Respiratory Rate Assessment for Student Nurses
Learn how to measure respiratory rate accurately, assess the wider pattern of breathing and recognise changes that may indicate patient deterioration.
Respiratory rate can provide an early warning
Respiratory rate is one of the physiological observations used in NEWS2. Changes in breathing may occur when the body is responding to illness, hypoxia, infection, pain, metabolic disturbance or other physiological stress.
Resting respiratory rate
Breaths per minute is a commonly taught resting reference range for a healthy adult.
Physiological parameter
Respiratory rate is one of the six physiological parameters used within NEWS2.
Look beyond rate
Depth, rhythm, work of breathing, patient appearance and oxygenation all contribute to the clinical picture.
How to measure respiratory rate
Accurate measurement matters. Estimating or routinely entering a familiar value can conceal an important change in a patient's condition.
Observe the patient
Notice their position, colour, ability to speak, apparent breathlessness and general condition before focusing on a number.
Watch chest or abdominal movement
Observe the rise and fall associated with breathing while maintaining the patient's dignity.
Count the respirations
Count accurately over an appropriate period according to your clinical teaching and local procedure.
Assess the pattern
Consider whether breathing appears regular or irregular, shallow or deep, relaxed or laboured.
Record accurately
Document the measured rate promptly on the appropriate observation system or chart.
Interpret and escalate
Compare with previous observations, review NEWS2 and communicate abnormalities or clinical concern appropriately.
Useful student nurse habit
Where appropriate, observing respiration without drawing unnecessary attention to the counting process may help you obtain a more representative resting respiratory rate.
What else should you observe?
A respiratory assessment involves considerably more than counting breaths. Develop the habit of describing what the patient's breathing actually looks and sounds like.
| Feature | What to consider | Why it matters |
|---|---|---|
| Rate | Is breathing faster or slower than expected? | A change may reflect physiological stress or deterioration. |
| Rhythm | Is the breathing pattern regular or irregular? | An altered pattern may provide additional clinical information. |
| Depth | Does breathing appear unusually shallow or deep? | Depth helps you build a fuller picture of ventilation. |
| Work of breathing | Does breathing appear comfortable or laboured? | Increased respiratory effort can be an important warning sign. |
| Speech | Can the patient speak comfortably in sentences? | Difficulty speaking because of breathlessness may indicate significant respiratory distress. |
| Sounds | Can you hear wheeze, stridor, gurgling or other abnormal sounds? | Audible respiratory sounds may require prompt assessment. |
| Appearance | Consider colour, distress, sweating, agitation and exhaustion. | The patient's appearance may reveal deterioration not captured by one observation. |
Changes that should get your attention
Avoid waiting for one dramatic abnormality. Deterioration may first appear as a collection of smaller changes.
- A respiratory rate that is increasing or decreasing compared with previous observations.
- New or worsening breathlessness.
- Increased effort or use of accessory muscles during breathing.
- Difficulty speaking comfortably because of breathlessness.
- New audible respiratory sounds.
- Falling oxygen saturation or an increasing oxygen requirement.
- New agitation, confusion, drowsiness or reduced responsiveness.
- A patient who simply looks significantly more unwell than before.
Clinical concern matters
NEWS2 supports recognition of deterioration, but it does not replace clinical judgement. If you are worried about a patient, communicate that concern to the appropriate registered practitioner and follow local escalation procedures.
Putting the observations together
Example
Earlier in the shift, your patient's respiratory rate was 15 breaths per minute. During the next set of observations you measure 22.
You also notice that the patient appears more breathless when speaking and their oxygen saturation has fallen compared with the previous observation.
The important finding is not simply that one number has changed. There is now a pattern of respiratory deterioration.
Your role as a student nurse is to recognise the change, obtain and record accurate observations and promptly communicate your concern to the appropriate registered practitioner.
Five respiratory-rate errors to avoid
- Guessing the rate. Measure it rather than automatically recording a familiar value.
- Looking only at the monitor. Respiratory assessment requires observation of the patient.
- Ignoring the trend. Compare the current result with previous observations whenever possible.
- Recording without interpreting. Ask whether the result fits the patient's clinical appearance.
- Delaying escalation. Significant respiratory change or clinical concern should be communicated appropriately.
Recognise → assess → communicate → escalate
Respiratory rate becomes much more useful when it forms part of a consistent approach to recognising patient deterioration.
Notice the change
Is the patient breathing differently, looking more unwell or reporting new symptoms?
Gather information
Measure respiratory rate accurately and consider the patient's wider observations and clinical presentation.
Speak up early
Communicate your findings clearly and follow local escalation procedures when deterioration is suspected.
Further professional learning: Royal College of Physicians — National Early Warning Score (NEWS2) .
Oxygen Saturation Assessment for Student Nurses
Learn what oxygen saturation measures, how pulse oximetry is used, why target ranges matter and how falling oxygen saturation can contribute to recognition of patient deterioration.
Continue to Oxygen Saturation Assessment →