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Showing posts with label Ineffective Breathing Pattern Care Plan. Show all posts
Showing posts with label Ineffective Breathing Pattern Care Plan. Show all posts

Ineffective Breathing Pattern Care Plan

Ineffective breathing pattern

DEFINITIONS:

Inspiration and / or expiration that does not provide adequate ventilation

PURPOSE:

Addressing the problem of ineffective breathing pattern

CRITERIA:
  • There was no increased work of breathing
  • There is no use of accessory muscles / retractions and asymmetrical chest expansion
  • No dyspnoea and cyanosis
  • Blood Gas Analysis within normal limits
  • Vital signs within normal limits
  • No additional breath sounds

NURSING DIAGNOSIS INEFFECTIVE BREATHING PATTERN CARE PLAN :

Ineffective breathing pattern related to
  • Fatigue, changes in the ratio of O2 and CO2
  • Anxiety, hyperventilation, hypoventilation syndrome
  • Pain
  • Bone deformities, spinal cord injury
  • Neuromuscular dysfunction
  • Obesity

NURSING INTERVENTIONS INEFFECTIVE BREATHING PATTERN CARE PLAN
  • Review the causes of respiratory failure
  • Observations of breathing patterns
  • Auscultation of lung sounds periodically, note the quality of breath sounds, wheezing, expiratory lengthening and observation symmetry chest movement
  • Determine the location and extent of crackles in the sternum
  • Ensure breathing in tune with vgentilator and no resistance (Fighting)
  • Attach and fill the balloon with the proper ETT fixation
  • Have resuscitation equipment close to the client, perform manual ventilation if necessary

HEALTH EDUCATION:
  • Teach the client and family relaxation techniques to increase effective breathing pattern
  • Teach how to cough effectively
  • Talk about home-care plan

Act of collaboration:
  • Ventilator settings and adjust the ventilator pattern with the client's condition
  • Observation konsintrasi O2 (Fi O2) is given
  • Encourage deep breath through the abdomen during the period of respiratory distress
  • Record the pressure and the airway pressure waveform monitor
  • Ensure humidity and air temperature of inspiration and periodically checks
  • Set and check the ventilator alarm
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