[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Vital signs and assessment](https://durgical.com/en/nursing/areas/vitals/) › Counting respirations without the patient noticing # Counting respirations without the patient noticing - Assessment Breaths are counted right after the pulse, fingers still on the wrist, so the patient does not change their breathing because they know they are watched. Updated Nov 5, 2026 ## Key points - Do not announce that you are counting breaths: keep your fingers on the pulse and watch the chest. - Count a full 60 seconds: 15 or 30 second counts tend to underestimate the rate. - One breath is one inspiration plus one expiration. - Assess depth, rhythm and effort: nasal flaring, neck muscle use, tripod position, noisy breathing. - Check sedation and breathing before an opioid and at intervals afterwards; a rate below 12/min is reported and further doses are held per protocol. ## What it is The respiratory rate is the vital sign most often skipped or guessed, and one of the first to change when a patient deteriorates. A person who knows their breathing is being counted changes it without meaning to. So nurses count it with their fingers still on the radial pulse, watching the chest, and also assess depth, rhythm and effort. Counting it well also matters before giving opioids or sedatives. ## Reference values - Adult: 12 to 20 breaths/min. Tachypnoea: above 20. Bradypnoea: below 12. - Newborn to 1 month: 30 to 60 breaths/min; 1 month to 1 year: 26 to 60; 1 to 10 years: 14 to 50; 11 to 18 years: 12 to 22. - Normal breathing at rest is relaxed, quiet and regular. ## What you need - Watch with a second hand. - Patient at rest, preferably sitting; chest visible or under light clothing. - Stethoscope if chest movement is hard to see. ## How to measure it (and why) - After the pulse, leave your fingers on the wrist and watch the chest or abdomen — the patient thinks you are still on the pulse and breathes naturally. - Count each rise of the chest as one breath — one breath is one inspiration plus one expiration, so counting them separately doubles the rate. - Count a full 60 seconds — shorter counts underestimate the rate, and infants breathe irregularly. - If the chest is hard to see, count the movements of the abdomen or listen over the lungs — so shallow breaths are not missed. - Watch depth, rhythm, symmetry and effort — a normal rate with heavy effort is still a warning sign. - Check the oxygen saturation at the same time: below 95 % needs follow-up — it completes the breathing assessment. - Record rate, method (observed or auscultated), pattern and any oxygen — this allows comparison with later checks. ## How to read it - Infants breathe irregularly and may pause for up to 10 seconds without distress: count a full minute while they are calm. - Oversedation with slow breathing after an opioid is a sign of respiratory depression. - Sleep, pain and crying change the rate: note the patient's state when you measure. - The respiratory rate is among the strongest predictors of deterioration on the ward and is part of early warning scores. ## Next step: when to call for help - Call if the rate falls outside the order's parameters or the range for age. - Call at once for new respiratory distress: accessory muscle use, nasal flaring, tripod position or noisy breathing. - Call if the rate drops after an opioid or sedative, and follow the facility protocol for respiratory depression. - Report at once a saturation below 92 %, worsening breathlessness, reduced consciousness or new restlessness. ## Test yourself Think of the answer, then tap the question to see it. ## Why are respirations counted without telling the patient? Because someone who knows they are being watched changes their breathing without meaning to, and the number is no longer true. ## How long are respirations counted? A full 60 seconds; shorter counts tend to underestimate the rate, and infants breathe irregularly. ## Which signs of breathing effort are observed besides the rate? Nasal flaring, neck muscle use, tripod position, noisy breathing and orthopnoea. ## Why are respirations counted before giving an opioid? Because opioids can depress breathing; the earlier value is the baseline for monitoring afterwards. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/counting-respirations-without-the-patient-noticing/) ## Elsewhere in DurgiPedia - [Respiratory rate and breathing patterns](https://durgical.com/en/clinical-exam/respiratory-rate-and-breathing-patterns/) ## Connections ## Related 3 - [Vital signs in nursing: when, how often and how to record them](https://durgical.com/en/nursing/vital-signs-in-nursing-when-how-often-and-how-to-record-them/) - [Pulse oximetry at the bedside: placement and pitfalls](https://durgical.com/en/nursing/pulse-oximetry-at-the-bedside-placement-and-pitfalls/) - [Early warning scores (NEWS2) and when to escalate](https://durgical.com/en/nursing/early-warning-scores-and-when-to-escalate/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Nursing Skills (Open RN), 1.3 Vital Signs](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/01%3A_General_Survey/1.03%3A_Vital_Signs) (Open RN, Wisconsin Technical College System (LibreTexts), 2021); [Nursing Skills (Open RN), 10.3 Respiratory Assessment](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/10%3A_Respiratory_Assessment/10.03%3A_Respiratory_Assessment) (Open RN, Wisconsin Technical College System (LibreTexts), 2021); [Kallioinen N, et al. Quantitative systematic review: Sources of inaccuracy in manually measured adult respiratory rate data. J Adv Nurs 77(1):98-124](https://pmc.ncbi.nlm.nih.gov/articles/PMC7756810/) (Journal of Advanced Nursing (PubMed Central, open access), 2021); [Nursing Fundamentals (Open RN), 11.5 Applying the Nursing Process (Comfort)](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/11%3A_Comfort/11.05%3A_Applying_the_Nursing_Process) (Open RN, Wisconsin Technical College System (LibreTexts), 2021). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/counting-respirations-without-the-patient-noticing/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/counting-respirations-without-the-patient-noticing/