Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Name of Student: __________________________ Grade: ________________

Year & Section: ____________________________ Date: _________________

PROCEDURE CHECKLIST
ASSESSING RESPIRATION

Instruction: Below is the grading scale which will be used in rating your performance.

Done
Not done
Assess:
1. Skin and mucous membrane color.
2. Position assumed for breathing.
3. Signs of cerebral anoxia.
4. Chest movements.
5. Activity tolerance.
6. Chest pain.
7. Dyspnea.
8. Medications affecting respiratory rate.
Materials:
1. Watch with a second hand or indicator

Not Procedure
REMARKS Done
done
Identify yourself 1.
Verify the client’s identity.
Explain to the client what you are
going to do and why it is necessary.
How the client can cooperate.
Perform hand hygiene and observe 2.
other appropriate infection control
procedures.
Provide for client privacy. 3.

If you anticipate the client’s awareness 4.

of respiratory assessment, place a
hand against the client’s chest to feel
the chest movements with breathing,
or place the client’s arm across the
chest and observe the chest
movements while supposedly taking
the radial pulse.
Count the respiratory rate for full 5.
minute. An inhalation and an
exhalation count as one respiration.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

Observe the respirations for depth by 6.

watching the movement of the chest.
Observe the respirations for regular or 7.
irregular rhythm.
Observe the character of respirations 8.
the sound they produce and the effort
they require.
Document the respiratory rate, 9.
depth, rhythm, and character on
the appropriate record.

Date/Time: _________________________________

Clinical Instructor/Facilitator: ___________________