Recognising Tachypnoea for Student Nurses
Learn how to recognise an increased respiratory rate, assess breathing systematically and understand why tachypnoea can be one of the earliest signs that a patient's condition is deteriorating.
What is tachypnoea?
Tachypnoea means breathing faster than expected. For many resting adults, a respiratory rate of around 12–20 breaths per minute is commonly used as a reference range, but interpretation should always take account of the individual patient and clinical context.
Breathing faster
A rate above 20 breaths per minute is commonly considered elevated in a resting adult.
Watch for a rise
A rate rising steadily from the patient's normal level may provide an important early warning.
Rate is only one clue
Depth, pattern, accessory muscle use and ability to speak all add important information.
How to assess respiratory rate effectively
Observe the patient at rest
Where possible, assess respiration without asking the patient to consciously alter their breathing.
Count accurately
Count chest or abdominal movements for an appropriate period and record the respiratory rate correctly.
Assess breathing effort
Look for accessory muscle use, recession, laboured breathing or other visible signs of increased work.
Listen to the patient
Consider whether they can speak comfortably in full sentences or are interrupted by breathlessness.
Assess oxygenation
Review oxygen saturation, prescribed target range and whether oxygen requirements have changed.
Review the wider observations
Check pulse, blood pressure, temperature, consciousness and other NEWS2 parameters.
Count it — don't guess it
Respiratory rate is sometimes poorly measured because it is estimated rather than counted. Accurate assessment can reveal deterioration that may otherwise be missed.
Why might respiratory rate increase?
| Possible context | Other clues | Clinical thinking |
|---|---|---|
| Respiratory illness | Cough, wheeze, breathlessness, sputum or altered oxygenation. | The patient may increase respiratory effort to maintain ventilation or oxygenation. |
| Hypoxia | Falling oxygen saturation, respiratory distress or altered mental state. | Increasing respiratory rate may accompany worsening oxygenation. |
| Infection or sepsis | Temperature change, tachycardia, hypotension or confusion. | Tachypnoea can be an important feature of systemic physiological stress. |
| Pain | Patient reports pain, guarding or distress. | Pain can increase respiratory rate and should be assessed in context. |
| Metabolic disturbance | Altered clinical state with deeper or faster breathing. | The body may change respiratory pattern in response to metabolic abnormalities. |
| Anxiety | Patient appears anxious or frightened. | Anxiety can increase breathing rate, but physical causes should still be considered appropriately. |
A rising respiratory rate may come before other dramatic changes
A patient whose respiratory rate moves from 16 to 20 to 26 breaths per minute may be deteriorating even if their blood pressure and oxygen saturation initially appear relatively stable.
Respiratory rate is only part of the assessment
- Observe depth and regularity of breathing.
- Look for accessory muscle use or visible respiratory effort.
- Assess whether the patient can speak in full sentences.
- Listen for audible wheeze, stridor or other abnormal sounds.
- Assess oxygen saturation and prescribed target range.
- Check whether supplemental oxygen is being used.
- Ask about chest pain, breathlessness or new respiratory symptoms.
- Compare current findings with previous observations.
Notice the direction of travel
16 breaths/min
Patient comfortable and breathing normally at rest.
21 breaths/min
A change is developing. Check whether symptoms or other observations have also altered.
28 breaths/min
The continuing rise represents a clinically important trend that requires assessment.
The trend may tell the story
A progressively increasing respiratory rate can provide important evidence of deterioration before the patient reaches a dramatic crisis.
Putting the observations together
Example
Earlier in the shift, a patient's respiratory rate was 16 breaths per minute and oxygen saturation was stable.
Their respiratory rate is now 28. They are visibly working harder to breathe and struggle to speak in full sentences.
Their oxygen saturation has fallen and their pulse has increased.
The concern is not simply a respiratory rate of 28. It is the combined pattern of increasing respiratory rate, increased work of breathing and worsening oxygenation.
As a student nurse, recognise the deterioration, assess within an ABCDE approach and promptly communicate the findings to the appropriate registered practitioner.
Tachypnoea assessment errors to avoid
- Estimating respiratory rate. Count it accurately.
- Looking only at oxygen saturation. A patient can have significant respiratory distress despite a relatively preserved SpO₂.
- Ignoring the trend. A steadily rising respiratory rate deserves attention.
- Assuming anxiety is the cause. Consider respiratory, circulatory, infectious and metabolic problems.
- Ignoring work of breathing. Observe how hard the patient is breathing, not just how fast.
- Delaying escalation while repeatedly checking observations. If breathing is deteriorating, seek help promptly.
Recognise → assess → communicate → escalate
Notice faster breathing
Identify tachypnoea or a significant rise from the patient's previous respiratory rate.
Look at breathing properly
Review respiratory effort, oxygenation, symptoms and the other physiological observations.
Report the pattern
Give the respiratory rate, trend and associated breathing or observation changes clearly.
Recognising Bradypnoea for Student Nurses
Learn how to recognise an abnormally slow respiratory rate, assess associated changes in consciousness and understand when reduced breathing may indicate serious deterioration.
Continue to Recognising Bradypnoea →