breathing pattern, ineffective a
nursing diagnosis approved by the North American Nursing Diagnosis Association, defined as
inspiration and/or
expiration that does not provide adequate
ventilation. Etiologic and contributing factors include disorders of the nervous system in which there is abnormal response to neural stimulation, as in spinal cord injury; impairment of musculoskeletal function, as in trauma to the chest; pain and discomfort associated with deep breathing, as after abdominal or thoracic surgery; fatigue and diminished energy level; inadequate lung expansion, as in poor body posture and positioning; inappropriate response to stress, as in hyperventilation; inflammation of respiratory structures; and tracheobronchial obstruction.
Subjective symptoms include reports of dyspnea, shortness of breath, pain associated with breathing, complaints of dizziness, and previous episodes of emotional or physical stress or fear and anxiety. Objective symptoms include increased respiratory rate and changes in depth of respirations, fremitus, abnormal arterial blood gases, nasal flaring, orthopnea or assumption of the three-point position, in which the patient sits down and elevates the shoulders by stiffening each arm and pushing downward with the hands on the chair or bed, use of accessory muscles of respiration, increased anteroposterior diameter of chest (
barrel chest), and altered chest excursion.
The goal of nursing intervention is to help the patient experience improved gas exchange by using a more effective breathing pattern. This might include teaching appropriate breathing exercises and proper use of accessory muscles of respiration, and encouraging body posture that maximizes expansion of the lungs. If postoperative pain is a contributing factor, providing support of the operative site to reduce strain during coughing or moving about could encourage deeper respirations and a more normal breathing pattern. If a causative factor is stress with resultant hyperventilation or some other ineffective breathing pattern, the patient may need help in developing more beneficial coping mechanisms such as relaxation techniques.