtained from my pt. I got really upset & proceeded to tell her that the pt was everyone's RR isn't going to be 18

Quote from fuzzywuzzyI get 16, 18, and 20 a lot. I usually count for 30 seconds, not a whole minute, so I never get an odd number. I hope my nurses don't think I'm faking.

When I worked in the hospital, it was obvious that some of the aides made up their respiratory rates. And, in pediatrics, everyone can't be 18. If a newborn is breathing at 18, we've got a problem. I have seen that documented before and then gone in and actually looked at the baby and seen that he was comfortably breathing at 36.

Quote from MattNurseDo you trust the respiratory rates the CNA's chart?

I always get my own when doing my assessment and do it repeatedly when giving a patient meds that affect respirations or when concerned about the patient's oxygenation for any real or potential reason. I do find counting respirations awkward though. Often the patient turns to look at me like "Why are you just staring at me?!". I don't like to tell them I am counting respirations because it tends to change their natural breathing pattern.

I usually count them when the bp pump is going or hold a wrist, peeking at my watch.... but really counting chest expansions. People generally stop talking when I do those things.

Depends. Most of my coworkers, yes. But I think a lot of people "eyeball" it, which can be problematic. A patient can be breathing really fast but appearing to be at a "comfortable" rate for their age. I had a coworker help me with initial vitals on a patient once, and this kid was charted as a respiratory rate of 24. About half an hour later, I noticed that he appeared to be breathing really quickly, so I recounted and got 40. "That can't be right" I thought. So I counted again, and again, and again, and each time it was right around 40. So now I'm freaking out because I think my patient has had a sudden change in status, to go from a comfortable if a little high rate to a seriously tachypneic rate. I start doing Q15 min vitals on him to make sure it wasn't a fluke, had the doctor over at the bedside, etc. Patient got a chest x-ray and ended up having raging pneumonia. After repeated vitals, I realized that the original 24 rr was likely eyeballed. If I hadn't noted the fast-appearing breathing, this patient's diagnosis and treatment would have been delayed, particularly since he had no other respiratory symptoms, was afebrile, etc. Luckily (?) the patient had a lot of other stuff going on, so it didn't change his assigned acuity, but what if it had?