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CNA Skill 21: How to Accurately Count and Record a Resident’s Respirations

Monitoring a resident’s respiration rate is a fundamental CNA skill that provides insight into a patient’s lung function, oxygenation, and overall health. Accurate measurement is critical for detecting respiratory distress, assessing recovery, and ensuring safe care delivery.

Understanding Respiratory Rate

  • Definition: Respiratory rate (RR) is the number of breaths a resident takes in one minute.
  • Normal Adult Range: 12–20 breaths per minute.
  • Clinical Importance: Abnormal rates (too fast or slow) can indicate respiratory, cardiac, or metabolic problems and must be reported promptly.

Pro Tip: Always count respirations while the resident is unaware, as conscious awareness can alter normal breathing patterns.

Supplies Needed

  • Watch with a second hand
  • Pen or chart for documentation

Step 1: Prepare for Measurement

  1. Knock on the resident’s door and wait for a response.
  2. Greet the resident by name, introduce yourself, and explain the procedure.
  3. Provide privacy by closing curtains or the door.
  4. Perform hand hygiene thoroughly.
  5. Confirm the resident’s identity using an ID band or verbal check.

Step 2: Measure Radial Pulse (Preparation for Respirations)

  1. Position the resident comfortably in bed.
  2. Support the resident’s forearm with one hand.
  3. Place your index and middle fingers on the radial artery (thumb side of the wrist).
  4. Count the pulse for one full minute.
  5. Record the pulse rate on the resident’s chart.

Note: Counting the pulse first allows you to measure respirations without alerting the resident, as their breathing is less likely to be consciously altered.

Step 3: Measure Respiratory Rate

  1. Tell the resident you are checking the pulse again, but this time focus on observing breathing.
  2. Observe the rise and fall of the chest, counting the first complete fall as breath one.
  3. Count respirations for one full minute for accurate measurement.
  4. Record the respiration rate on the resident’s chart.

Step 4: Post-Procedure Steps

  • Wash hands again after completion.
  • Place the call light within reach of the resident.
  • Adjust the head of the bed according to the resident’s preference.
  • Ensure comfort and ask if anything else is needed.

Tips for Accurate Respiratory Assessment

  • Discreet Counting: Residents may alter their breathing if they know it’s being counted. Observe without drawing attention.
  • Consistency: Count for a full 60 seconds – partial counts are not reliable.
  • Record Immediately: Document the result right after measurement to avoid memory errors.
  • Watch for Abnormalities: Report tachypnea (>20 breaths/min), bradypnea (<12 breaths/min), or irregular breathing patterns immediately.

CNAs who master subtle observation techniques are better prepared for clinical testing and real-world patient care.

Reference for Best Practices

For detailed guidance on safe respiratory assessment techniques and ranges:
https://www.mayoclinic.org/first-aid/first-aid-respiratory-rate