Nursing Care Plan

Ineffective Breathing Pattern NIC NOC

Nursing Diagnosis for Ineffective Breathing Pattern

Definition: The exchange of air inspiration and / or expiration inadequate.

Ineffective breathing pattern related to
  • Hyperventilation
  • Hypoventilation syndrome
  • Damage muskuloskletal
  • Neuromuscular Dysfunction
  • Fatigue muscles of respiration
  • Changes in chest movement
  • Bradipnea, tachypnea
  • Decrease in inspiratory and expiratory pressures
  • Breath nostril
  • The use of auxiliary respiratory muscles
  • Increased vital signs

Nursing Interventions for Ineffective Breathing Pattern
a. Airway Management:
  • Open the airway with headtilt, chinlift, jaw thrust
  • Set the position to maximize ventilation
  • Use tools airway
  • Perform chest physiotherapy
  • Teach breath deeply and cough effectively
  • Auscultation of breath sounds
  • Give bronchodilators (Collaboration)

b. Oxygen therapy
  • Provide humidification system of oxygen equipment
  • Monitor the flow of oxygen and the amount given
  • Monitor signs of oxygen toxicity

c. Monitoring of respiration
  • Monitor the frequency, rhythm and depth of breathing
  • Monitor the use of auxiliary respiratory muscles

d. Monitoring of vital signs
  • Monitor blood pressure, pulse, respiratory rate, temperature
  • Monitor blood pressure during sleep, sit, stand up if indicated
  • Monitor signs and symptoms of hypothermia or hyperthermia
  • Monitor rhythm and breath sounds
Ineffective Breathing Pattern related to Cardiac Tamponade
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