An ineffective breathing pattern is defined as inspiration and/or expiration that does not provide adequate oxygenation. This diagnosis is related to the observed rate and depth of breathing, as well as abnormal chest expansion, and accessory muscle use that results in a breathing pattern that does not supply adequate ventilation to the body.
The ABCs; airway, breathing, and circulation, are the highest priority of nurses in caring for patients. An ineffective breathing pattern can arise from an array of causes and can occur suddenly. Nurses must be vigilant in observing acute changes and preventing the deterioration of patients and the possibility of respiratory failure.
In this article:
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
The following are common causes of an ineffective breathing pattern:
- Chronic pain and/or Acute Pain
- Anxiety
- Trauma to the chest
- Brain or spinal cord injury
- Airway obstruction
- Lung diseases such as COPD
- Infection
- Obesity
- Chest wall or diaphragm deformities
- Body positioning
- Respiratory muscle fatigue
- Cognitive impairment
Signs and Symptoms (As evidenced by)
The following are common signs and symptoms of an ineffective breathing pattern. They are categorized into subjective and objective data based on patient reports and assessment by the nurse.
Subjective: (Patient reports)
- Difficulty breathing; shortness of breath or dyspnea
- Anxiety in relation to breathing
Objective: (Nurse assesses)
- Dyspnea
- Abnormal respiratory rate; tachypnea or bradypnea
- Poor oxygen saturation
- Abnormal ABG results
- Shallow breathing
- Pursed-lip breathing
- Accessory muscle use when breathing
- Nasal flaring
- Cough
- Restlessness and anxiety
- Decreased level of consciousness
- Diaphoresis
- Abnormal chest x-ray results
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for an ineffective breathing pattern:
- Patient will deny shortness of breath.
- Patient will maintain an effective breathing pattern with normal respiratory rate, depth, and oxygen saturation.
- Patient will have ABG results within normal limits.
- Patient will incorporate breathing techniques to improve breathing pattern.
- Patient demonstrates the ability to complete ADLs without dyspnea.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to an ineffective breathing pattern.
1. Assess medical history for possible causes of ineffective breathing.
Emphysema, COPD, bronchitis, asthma, and pneumonia can disrupt breathing patterns. A recent history of smoking may also give insight into respiratory health.
2. Assess breath sounds and other vital signs.
Monitor for changes in lung sounds, respiratory rate and depth, and oxygen saturation closely for worsening or improvement.
3. Monitor for anxiety or change in mental status.
Feeling short of breath can induce panic which can, in turn, worsen hyperventilation. As oxygen decreases in the brain, the patient may become confused or lose consciousness. Monitor closely for changes in behavior or incoherent responses.
4. Review ABGs.
Arterial blood gas is drawn to measure the amount of oxygen and CO2 in the blood. Blood gases determine how well the lungs are able to move O2 into the blood and remove CO2. Abnormal blood pH levels can indicate respiratory problems.
5. Assess for pain.
Pain can cause increased blood pressure, heart rate, and ineffective breathing patterns. Some patients breathe very shallowly to guard against pain. This prevents them from getting adequate oxygenation. The nurse should assess for verbal and nonverbal signs of pain.
6. Assess for oversedation.
On the opposite side of pain, is the risk of oversedation. Narcotics, tranquilizers, and benzodiazepines have a risk of decreased level of consciousness and respiratory depression. The patient should be assessed to monitor for overdoses of medications.
7. Assess for secretions or ability to cough.
If secretions cannot be expectorated effectively, this can impede breathing.
8. Obtain sputum specimen as ordered.
Patients with secretions causing an ineffective breathing pattern may need their sputum cultured to assess for the presence of infection.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with an ineffective breathing pattern.
1. Apply oxygen.
Apply the lowest amount of oxygen required to support ventilation.
2. Request Respiratory Therapist support.
Respiratory therapists often manage patients with complex breathing issues. They are a wealth of knowledge regarding the correct oxygen therapy for each patient.
3. Reposition the patient.
Patients who cannot reposition themselves may become slumped in bed which prevents proper expansion of the lungs. Elevate the head of the bed and keep the patient in Semi-Fowlers or High-fowler’s position as tolerated to promote oxygenation.
4. Teach the patient pursed-lip breathing.
Pursed-lip breathing is a technique that allows for controlled ventilation. The breath is inhaled through the nose then slowly exhaled through pursed lips allowing for a prolonged expiration. This technique keeps the airways in the lungs open longer, preventing CO2 trapping.
5. Encourage the use of an incentive spirometer.
Incentive spirometers promote taking slow, deep breaths and expanding the lungs. This can help prevent lung problems like pneumonia.
6. Keep a cool, calm, relaxing environment.
The use of a fan blowing on the patient can decrease the feeling of dyspnea. Feeling overly hot can increase breathlessness so a cool room is usually preferred. The nurse can use relaxing techniques such as a quiet voice and soothing music to help with anxiety.
7. Medicate for pain or anxiety.
Narcotics, especially morphine, decrease the work of breathing and can be an effective treatment for dyspnea. Anti-anxiety medications can also help prevent hyperventilation and promote relaxation.
8. Promote energy conservation.
Teach the patient about performing the most taxing or important activities first, such as bathing, when energy is the highest. Rest as needed and take breaks between tasks to limit fatigue.
9. Encourage smoking cessation.
Educate the patient on the correlation between smoking and respiratory function. Help the patient develop a plan and goals to quit smoking.
10. Suction secretions or administer expectorants.
For patients who can cough effectively, expectorants can loosen mucus so the patient can more easily expel it. If the patient cannot cough on their own, they may need secretions suctioned frequently to prevent aspirating or poor ventilation. Anticholinergic medications can also dry up saliva and secretions.
11. Teach splinting of the chest & abdomen for deep breathing and coughing.
Those with recent chest or abdominal surgery may need to splint their incision with a pillow when deep breathing or coughing. This helps support the area and provides comfort.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for an ineffective breathing pattern.
Care Plan #1
Diagnostic statement:
Ineffective breathing pattern related to excessive secretions secondary to COPD as evidenced by pursed-lip breathing and reported dyspnea.
Expected outcomes:
- Patient will have clear breath sounds.
- Patient will have a respiratory rate of 12 to 20 breaths per minute.
- Patient will be able to cough up secretions.
- Patient will exhibit a normal depth of respiration.
- Patient will remain comfortable and not in respiratory distress.
Assessment:
1. Auscultate breath sounds.
Patients with COPD experience increased mucus production due to the hypertrophy and hyperplasia of goblet cells. The excessive secretions are also retained due to impaired ciliary movement and ineffective coughing. Decreased or absent breath sounds indicate a mucus plug.
2. Assess for changes in respiratory rate, depth, use of accessory muscles, and tripod positioning.
Tachypnea, increased respiratory depth, and use of accessory muscles indicate respiratory distress. Patients may also assume a tripod positioning to facilitate breathing and improve dyspnea.
3. Assess lung function spirometry results.
Spirometry results will show the severity and prognosis of COPD.
- Stage I (mild): FEV1 > 80%
- Stage II (moderate): FEV1 50-79%
- Stage III (severe): FEV1 30-49%
- Stage IV (very severe): FEV1 <30% or FEV1 <50% and chronic respiratory failure
4. Review Arterial Blood Gases.
ABGs show the chronicity and severity of COPD exacerbation. In mild COPD, results may reveal mild to moderate hypoxemia without hypercapnia. Hypercapnia and worsening hypoxemia may develop in severe stages.
Interventions:
1. Position the patient to high-Fowler’s position as indicated.
This position will facilitate optimal breathing by pushing the diaphragm downward for better lung expansion.
2. Administer low-flow oxygen therapy at 2L/min via nasal cannula as indicated. If insufficient, the patient may switch to a high-flow oxygen apparatus (e.g., Venturi Mask) for more accurate oxygen delivery.
Due to chronic air-trapping of carbon dioxide, their breathing stimulus switched to hypoxic drive. Hence, high oxygen therapy may be unsafe for patients with COPD as it may result in apnea. It is important to consult with a respiratory therapist.
3. Administer bronchodilators, expectorants, anti-inflammatories, and antibiotics, as ordered.
These medications decrease airway resistance, treat infection, and facilitate secretion removal.
4. Assist with effective coughing techniques:
- Splint the chest.
- Use abdominal muscles
- Instruct huff coughing
- Take two slow, deep breaths, hold your breath, and cough 2-3 consecutive coughs without inhaling in between
Controlled coughing techniques help mobilize secretions from smaller airways to larger airways. Forced expiratory coughing through an open airway may effectively mobilize trapped secretions in large airways.
Care Plan #2
Diagnostic statement:
Ineffective breathing pattern related to pulmonary congestion secondary to heart failure as evidenced by orthopnea.
Expected outcomes:
- Patient will demonstrate good breathing patterns as evidenced by the following:
- Normal respiratory rate: 12-20 breaths per minute
- Regular respiratory rhythm and normal respiratory depth
- Patient will exhibit an oxygen saturation level of 90% and above.
- Patient will report decreased orthopnea.
Assessment:
1. Monitor for changes in blood pressure, heart rate, respiratory rate, depth, and rhythm.
The patient will exhibit elevated BP, HR, and RR in the early stages of hypoxia and hypercapnia. As pulmonary congestion progresses, there will be a marked drop in BP and HR with concomitant dysrhythmias.
2. Auscultate for wheezes and crackles in lung bases.
Bubbling, wheezes, and crackles can be heard in fluid-filled lung fields.
3. Monitor oxygen saturation.
Pulse oximetry can detect changes in oxygenation. 90% and above indicates optimal oxygen level.
4. Monitor laboratory findings.
- Chest x-ray: Acute pulmonary edema will appear with cloudy white lung fields in x-ray films.
- ABG findings indicating pulmonary edema will reveal hypoxemia and respiratory alkalosis in the early stages. As the condition worsens, hypoxemia and hypercapnia progress, accompanied by respiratory acidosis.
Interventions:
1. Administer prescribed medications as ordered.
Medications may be given to reduce pulmonary congestion and associated discomfort. Diuretics such as Lasix may be given to reduce the amount of fluid in the body. Medications that may be given to improve overall heart function which include drugs to lower blood pressure and drugs to improve heart contractility. Morphine is also sometimes given to relieve shortness of breath and reduce anxiety associated with shortness of breath.
2. Position the patient upright as indicated.
An upright position allows for an increased thoracic capacity and full descent of the diaphragm. If the patient is having trouble sleeping while laying flat, the nurse can suggest sleeping in a more upright position.
3. Administer oxygen as needed.
Supplemental oxygen may be required to maintain oxygen at an acceptable level.
4. Anticipate endotracheal intubation and use of mechanical ventilation.
Early intubation and mechanical ventilation are recommended to prevent full decompensation of the patient if the patient is not responding to therapy.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Agarwal, A.K., Raja, A.,& Brown, B.D. (2022). Chronic obstructive pulmonary disease. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK559281/
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Nall, R. (2019, July 2). Blood Gas Test. Healthline. https://www.healthline.com/health/blood-gases
- Nguyen JD, Duong H. Pursed-lip Breathing. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545289/
