Vital Signs: Respiratory Rate (RR)

Describe what a *stridor* breath sounds like.

- Continuous, musical abnormal breath sounds. - Heard over the trachea and is an inspiratory musical wheeze that suggests obstruction of the trachea or larynx. - Considered a medical emergency.

Describe what a *rhonchi* breath sounds like.

- Continuous, musical abnormal breath sounds. - Occur when air flows through a narrowed airway and are heard during expiration.

Describe what a *wheezes* breath sounds like.

- Continuous, musical abnormal breath sounds. - Occur when air flows through a narrowed airway and are heard during expiration. - Occur in patients with chronic obstructive pulmonary disease, asthma, chronic bronchitis, congestive heart failure, and pulmonary edema and can be heard anywhere in the lungs where obstruction exists.

Describe what a *crackles or rales* breath sounds like.

- Discontinuous adventitious breath sounds. - Can be heard in patients with asthma, bronchitis, interstitial lung disease, bronchiectasis, and early congestive heart failure.

Describe what a *bronchovesicular* breath sounds like.

- High-pitched and soft. - Best heard between the scapulae or at the triangle of auscultation. - Come from the main stem bronchi.

Describe what a *tracheal* breath sounds like.

- High-pitched, harsh, hollow, and loud. - Best heard in the neck region.

Describe what a *bronchial* breath sounds like.

- Loud, tubular, less harsh sounds. - Best heard over the manubrium of the sternum. - These are abnormal if heard in the peripheral lung fields.

Describe what a *pleural friction rubs* breath sounds like.

- Sharp, discrete bursts of sound heard most commonly on inspiration. - Sound like brushing or creaking sounds. - Found in patients with pneumothorax or a pleural effusion.

Describe what a *vesicular* breath sounds like.

- Soft and low-pitched. - Best heard over the periphery of both lung fields. - The expiratory phase heard is shorter than the inspiratory phase.

What affects RR?

1. Age. 2. Body size/stature. 3. Exercise. 4. Positioning. 5. Disease processes (COPD, asthma, pneumonia).

What breath sounds are considered *normal*?

1. Bronchial. 2. Bronchiovesicular. 3. Vesicular.

What breath sounds are considered *abnormal*?

1. Crackles or rales. 2. Pleural friction rubs. 3. Wheezes. 4. Rhonchi. 5. Stridor.

What are some *abnormal* responses of RR during exercise?

1. Does not increase with exercise. 2. Slow to decrease after exercise stops. 3. Irregular in rate or rhythm.

What is considered normal Respiratory Rate (RR) for infants and adults? (*TEXTBOOK*)

1. Infants: 30-50 breaths/min. 2. Adults: 12-18 breaths/min.

What is considered normal Respiratory Rate (RR) for infants, children, and adults?

1. Infants: 30-60 breaths/min. 2. Children: 18-30 breaths/min. 3. Adults: 12-16 breaths/min.

How would you assess *pulmonary auscultation*?

1. Listen anteriorly in 4 places, posteriorly in 6 places, and under each axilla. 2. Listen for at least one complete respiratory cycle at each site.

How do you assess a patient's RR?

1. Simulate measurement of pulse while observing pt's breathing, can rest your other hand on patient's shoulder, thorax, or abdomen. 2. Measure either inspirations or expirations for 1 minute.

What is *apnea*?

Absence of breathing.

What is *orthopnea*?

Difficulty breathing when recumbent.

What's important to *NOT* do if you're going to take a patient's RR?

Do *NOT* explain the procedure to patient to avoid inaccurate results.

What's the *normal* response of RR during exercise?

Increases.

What is *pulmonary auscultation*?

Listening for breath sounds in the lungs using the diaphragm of the stethoscope.

How would you measure someone's Respiratory Rate (RR)?

Measured in breaths per min.

What is the measurement of Respiratory Rate (RR)?

Measurement of either a person's inspiration or expiration.

Besides the number of breaths, what else should you note when assessing RR?

Note rhythm, depth, and character of respirations in addition to rate.

What sort of body size or posture might increase RR?

Obese or kyphotic postures increase respiratory rate.

What is *tachypnea*?

Rapid breathing, more than 20 breaths per minute.

Does RR increase or decrease with the increase of age?

Respiratory rate decreases with the increase of age.

What position may increase RR?

Respiratory rate is increased while supine.

What is *dyspnea*?

Shortness of breath.

What's the first thing you should do before assessing RR?

Wash your hands and gather equipment (watch or timer that measures seconds).