When Counting Respirations, What Should the Nurse Aide Do?

When counting respirations, the nurse aide should do it without telling the resident, count for a full 60 seconds, and record the rate, depth, rhythm, and effort of breathing. Respiration is one of the vital signs, and accuracy matters because changes can signal hypoxia, infection, or respiratory distress.

Steps for Counting Respirations Correctly

1. Keep your fingers on the pulse. After measuring the radial pulse, leave your fingers in place and watch the chest rise and fall. This disguises the respiration count so the resident breathes normally.
2. Count one full minute. Count each inhale-exhale cycle as one respiration. If the rhythm is irregular, count for a full minute; if regular, you may count for 30 seconds and multiply by two, but a full minute is always acceptable and often preferred.
3. Observe quality. Note depth (deep, shallow), rhythm (regular, irregular), and effort (labored, use of accessory muscles, nasal flaring). Also listen for abnormal sounds like wheezing or gurgling.
4. Record and report. Document the rate and character in the resident's chart. Report any rate below 12 or above 20 breaths per minute in adults, or any signs of distress, to the nurse immediately.

What to Avoid

• Do not announce that you are counting respirations, residents often change their breathing pattern when they know.
• Do not count for less than 30 seconds if the rhythm is irregular.
• Do not rely on a pulse oximeter reading alone; it does not measure respiratory rate or effort.

For more vital-signs and clinical-skills review, see our CNA skills test practice PDF and basic nursing care skills resources. Always follow your state's nurse aide curriculum and facility policy. According to the CDC, a normal adult respiratory rate is 12–20 breaths per minute at rest.