Respiratory rate is normal. Determination of the number of respiratory movements

1. Create a trusting relationship with the patient.

2. Explain to the patient the need to count the pulse and obtain consent.

3. Take the patient's hand as for examining the pulse.

4. Place your and the patient’s hands on chest(for thoracic breathing) or the epigastric region (for abdominal breathing) of the patient, simulating a pulse examination.

6. Assess the frequency, depth, rhythm and type of breathing movements.

7. Explain to the patient that his respiratory rate has been counted.

8. Wash and dry your hands.

9. Record the data in the temperature sheet.

Note: NPV calculation is carried out without informing the patient about the respiratory rate study.

5. Conducting anthropometry (measurement of height)

Execution sequence:

    Place a replaceable napkin on the stadiometer platform (under the patient’s feet).

    Raise the stadiometer bar and invite the patient to stand (without shoes!) on the stadiometer platform.

    Place the patient on the stadiometer platform; the back of the head, spine in the area of ​​the shoulder blades, sacrum and heels of the patient should fit tightly to the vertical bar of the stadiometer; the head should be in such a position that the tragus of the ear and the outer corner of the orbit are on the same horizontal line.

    Lower the stadiometer bar onto the patient's head and determine the height on the scale along the lower edge of the bar.

    Help the patient leave the stadiometer platform and remove the napkin.

6. Conducting anthropometry (determining body weight)

Execution sequence:

    If possible, establish a trusting relationship with the patient. Explain the purpose and progress of the procedure, obtain consent to carry out it.

    Place a replaceable napkin on the scale platform (under the patient’s feet).

    Open the shutter of the scales and adjust them: the level of the balance beam, at which all the weights are in the “zero position”, must coincide with the control mark - the “nose” of the scales on the right side.

    Close the shutter of the scale and invite the patient to stand (without shoes!) in the center of the scale platform.

    Open the shutter and determine the patient’s weight by moving the weights on the two bars of the rocker arm until the rocker arm is level with the control mark of the medical scale.

    Close the shutter.

    Help the patient get off the scale and remove the napkin.

    Record measurement data.

7.Assessing the risk of development and severity of pressure ulcers

Execution sequence:

I. Preparation for the examination

1. Introduce yourself to the patient, explain the purpose and course of the examination (if the patient is conscious). II. Performing the examination The risk of developing pressure ulcers is assessed using the Waterlow scale, which is applicable to all categories of patients. In this case, the points are summed up according to 10 parameters: 1. physique; 2. body weight, relative to height; 3. skin type; 4. gender, age; 5. special risk factors; 6. retention of urine and feces; 7. mobility; 8. appetite; 9. neurological disorders; 10. surgical interventions or injuries. III. End of the procedure 1. Inform the patient(s) of the examination result 2. Make an appropriate entry about the results in the medical documentation

SEVERITY ASSESSMENTS

Execution Sequence I. Preparation for the procedure 2.. If possible, establish a trusting relationship with the patient. Explain the purpose and progress of the procedure, obtain consent to carry out it. 3.. Adjust the height of the bed. 4. Treat hands hygienically and dry. Wear gloves. II. Performing the procedure 1. Help the patient lie on his stomach or side. 2. Inspect the places where bedsores form: the sacrum, heels, ankles, shoulder blades, elbows, back of the head, greater trochanter of the femur, inner surfaces of the knee joints. 3. Assess: location, color of the skin, presence of odor and pain, depth and size of the lesion, presence and nature of discharged fluid, swelling of the edges of the wound, presence of a cavity in which tendons and/or bone formations may be visible. 4. If necessary, use sterile tweezers and sterile gloves. III. End of the procedure 1. Inform the patient the result of the study 2. Disinfect the used material and gloves. 3. Treat hands hygienically and dry. 4. Make an appropriate entry about the results of the implementation in the medical documentation

When a person breathes, he inhales oxygen and exhales carbon dioxide. Respiratory rate (the number of breathing movements per minute) is tested by health authorities to determine a person's health status. Normal indicator 12 – 18 breathing movements (inhalations and exhalations) per minute. Many factors influence a person’s breathing; this article will show you what determines the amount of breathing movement and how to determine this indicator.

Steps

    Ask for consent from the person whose breathing rate you want to determine.

    • There is a theory that it is best to check the breathing rate without warning, in order to exclude the influence of external factors and nervous system. However, this is not very good idea from an ethical point of view.

  1. Choose a place with good lighting and find a clock with a second hand (or stopwatch).

    Ask the person to sit up straight and straighten their back. Make sure he is not nervous. The breathing rate should be checked in a calm, relaxed environment.

    It is important to rule out breathing problems. Their main signs are: cold, damp skin, blue discoloration of the lips, tongue, nail plates or buccal mucosa, raised shoulder girdle when breathing, intermittent speech.

    Place your palm on top part a person's chest, slightly below the collarbone.

    Wait until the second hand of the watch is at 12 or 6. This will make it easier to start counting.

    Count the number of breaths you take using your chest movements. One breathing movement includes 1 inhalation and 1 exhalation. Pay attention to your breaths - this will make counting easier.

    Stop counting after 1 minute. Normal frequency breathing 12 - 18. Consult a doctor if the readings are below 12 or above 25 - this indicates breathing problems.

  2. The following reasons may explain slow or fast breathing:

    • Children breathe faster than adults. Rapid breathing can be caused by nervousness, physical exercise, loud or fast music, high altitude. Breathing problems can also be caused by medical reasons such as anemia, fever, brain disease, heart disease. vascular diseases, pneumonia, asthma or other respiratory diseases.
    • Elderly people breathe slower. Breathing also slows down during sleep or a relaxed state. Medical reasons may be: taking narcotic drugs (in particular morphine), lung diseases, cerebral edema, diseases in the final stages.

  3. Check availability the following symptoms, which may indicate breathing problems:

    • Uneven breathing. Does a person inhale and exhale at the same rate? Irregular breathing movements may indicate breathing problems.
    • Depth of breathing. Is breathing deep (the chest expands slightly) or shallow? Older people tend to breathe shallowly.
    • Do the right and right ones expand equally? left side chest while inhaling?
    • Sound while breathing. Are there any sounds during breathing, such as wheezing, gurgling, rumbling, do they occur during inhalation or exhalation? To differentiate them, use a phonendoscope or stethoscope.
  • When listening to sounds while breathing, use a stethoscope, resting it on your naked body.
  • The first few times, you can check the breathing rate and listen for lung sounds separately. When you gain more experience, you can do both at the same time.
  • You can determine your breathing rate using chest excursion; placing your hand on your chest will also help. If a person wears loose clothing, chest excursion will be more difficult to determine.
  • Pregnant women and obese people breathe at an irregular rate.
  • Once you have gained experience in determining your breathing rate, you can determine the number of breaths in 30 seconds and multiply this value by two. This can be done if the person breathes regularly

Warnings

  • Seek immediate medical attention if a person's lips, tongue, or buccal mucosa turns blue.

Article information

In other languages.

Determination of pulse and respiration, their assessment

Pulse- These are periodic jerky vibrations of the walls of the arteries caused by the movement of blood entering the vessels during the contraction of the heart. It is characterized by frequency, rhythm, filling, tension and is determined by touch (palpation).

The pulse rate under physiological conditions depends on many factors: on age (in newborns 130-140 contractions, at 3-5 years old - 95-100, at 7-10 years old - 85-90, in adults - 60-80); by gender (women have 6-10 more contractions than men);

depending on the time of day (during sleep, the pulse becomes slower); from muscular work, from body position, from the state of the neuropsychic sphere (with fear, pain, the pulse quickens), etc.

Increased heart rate (more than 80 beats per minute) is called tachycardia, and a decrease (less than 60) - bradycardia.

Distinguish rhythmic pulse And arrhythmic. With a rhythmic pulse, pulse waves follow one another at regular intervals and with equal strength. With an arrhythmic pulse, the intervals between pulse waves and their strength are different. The most common types of arrhythmias are extrasystole And atrial fibrillation.

Extrasystole when palpating the pulse, it is determined as an extraordinary premature pulse wave of lesser strength.

Atrial fibrillation characterized by the absence of any order in the pulse rhythm: pulse waves are determined by different sizes, following one after another at different intervals. Moreover, some systoles are so weak, and the pulse wave is so small that it does not reach the periphery and, accordingly, cannot be palpated. There is a difference between the number of systoles when listening to the heart and the number of pulse waves - the so-called pulse deficiency. Atrial fibrillation occurs due to heart defects.

Pulse filling depends on the systolic volume of blood (60-80 ml) ejected by the heart into the systemic circulation (aorta), as well as on the strength of heart contractions, vascular tone, the total amount of blood in the system and its distribution. The strength of heart contractions is judged by the filling of the pulse. With blood loss, pulse filling decreases.

Pulse voltage is determined by the force that must be applied by the examining finger to completely stop the flow of blood in the palpated artery, and by the resistance of the artery wall when it is compressed. Pulse voltage depends on altitude blood pressure: the higher it is, the more intense the pulse. Pulse voltage increases with sclerosis of the vascular wall. With a significant weakening of the heart’s activity and a decrease in the mass of circulating blood, the pulse becomes weak and can barely be felt (thread-like pulse).

The pulse is examined in those places where the arteries are located superficially, close to the bone and accessible to direct palpation. Most often, the pulse is determined at the peripheral end of the radial artery: this is convenient for assessing the pulse because the radial artery at the wrist joint is located superficially and lies on the radial bone.

The arm of the subject should be in a comfortable half-bent position, eliminating muscle tension. The examiner places the 2nd, 3rd, 4th fingers on the inner surface of the lower part of the forearm in the area of ​​the radius bone, placing thumb on outer surface hands; Having found the pulse, it determines its frequency, rhythm, filling and tension.

If the pulse on the radial artery cannot be examined (in case of injuries, burns), then it is determined on the carotid, femoral, and temporal arteries.

Breath

The frequency of respiratory movements in an adult ranges from 16 to 20 per minute, in women it is 2-4 breaths per minute more, in newborns it is 40-60 per minute. In trained athletes, the respiratory rate can be 6-8 per minute.

Respiratory movements are counted as follows: the examiner places his hand on the patient’s chest or upper abdomen and counts the number of breaths for a minute. It is most convenient to count breathing visually, observing the movements of the chest and abdominal wall. The counting is carried out unnoticed by the patient, best during palpation of the pulse, since the patient can voluntarily hold or speed up his breathing. The number of respiratory movements per minute correlates with the heart rate as 1: 4. Violation of the frequency, depth and rhythm of breathing is called shortness of breath. Shortness of breath may be associated with disturbances in inhalation and exhalation, the former being called inspiratory (inhalation), second- expiratory (exhalation).

To facilitate breathing during shortness of breath, you should free the chest from constricting clothing, take a semi-sitting position, increase the access of fresh air, and also give the patient oxygen.

In some cases, even at home, there is a need for digital and graphic recording of body temperature, pulse and number of respirations on a temperature sheet. A temperature sheet is an important document that includes leading indicators of the patient’s condition and their dynamics. Chronological indicators (days of illness and temperature) are noted on the sheet. Each day (a square on the sheet) has two halves to mark the morning and evening temperatures. Horizontally on the left edge of the sheet there are graphs for indicators of pulse rate (P), respiration (D) and temperature altitude (T).

The obtained data is drawn with multi-colored pencils or felt-tip pens in the form of curves.

Table 7 shows average data on changes in the considered indicators throughout life.

Table 7. Indicators of pulse, pressure, respiration in different age periods

Age Systolic blood pressure Diastolic blood pressure Pulse Breath
Newborns 59-71 30-40 90-100 45-60
1 month - 1 year 85-100 35-45 120-140 35-45
3-7 years 86-110 55-63 120-140 20-25
8-16 years 93-117 59-75 78-84 18-25
17-20 years old 100-120 70-80 60-80 16-18
21-60 years up to 140 up to 90 60-80 14-18
Over 60 years old up to 150 up to 90 60-80 14-18

The combination of inhalation and subsequent exhalation is considered one breathing movement. The number of breaths in 1 minute is called the respiratory rate (RR) or simply the respiratory rate. Normally, breathing movements are rhythmic.

In some cases, it is necessary to determine the respiratory rate. The respiratory rate of an adult at rest is 16-20 per minute; in women it is 2-4 breaths more than in men. In the lying position, the number of respirations usually decreases (to 14-16 per minute), in an upright position it increases (18-20 per minute). In trained people and athletes, the frequency of respiratory movements can decrease and reach 6-8 per minute.

Factors that cause the heart to beat faster can cause increased depth and speed of breathing. These include: physical activity, increased body temperature, strong emotional experience, pain, blood loss, etc.

The patient can voluntarily change the frequency, depth, and rhythm of breathing, so monitoring of breathing should be carried out discreetly. For example, while counting respiratory movements, you can tell the patient that you are examining their pulse.

Determination of frequency, depth, rhythm of breathing (in a hospital setting)

Material resources: watch or stopwatch, temperature sheet, pen, paper.

Execution algorithm.

Preparation for the procedure

1. Warn the patient that a study will be performed

pulse (the patient should not be informed that it will be examined

breathing rate).

2. Wash your hands.

3. Ask the patient to sit (lie down) more comfortably so that you can see the upper part of his chest and (or) abdomen.

Executing the procedure

4. Take the patient’s hand as for examining the pulse, but observe the excursion of his chest and count the respiratory movements for 30 s, then multiply the result by 2.

5. If you cannot observe the excursion of the chest, then place your hands (yours and the patient’s) on the chest (in women) or the epigastric region (in men), simulating the examination of the pulse (while continuing to hold your hand on the wrist).

6. Record the results in the accepted documentation.

Completing the procedure

7. Wash your hands.

8. Inform the patient about the results of the study.

Questions to test knowledge.

1. Devices for determining blood pressure.

2. Blood pressure measurement.

3. Registration of blood pressure indicators. Patient information.

4. Errors in measuring blood pressure.

5. Teaching the patient self-monitoring of blood pressure.

6. Disinfection of tonometer, phonendoscope.

7. Determination of respiratory rate, registration of indicators, informing the patient.

8. Determination of pulse, location of pulse determination.

9. Registration of pulse indicators. Patient information.

10. Teaching the patient self-monitoring of the pulse.

Determination of pulse.

Plan.

1. Determination of pulse, location of pulse determination, registration.

2. Informing the patient.

3. Teaching the patient self-monitoring of the pulse.

Questions on the topic.

1. Concepts, basic properties of the pulse.

2. Pulse indicators: normal, pathological.

1. Determination of pulse, location of pulse determination, registration.

Pulse studies can be carried out not only on the radial artery, but also on the carotid, temporal, femoral arteries, as well as arteries of the foot, etc. Pulse studies should be carried out on both limbs, comparing its properties.

If the pulse is rhythmic, it is possible to count pulse waves in 30 seconds, and the result should be doubled.

If the patient has an infectious skin disease medical service It is recommended to wear gloves.

The patient or relatives (trusted persons) must be informed about the upcoming procedure. Information reported medical worker, includes information about the purpose and progress of this procedure. Written confirmation of the consent of the patient or his relatives (authorized representatives) for this procedure is not required, since this service is not potentially dangerous to the life and health of the patient.

Rice. Pulse and its characteristics

There are arterial, capillary and venous pulses.

Arterial pulse is a rhythmic oscillation of the arterial wall caused by the release of blood into the arterial system during one heartbeat. There are central (on the aorta, carotid arteries) and peripheral (on the radial, dorsal artery of the foot and some other arteries) pulse.

For diagnostic purposes, the pulse is determined in the temporal, femoral, brachial, popliteal, posterior tibial and other arteries.

More often, the pulse is examined in adults on the radial artery, which is located superficially between the styloid process of the radius and the tendon of the internal radial muscle.

When examining the arterial pulse, it is important to determine its frequency, rhythm, filling, tension and other characteristics. The nature of the pulse also depends on the elasticity of the artery wall.

Frequency is the number of pulse waves per minute. Normally, a healthy adult has a pulse of 60-80 beats per minute. An increase in heart rate of more than 85-90 beats per minute is called tachycardia. A heart rate rate of less than 60 beats per minute is called bradycardia. The absence of a pulse is called asystole. With an increase in body temperature at HS, the pulse increases in adults by 8-10 beats per minute.

Rice. Blood pressure measurement

Arterial pressure is the pressure that is formed in the arterial system of the body during contractions of the heart and depends on complex neurohumoral regulation, the magnitude and speed of cardiac output, the frequency and rhythm of heart contractions and vascular tone.

There are systolic and diastolic pressure. Systolic is the pressure that occurs in the arteries at the moment of maximum rise of the pulse wave after ventricular systole. The pressure maintained in the arterial vessels during ventricular diastole is called diastolic.

To determine blood pressure, it is necessary to place the patient in a comfortable sitting or lying position. Place the patient's arm in an extended position, palm up, with a cushion under the elbow. Place the tonometer cuff on the patient's bare shoulder 2-3 cm above the elbow bend so that 1 finger passes between them.

Note: Clothing should not compress the shoulder above the cuff. Lymphostasis that occurs when air is pumped into the cuff and the vessels are compressed is eliminated.

Connect the pressure gauge to the cuff, securing it to the cuff. Check the position of the pressure gauge needle relative to the “0” scale mark. Determine the pulsation in the ulnar fossa with your fingers and apply a phonendoscope to this place.

Close the bulb valve, pump air into the cuff until the pulsation in the ulnar artery disappears +20-30 mmHg. Art. (i.e. slightly higher than expected blood pressure).

Open the valve, slowly release air, listen to the tones, and monitor the readings of the pressure gauge.

Note the number at which the first beat of the pulse wave appears, corresponding to systolic blood pressure, and continue to slowly release air from the cuff. “Note” the disappearance of tones, which corresponds to diastolic blood pressure.

Note: the sounds may weaken, which also corresponds to diastolic blood pressure.

Register the result in the form of a fraction (in the numerator - systolic pressure, in the denominator - diastolic) in the necessary documentation.

Watching the Breath

The respiratory movement is carried out by alternating inhalation and exhalation. The number of breaths in 1 minute is called the respiratory rate (RR).

Observation of breathing should be carried out unnoticed by the patient, since he can arbitrarily change the frequency, rhythm, and depth of breathing. NPV is related to heart rate on average as 1:4. When body temperature increases by 1°C, breathing becomes more frequent by an average of 4 respiratory movements.

The respiratory rate is calculated by the movement of the chest or abdominal wall, unnoticed by the patient. Taking the patient's hand, you can pretend that you are currently counting the pulse rate, but in fact count the frequency of respiratory movements in one minute. The counting should be carried out at rest; before counting, the patient should not do physical work, eat or worry, because these conditions increase the respiratory rate. Normally, the respiratory rate of an adult is 16-20 per minute. During sleep, the breathing rate decreases to 12-14 per minute. The respiratory rate increases with increasing temperature, with various diseases, especially with diseases of the pulmonary and cardiac systems, when the patient is nervous, after eating. A sharp increase in respiratory rate in patients with pulmonary and cardiac diseases may indicate the development of complications or worsening of the patient’s condition and requires urgent consultation with a doctor. We must not forget that a decrease in breathing rate is a pathological sign and requires consultation with a doctor!

In most medical institutions, pulse rate readings are recorded on a temperature sheet. All indicators of pulse rate, respiration, and blood pressure must be recorded in the diaries of the patient’s medical record (medical history).

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