Rate The respiratory rate is counted by watching the chest rise and fall. Each rise and fall is counted as one respiration. Rate The normal respiratory rate for an adult is 12-20 breaths per minute. Respiratory rate does vary by age. Rhythm The respiratory rhythm should be regular, meaning breaths are evenly spaced out. Other times, the rhythm may be irregular, shallow, deep, or a combination of these. Quality The quality of respiration can be observed as the client breathes. This focuses on the effort that the client requires in order to move air into and out of the lungs. Unlabored breathing is observed when the client uses the muscles with ease during inspiration and expiration. Increased work of breathing is noted when the client requires more effort to move air into and out of the lungs. Use of accessory muscles is seen when clients begin to use muscles other than the diaphragm when breathing. Some of these muscles include the sternocleidomastoid, scalene muscles, and trapezius muscles. Retractions can also be observed as the client continues to use other muscles to pull air into and out of the lungs. Some examples of these include intercostal retractions and subcostal retractions.

Level of consciousness can be described in terms such as alert, lethargic, obtunded, stupor, or coma.

Reference Jarvis, C., & Eckhardt, A. L. (2024). Pocket companion for physical examination & health assessment (9th ed., pp. 9–16). Elsevier.