Friday, April 22, 2011

Respiratory Rate

I got this lecture in med school where the professor/attending told us that the normal respiratory rate for an adult is about 12. And when nurses record 18-20, which they usually do, that actually represents a HIGH respiratory rate.

I just recorded my respiratory rate and it was 12. So I guess he had something there. That or I've OD'd on benzos again. (Kidding!)

He was also right that nurses ALWAYS record the respiratory rate as 18 or 20 (per minute). I have worked at tons of hospitals in several different parts of the country and that seems to be universally true. I'm not even sure what the point is of recording a number, since nobody actually stands there and counts respirations for a minute (or even 15 or 30 seconds). Clearly, this number is always made up.

The one that always baffles me is when they record the respiratory rate as 19. How do they come up with that one?

28 comments:

  1. You do realize that in nursing school they are receiving the same lecture, except in reverse?

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  2. I just want to know where that 19 comes from...

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  3. Interesting. I don't really know what this is, but I'm guessing 'normal breaths per minute'?
    If so mine is 11! So I guess that's good.

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  4. Maybe by listening for a full minute.

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  5. Nurses aren't usually the ones counting respirations -- it's the aids/CNAs. :)

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  6. We're totally taught that the nurses will always record RR as 20.

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  7. I loved it when I worked at the VA. You'd have 4 guys in the same room, and all 4 would have the same vital signs.

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  8. Oh, and for the number 19- they use a 20 sided dice from Dungeon's & Dragons, roll it, and add 10 to whatever comes up. And that's your respiratory rate.

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  9. The RR always seemed like a total formality. Was it really crucial whether the RR was 18 or 19 or 20? I've been taught we care about three types of breathing:

    1) Normal
    2) Rapid/Laboured
    3) Not

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  10. Maybe a RR of 19 was taken from the monitor?

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  11. @iamnothouse - GENIUS! I'll have to remember that.

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  12. As a Pulm/Critical care doc, I never counted the respirations. I examined the patient. What did I care if the rate was 12 or 20, if the patient wasn't laboring, using accessory muscles, cyanotic or making noise with their breathing? Most of my patients were tachypneic anyhow.

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  13. I remember when I was a nursing student, trying to make awkward excuses to stay in the room with the patient so I could count the RR for 30 seconds...we were taught if the patient KNOWS we're counting the RR, that he/she would inadvertently change his/her breathing pattern. I still count them for 30 seconds, but I agree, it's much more important to assess whether it's labored breathing, if the patient is cyanotic etc.

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  14. When I was a PCA I had to record the RR and it was impossible to get the patient to shut up for 30 seconds to get the stupid thing. So since i had the same lecture in med school by that point (I was a PCA on the side for a little while) I just went with 14.

    On an inpatient rehab unit, no one really cared what the RR was since they figured if you could do 2 hours of PT and 2 of OT, you probably weren't about to get intubated.

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  15. Yeah, I have no idea why nurses do this. Then, as a student, I come along and actually check the resp rate so the obs chart looks something like "18 18 18 18 12 18 18 18." I hate doing them though, if I'm trying to do a RR and the pt wont shut up, I don't bother (nor do I write anything - just write in the notes that patient is talking with nil signs resp distress). I think iamnothouses description of RR should be implemented.

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  16. As a pca I counted while I took the temp- the only time the pt's mouth was shut. But yeah, there's really only the 3 types of respiration you care about.

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  17. I just figure that if someone writes 19-20, they didn't bother to actually count and they are just saying, "hey, patient looks fine to me"

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  18. 19? Off the bipap? usually.....

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  19. the only time i ever see a RR of 12 is when a (ICU) pt is asleep. when they're awake they're usually breathing 16-20/min because they're nice and atalectatic and in pain and won't do their IS.

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  20. Haha you know what's funny? You mentioning the number 19 and me seeing that there were 19 comments. Well mine is number 20
    Honestly, I have no idea how they recorded 19 but even in my part of the world, the respiratory rate is recorded as 20 most of the time

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  21. All RRs are recorded manually where I work, yet we still get 19 sometimes.

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  22. @ Grumpy

    I wonder if that's how they determine other outcomes in the hospital.

    "Alright Mr. Smith, it looks like you're going to get *roll* 16 mg of warfarin today. Thank you, and I hope you have a *roll* pleasant day"

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  23. I've been both med student and OR nurse, and it's always been the anesthesiologist that comes up with the magic (high) number.

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  24. haha, when I did my surgical placement as a nurse the patient generally came back from OT with recorded 16-18! :)

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  25. Just a lowly EMT here. Wouldn't taking your own RR be pointless considering that the second you start counting, your breathing is under conscious control thus changing the rate? I was trained to check RR without the pt knowing in order to get an accurate read.

    Just because you don't observe any signs of respiratory distress doesn't mean everything is fine. Isn't it all about trending. If you got a 'real' (not made up) RR of 14 and reassess in 15 minutes and get a RR of 20, something might be wrong. Just saying - I think it's wrong to make up numbers.

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  26. If you're doing routine obs on a stable patient and they keep talking while you're trying to take a RR, it's pretty clear they have no signs of resp distress, and I would document as such (still don't believe in making up a number, I just don't write anything). If I had a drowsy post-op pt who's just had an SDH evacuated, I would make sure I was getting the correct respiratory rate (didn't stop nurses from going ahead and writing 18 though!). Now I work in outpatient dialysis and we don't do RR's at all. It should depend on the ward and your patient.

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  27. To clarify, I don't write a number on the obs chart and document in the progress notes that the patient was talking with nil signs of resp distress.

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