Counting respirations

Because we can take all vitals except respirations with machines (all hail the Dynamap!), do you find that most CNAs and nurses skip that part and then chart 18 or 20?

I've seen it happen a LOT as a student, and I just want to know if it's the norm where you work.
why nurses skip it, beyond me...it's total laziness on their part. I just automatically count for 30 seconds as i check their pulse. the trick is the place their hand on their chest as you count their pulse - but use the hand with the watch on it. then they won't be the wisest that you are counting their respirations.....

Many nurses take the radial pulse and count respirations at the same time( maybe that's why you are not seeing it). I am a student and I can't do that at the same time, I have to place my hand in their abdominal and talk to the patient at the same time to get the respirations down.

Quote from healthstarMany nurses take the radial pulse and count respirations at the same time( maybe that's why you are not seeing it). I am a student and I can't do that at the same time, I have to place my hand in their abdominal and talk to the patient at the same time to get the respirations down.

After taking umpteen million vitals over the years (we do our own most of the time in my detox unit), I have developed an ear for RR between 16-18. If I hear that the person is breathing in a labored fashion, or may have a depressed RR d/t OD, then I will most definitely do a thorough count. Generally, our unit is not populated by critical-type patients--we ship those out.

Even if I use a Dynamap and get a pulse reading from it, I tell the patient that I need to take their pulse and will place my fingers on their radial artery. I fake them out and use this time to actually count the respirations. It gives me the opportunity, though, to feel the pulse amplitude and rhythm, something a machine can't always tell you. So, it may sometimes look like I'm skipping the respiratory rate, even though I'm not.

I feel the pulse for 15 seconds and multiply by 4 then keep feeling the pulse but am watching their chest rise and fall and am counting their respiratory rate.

If I am using an O2 meter to get the pulse, I count respirations while the machine does its thing. The resident is usually so focused on the machine that they don't even notice. If I am doing a radial pulse, I do the first 30 seconds counting pulse and keep my hand on their wrist for the next 30 seconds but count respirations, once again resident thinks I'm just taking a while to take their pulse so it does not effect respirations. As far as having lots of 20's and 18's, that is a common rate and they may be correct.

I think it's very commonly skipped (or at best, guessed). I had a lot of my clinicals at this one hospital, and I never saw a single list of vitals that had the respiratory rate listed as anything other than 18. Every single pt, every single time. Uh-huh...

In the ICU, it's pretty easy to do. You can get a very accurate RR off of the ventilator (it counts them for you) and our monitors will also pick up a RR off the telemetry leads for a non-vented patient -- but this is notoriously inaccurate. Generally I will assess the non-vented patient and sit down to do my charting at the computer in the room, and then I will watch for chest rise and fall as I watch the clock in the room since I am only a few feet away. I'll usually watch for 10-15 seconds and then multiply. There really isn't any excuse not to do it -- it takes just a few seconds (literally.)

I do what many others have listed above, which is while checking the radial pulse, count respirations. I'm only a student, but respirations are very important in assessments and should be checked with accuracy. On one of my very first clinical rotations, I counted respirations and got around a 26 on this one fellow. I got a whole lot of flack for it, even a nurse manager told my instructor that I needed to get off of the floor and learn something else because she believed I didn't know what I was doing on the floor. It felt great when my instructor went in and got the same count and to stand there in front of that manager while my instructor told her I did an excellent job and they needed to do theirs

Never trusted the Dynamap to give me an accurate reading. I prefer to rely on my "old fashioned" skills.