NURSING DIAGNOSIS: Ineffective breathing pattern

related to:
  1. increased rate and decreased depth of respirations associated with fear and anxiety;
  2. decreased rate and depth of respirations associated with the depressant effect of some medications (e.g. narcotic [opioid] analgesics, some antiemetics);
  3. diminished lung/chest wall expansion associated with:
    1. reluctance to breathe deeply because of pain
    2. decreased activity
    3. positioning (client often positions self on side with knees and trunk flexed to reduce pain)
    4. pleural effusion if present
    5. pressure on the diaphragm resulting from accumulation of gastrointestinal gas and fluid and ascites if present.
Desired Outcome
The client will maintain an effective breathing pattern as evidenced by:
  1. normal rate and depth of respirations
  2. absence of dyspnea
  3. symmetrical chest excursion.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for signs and symptoms of an ineffective breathing pattern (e.g. shallow respirations, dyspnea, tachypnea, use of accessory muscles when breathing, limited chest excursion).
  2. Implement measures to improve breathing pattern:
    1. perform actions to reduce fear and anxiety (e.g. assure client that staff are nearby; provide a calm, restful environment; explain all tests and procedures) in order to prevent the shallow and/or rapid breathing that can occur with fear and anxiety
    2. perform actions to reduce pain (see Diagnosis 4, action d) in order to increase the client's willingness to move and breathe more deeply
    3. perform actions to reduce pressure on the diaphragm:
      1. implement measures to reduce the accumulation of gas and fluid in the gastrointestinal tract (see Diagnosis 6, action b)
      2. implement measures to prevent further third-spacing and/or promote mobilization of fluid back into vascular space (see Diagnosis 2) in order to reduce ascites
    4. perform actions to prevent and treat pleural effusion (see Diagnosis 8, actions B and C in pleural effusion complication)
    5. when severe pain has subsided, place client in a semi- to high Fowler's position unless contraindicated; position with pillows to prevent slumping
    6. if client must remain flat in bed, assist with position change at least every 2 hours
    7. instruct client to deep breathe or use incentive spirometer every 1-2 hours
    8. 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
    9. increase activity as allowed and tolerated
    10. 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. respiratory therapist, physician) if:
    1. ineffective breathing pattern continues
    2. signs and symptoms of atelectasis (e.g. diminished or absent breath sounds, dull percussion note over affected area, increased respiratory rate, dyspnea, tachycardia, elevated temperature) develop
    3. 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.