Even though the respiratory rate might already be recorded, again carefully observe the rate, rhythm, depth, and effort of breathing. A healthy resting adult breathes quietly and regularly about 20 times a minute. Note whether expiration lasts longer than usual.

Begin by observing the patient for signs of respiratory distress.

Signs of Respiratory Distress

■ Assess the respiratory rate for tachypnea (>25 breaths/minute).

■ Inspect the patient's color for cyanosis or pallor. Recall earlier relevant findings, such as the shape and color of the fingernails.

■ Listen for audible sounds of breathing. Is there audible whistling during inspiration over the neck or lungs?

■ Inspect the neck. During inspiration, is there contraction of the accessory muscles, namely the SCM and scalene muscles, or supraclavicular retraction? During expiration, is there contraction of the intercostal or abdominal oblique muscles? Is the trachea midline?

Also observe the shape of the chest, which is normally wider than it is deep. The ratio of the anteroposterior (AP) diameter to the lateral chest diameter is usually 0.7 to 0.75 up to 0.9 and increases with aging.

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