Respiratory care/rate

The process of respiration is essential for human life on every level from cell to system, as everything needs oxygen (Chourpiliadis and Bhardwaj, 2022). The respiratory system is a complex and dynamic system, which manages the constant supply of oxygen to the body and the removal of waste such as carbon dioxide, through gas exchange (Davison et al, 2020).

In the UK approximately 1 in 5 people have had a history of respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD) or other longstanding respiratory illness, to which approximately 6.5 million people have reported to take prescribed medication (British Lung Society, 2022). Within England, respiratory disease is the third highest cause of death (NHS, 2023a).

Due to the high number of people in the UK with respiratory conditions, respiratory care has been highlighted within the NHS long-term plan. The aim is for patients with respiratory disease to have early

Healthcare professionals will assess, diagnose and treat using a systematic approach. They will assess the patient airway and breathing using the Airway, Breathing, Circulatory, Disability, Exposure (A-E Assessment) approach in conjunction with the look, listen and feel approach (UK Resuscitation Council, 2021).

To undertake an in depth structured respiratory assessment you need to:

• inspect the chest
• palpate the chest
• percuss the chest
• auscultate the chest

In conjunction, six physiological observations (blood pressure, pulse, respiratory rate, oxygen saturation, temperature and conscious level) should be recorded. These observations are vital (Sapra et al, 2023). The normal parameters for an adult respiratory rate are between 12-20 respirations per minute (NHS, 2023b). A change in the respiratory rate (either higher or lower) can be an early sign of deterioration within a patient, to which failing to recognise and acknowledge this has been shown to be highly detrimental to patient outcomes (Cretikos et al, 2008;

• a watch with a second hand
• personal protective equipment (if required)

1. Introduce yourself to the patient and confirm details to check you have the correct patient
2. Ask if you are able to take the patient physiological observations and gain consent
3. Maintain privacy and dignity at all times
4. Wash hands in line with trust policy and World Health Organization (2023) recommendations
5. Wear the appropriate personal protective equipment as required and per risk assessment
6. Observe the respiratory rate for 60 seconds (1 minute), recording how many times the chest rises and falls, using your fob watch to calculate the 60 seconds
   1. Make sure the patient does not speak during this time
7. Assess for equal chest rise and fall and listen for any abnormal sounds, such as stridor, wheeze and crowing
8. If you need to feel the chest for any abnormalities, such as swelling, bruising and crepitus, you will need a chaperone
9. Following this, ask the patient to talk to you to assess if they

The health professional should count for a full minute, and not for 30 seconds and multiplying the number by 2, for example. Otherwise this could give you a false result and not allow you to assess the chest and respiratory system correctly. Also, the health professional must make sure they do not tell the patient that they are recording their respiratory rate, as patients may alter their breathing rate accordingly, thus giving a false result. 

• assess the patient on a regular basis and calculate the National Early Warning Score 2 if used
• include the respiratory rate every time a set of observations is recorded
• document as trust policy and procedure as well as the rate, rhythm and depth
• escalate if required

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

2.8 undertake chest auscultation and interpret findings

2.7 undertake a whole body systems assessment including respiratory, circulatory, neurological, musculoskeletal, cardiovascular and skin status

Part 2: Procedures for the planning, provision and management of person-centred nursing care

8. Use evidence-based, best practice approaches for meeting needs for respiratory care and support, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

British Lung Foundation. Lung disease in the UK – big picture statistics. 2022. https://statistics.blf.org.uk/lung-disease-uk-big-picture (accessed 25 January 2024)

British Thoracic Society. Introducing respiratory support units in all NHS hospital with transform respiratory care for staff and patients. 2021. https://www.brit-thoracic.org.uk/news/2021/introducing-respiratory-support-units-in-all-nhs-hospitals-will-transform-respiratory-care/ (accessed 25 January 2024)

British Thoracic Society and Scottish Intercollegiate guidelines network. Outcomes report SIGN 153
and SIGN 158: BTS/SIGN guidelines for the management of asthma. 2022. https://www.sign.ac.uk/media/1980/20220125-asthma-guideline-outcomes-report-mb-bc-final.pdf (accessed 25 January 2024)

Chourpiliadis C, Bhardwaj A. Physiology, respiratory rate. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 

Cretikos MA, Bellomo R, Hillman K et al. Respiratory rate: the neglected vital sign. Medical Journal of Australia. 2008;188(11):657-659. https://doi.org/10.5694/j.1326-5377.2008.tb01825.x 

Hill B, Annesley SH. Monitoring respiratory rates in adults. Br J Nurs. 2020; 29(1):12. https://doi.org/10.12968/bjon.2020.29.1.12 

Kelly C. Respiratory Rate 1: Why accurate measurement and recording are crucial. Nursing Times. 2018;114(4):23-24 

NHS. Respiratory disease. Our ambition for respiratory disease. 2023a https://www.england.nhs.uk/ourwork/clinical-policy/respiratory-disease/ (accessed 25 January