NURSING DIAGNOSIS: Ineffective breathing pattern

related to:
  1. decreased rate and depth of respirations associated with the depressant effect of some medications (e.g. narcotic [opioid] analgesics, sedatives, centrally acting muscle relaxants) that may be given for treatment of current diagnosis;
  2. diminished lung/chest wall expansion associated with:
    1. recumbent positioning (in this position, full expansion of the lungs is restricted by the bed surface and by the abdominal contents pushing up against the diaphragm)
    2. weakness.
Desired Outcome
The client will maintain an effective breathing pattern as evidenced by normal rate and depth of respirations.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for signs and symptoms of an ineffective breathing pattern (e.g. shallow or slow respirations).
  2. Implement measures to improve breathing pattern:
    1. place client in a semi- to high Fowler's position unless contraindicated; position client with pillows to prevent slumping
    2. if client must remain flat in bed, assist with position change at least every 2 hours unless contraindicated
    3. instruct client to deep breathe or use incentive spirometer every 1 - 2 hours
    4. perform actions to reduce chest or abdominal pain if present (e.g. splint chest/abdomen with a pillow when positioning, coughing, and deep breathing; administer prescribed analgesics) in order to increase the client's willingness to move and breathe more deeply
    5. perform actions to decrease fear and anxiety (see Diagnosis 13, action b) in order to prevent the shallow and/or rapid breathing that can occur with fear and anxiety
    6. assist with positive airway pressure techniques (e.g. IPPB, continuous positive airway pressure [CPAP], bilevel positive airway pressure [BiPAP], expiratory positive airway pressure [EPAP]) if ordered
    7. instruct client to avoid intake of gas-forming foods (e.g. beans, cauliflower, cabbage, onions), carbonated beverages, and large meals in order to prevent gastric distention and additional pressure on the diaphragm
    8. increase activity as allowed
    9. administer central nervous system depressants judiciously; hold medication and consult physician if respiratory rate is less than 12/minute.
  3. Consult appropriate health care provider (e.g. physician, respiratory therapist) if:
    1. ineffective breathing pattern continues
    2. signs and symptoms of impaired gas exchange (e.g. restlessness, irritability, confusion, significant decrease in oximetry results, decreased PaO2 and increased PaCO2 levels) are present.