INEFFECTIVE BREATHING PATTERN
Definition:
Inspiration and/or expiration
that does not provide adequate ventilation
Related
factors:
- Anxiety
- Body position
- Chest wall deformity
- Musculoskeletal impairment
- Obesity
- Pain
- Respiratory muscle fatigue
Defining
Characteristics:
Subjective
Shortness of breath
Objective
Dyspnea; orthopnea
Respiratory rate:
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
Expected
outcomes:
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:
Determine:
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.
Perform:
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.
Inform:
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.
Attend:
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.
Manage:
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.
Reference
Booker, R. (2005, January). Chronic
obstructive pulmonary disease: Nonpharmacological approaches. British Journal
of Nursing, 14(1), 14–18.
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