10 Assessing Respirations
Assessment
- Determined need to assess client’s respirations.
- Assessed factors that normally influence client’s respirations.
- Determined client’s baseline respiratory rate from client’s record.
Nursing Diagnosis
- Identified the purpose and risks associated with assessing respirations.
Planning
- Assessed respirations after pulse measurement in adult while keeping fingers on the client’s wrist.
- Assisted client into a comfortable position.
Evaluation
- Compared characteristics of client respirations with previous baseline data and/or normal range for client’s age.
- Identified unexpected outcomes.
- Reported and recorded respirations correctly.
Assessing Respiration – Implementation
- Performed hand hygiene. Provided privacy.
- Positioned client and self properly to ensure view of chest wall movement.
- Correctly counted respirations for 30 seconds in normal adult and multiplied by 2. If respirations were irregular, counted for a full minute.
- Assessed the depth and rhythm of the respirations.
- Provided comfort to the client.
- Washed hands.
Faculty Comments
| Assessment | Nursing Diagnosis | Planning | Implementation | Evaluation |
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| Attempt Number & Outcome Number |
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| Student Signature
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Faculty Signature |
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| The student was unable to perform the skill competently and will be retested. |
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