When you’re at the bedside, one of the first things you’ll notice about a patient is how they’re breathing. Is their chest rising evenly? Do they look comfortable, or are they struggling for air? For nurses, spotting these early signs can make the difference between timely intervention and a rapid deterioration. Whether you’re working in triage, emergency, ICU, paediatrics, or mental health, a solid respiratory assessment is one of the most essential skills in your toolkit. It’s not just about ticking a box. It’s about recognising when something isn’t right and acting fast to keep your patient safe.

Breathing problems are often the first warning sign of serious illness. A patient who looks fine one minute may suddenly deteriorate, and as the nurse at the bedside, you’re often the first to pick it up.

"The respiratory assessment is a key component to nursing skill and care," says Registered Nurse and academic, Jessica Stokes-Parish. "It is fundamental to a good nursing assessment and should be a part of your suite of skills. It takes time to develop, and should be a priority area of skill development.”

A thorough respiratory assessment helps you decide whether you need to escalate care, call a doctor for review, or, in urgent cases, make a Medical Emergency Team (MET) call.

Many hospitals now use the A–G method for structured patient assessments. It’s a systematic approach originally designed for resuscitation, but it’s just as useful for routine checks:
A – Airway
B – Breathing
C – Circulation
D – Disability
E – Exposure
F – Further information (family, friends, history)
G – Goals of care

1. Airway and breathing are the first two steps, and together, they make up your respiratory assessment. Airway: Is it Clear? The priority is ensuring the airway is open and free from obstruction. Common causes include:
   Foreign body or aspiration
   Trauma or swelling (e.g. allergic reaction, haematoma)
   Vocal cord paralysis
   Laryngeal oedema or abscess
   Signs of partial obstruction: gurgling or wheezing, laboured breathing, coughing, gasping for air, or struggling to speak in full sentences.
   Signs of complete obstruction: no chest movement, stridor, panic, choking, or unconsciousness.
2. Breathing: A healthy patient should breathe effortlessly, at 12–20 breaths per minute, with symmetrical chest expansion and no abnormal noises. When assessing, use the Look, Listen and Feel method:
   Look: Is the patient using accessory muscles? Is their chest movement equal?
   Listen: Can you hear wheeze, stridor, or rattling?
   Feel: Place a hand on the chest to gauge depth, symmetry, and movement.

Don’t forget to check oxygen saturation (SpO₂), skin colour, and whether the patient can talk in full sentences. For most patients, SpO₂ should be >96%. For those with COPD or risk of hypercapnia, 88–92% is acceptable.

Every hospital has criteria for escalation, but as a rule of thumb, call a MET if your patient has:

• Threatened or obstructed airway
• Respiratory rate <8 or >36 breaths/min
• SpO₂ <90% despite oxygen
• Blue lips/skin, stridor, or sudden deterioration

And remember: if you’re worried, even if the numbers look “normal”, call anyway.

If you’ve activated the MET, follow the ABCDE approach:

• Airway: Clear obstructions, suction, position patient on side if possible.
• Breathing: Give high-flow oxygen (unless contraindicated).
• Circulation: Insert IV access, check BP, consider fluids, run an ECG.
• Disability: Check blood glucose.
• Exposure: Expose for assessment but maintain warmth and dignity.

When the patient is stable enough, dig deeper into their history:

• Family history: asthma, COPD, cancer
• Occupation: exposure risks (e.g. mining, asbestos)
• Smoking: record in pack-years
• Current medications: some drugs have respiratory side effects
• Presenting symptoms: cough, sputum (colour/consistency), blood in sputum, dyspnoea, wheeze, chest pain, night sweats, or weight loss

These details help guide next steps and highlight red flags like possible TB, cancer, or pulmonary embolism.

Paediatric patients present unique challenges. Their airways are smaller and more easily obstructed, and their normal respiratory rates differ from adults.

"Children are also more likely to occlude their airway due to the size of their tongue, and are more susceptible to airway obstruction," says Ms Stokes-Parish.

Key red flags in children include:

• Barking cough (croup) or whooping cough
• Stridor or suspected swallowed foreign body
• Nasal flaring, tracheal tug, or intercostal retractions
• Lethargy, poor feeding, or reduced wet nappies
• Not being up to date with vaccinations

Always escalate concerns early, as children can deteriorate quickly.

A respiratory assessment isn’t just a checklist, it’s about watching, listening and trusting your instincts. The more you practise, the more confident you’ll become at spotting subtle changes that signal danger.

As Jessica Stokes-Parish reminds us: “Look at the chest rise and fall, listen to the sounds, feel for depth and symmetry. If you’re worried, escalate. It’s always better to call early than too late.”

Sources:

ARC Advanced Life Support Level 1: Immediate Life Support. Third Edition. Australian Edition. Australian Resuscitation Council 2011.
Oxford Handbook of Clinical Medicine (9 ed.) by Murray Longmore, Ian Wilkinson, Andrew Baldwin, and Elizabeth Wallin.