INEFFECTIVE BREATHING PATTERN
Inspiration and/or expiration that does not provide adequate ventilation
- Body position
- Chest wall deformity
- Musculoskeletal impairment
- Respiratory muscle fatigue
Shortness of breath
Adults >14 yr: ≤ 11 or [ >]24
Children 1 to 4 yr, <20 or >30
5 to 14 yr, <14 or >25
Infants [0 to 12 mo], <25 or >60
Depth of breathing:
Adult tidal volume: 500 mL at rest
Infant tidal volume: 6 to 8 mL/kg
Timing ratio; prolonged expiration phases; pursed-lip breathing
Decreased minute ventilation; vital capacity
Decreased inspiratory/expiratory pressure
Use of accessory muscles to breathe; assumption of three-point position
Altered chest excursion; [paradoxical breathing patterns]
Nasal flaring; [grunting]
Increased anterior-posterior diameter
The patient will
- Maintain respiratory rate within 5 of baseline.
- Regain arterial blood gases to baseline.
- Express feelings of comfort when breathing.
- Demonstrate diaphragmatic pursed-lipped breathing.
- Achieve maximal lung expansion with adequate ventilation.
- Maintain heart rate, rhythm, and blood pressure within expected range during periods of activity.
- Demonstrate skill in conserving energy while carrying out ADLs.
Interventions and Rationales:
Monitor and record respiratory rate and depth at least every 4 hr to detect early stages of respiratory failure. Auscultate breath sounds at least every 4 hr to detect decreased or adventitious breath sounds. Report changes.
Administer oxygen, as ordered, to maintain an acceptable level of oxygen at the tissue level.
Suction airway as needed to maintain patent airways.
Assist patient to Fowler’s position, which will promote expansion of lungs and provide comfort. Support upper extremities with pillows, providing a table and cover it with a pillow to lean on.
Turn and reposition patient at least every 2 hr. Establish a turning schedule for the dependent patient. Post schedule at bedside and monitor frequency. Turning and repositioning prevent skin breakdown and improve lung expansion and prevent atelectasis.
Assist patient with ADLs as needed to conserve energy and avoid overexertion.
Encourage active exercise: Provide a trapeze or other assistive device whenever possible. Such devices simplify moving and turning for many patients and allow them to strengthen some upper body muscles.
Teach patient the following measures to promote participation in maintaining health status and improve ventilation: pursed lip breathing, abdominal breathing, and relaxation techniques (deep breathing, meditation, guided imagery), taking prescribed medications (ensuring accuracy and frequency and monitoring side effects); and scheduling of activities to allow for rest periods.
Teach caregivers to assist patient with ADLs in a way that maximizes patient’s potential. This enables caregivers to participate in patient’s care and encourages them to support patient’s independence.
Provide emotional support and encouragement to improve patient’s self-concept and motivate patient to perform ADLs.
Involve patient in planning and decision making. Having the ability to participate will encourage greater compliance with the plan for activity.
Have patient perform self-care activities. Begin slowly and increase daily, as tolerated. Performing self-care activities will assist patient to regain independence and enhance self-esteem.
Schedule activities to allow for periods of rest.
Refer to case manager/social worker to ensure that a home assessment has been done and that whatever modifications were needed to accommodate the patient’s level of mobility have been made. Making adjustments in the home will allow the patient a greater degree of independence in performing ADLs, allowing better conservation of energy.
Refer patient for evaluation of exercise potential and development of individualized exercise program. Gradual increase in exercise will promote conditioning and ease breathing.
Booker, R. (2005, January). Chronic obstructive pulmonary disease: Nonpharmacological approaches. British Journal of Nursing, 14(1), 14–18.