Shortness of breath, also known as dyspnea, is a common and often distressing symptom experienced by many patients. As a nurse, understanding the intricacies of this condition is crucial for providing effective care. This comprehensive guide will explore the nursing diagnosis of shortness of breath, including its causes, assessment techniques, and evidence-based interventions.
Understanding Shortness of Breath
Shortness of breath is the subjective feeling of difficulty breathing or not getting enough air. It can range from mild discomfort to severe distress and may be acute or chronic. Patients often describe it as:
- Feeling breathless
- Unable to catch their breath
- Tightness in the chest
- Air hunger
- Suffocating sensation
Dyspnea can be caused by various factors, including:
- Respiratory conditions (e.g., asthma, COPD, pneumonia)
- Cardiovascular diseases (e.g., heart failure, pulmonary embolism)
- Anxiety disorders
- Obesity
- Anemia
- Neuromuscular disorders
- Environmental factors (e.g., high altitude, air pollution)
Nursing Assessment
A thorough nursing assessment is crucial for identifying the underlying cause of shortness of breath and developing an appropriate care plan. The assessment should include:
Health History Review
- Onset and duration of symptoms
- Aggravating and alleviating factors
- Associated symptoms (e.g., chest pain, cough, fever)
- Past medical history, especially respiratory and cardiac conditions
- Medications
- Smoking history and occupational exposures
Physical Examination
- Vital signs (respiratory rate, heart rate, blood pressure, temperature, oxygen saturation)
- Inspection of chest wall movement and use of accessory muscles
- Auscultation of lung sounds
- Assessment of skin color (cyanosis)
- Evaluation of mental status and level of anxiety
Diagnostic Tests
- Pulse oximetry
- Arterial blood gas (ABG) analysis
- Chest X-ray
- Pulmonary function tests
- Electrocardiogram (ECG)
- Complete blood count (CBC)
Nursing Care Plans for Shortness of Breath
Based on the assessment findings, nurses can develop appropriate care plans to address the patient’s needs. Here are five common nursing diagnoses related to shortness of breath, along with their corresponding interventions and desired outcomes:
Nursing Care Plan 1. Ineffective Breathing Pattern
Nursing Diagnosis Statement: Ineffective Breathing Pattern related to anxiety, respiratory muscle fatigue, and airway obstruction as evidenced by dyspnea, use of accessory muscles, and abnormal respiratory rate and rhythm.
Related Factors/Causes:
- Anxiety
- Respiratory muscle fatigue
- Airway obstruction
- Pain
- Neurological impairment
Nursing Interventions and Rationales:
- Position the patient in a semi-Fowler’s or high Fowler’s position to maximize lung expansion and ease breathing.
- Teach and encourage pursed-lip breathing and diaphragmatic breathing techniques to improve ventilation and reduce anxiety.
- Administer oxygen therapy as prescribed to improve oxygenation and reduce the work of breathing.
- Encourage relaxation techniques such as guided imagery or progressive muscle relaxation to reduce anxiety and promote calm breathing.
- Monitor vital signs, especially respiratory rate and oxygen saturation, to assess the effectiveness of interventions and detect any deterioration.
Desired Outcomes:
- The patient will demonstrate an improved breathing pattern, with a respiratory rate within normal limits (12-20 breaths/minute) and reduced use of accessory muscles.
- The patient will report decreased shortness of breath and anxiety related to breathing.
Nursing Care Plan 2. Impaired Gas Exchange
Nursing Diagnosis Statement: Impaired Gas Exchange related to ventilation-perfusion imbalance and alveolar-capillary membrane changes as evidenced by dyspnea, abnormal arterial blood gases, and cyanosis.
Related Factors/Causes:
- Ventilation-perfusion imbalance
- Alveolar-capillary membrane changes
- Airway obstruction
- Atelectasis
- Pulmonary edema
Nursing Interventions and Rationales:
- Assess and monitor respiratory status, including rate, depth, and pattern, to detect early signs of deterioration.
- Auscultate lung sounds regularly to assess for changes in breath sounds that may indicate worsening gas exchange.
- Administer prescribed medications (e.g., bronchodilators, diuretics) to improve airway patency and reduce fluid accumulation.
- Encourage deep breathing and coughing exercises to promote airway clearance and improve ventilation.
- Monitor arterial blood gas results and oxygen saturation to evaluate the effectiveness of interventions and guide therapy.
Desired Outcomes:
- The patient will maintain oxygen saturation ≥ 95% on room air or prescribed oxygen therapy.
- The patient will demonstrate arterial blood gas values within normal limits.
- The patient will report decreased dyspnea and improved comfort with breathing.
Nursing Care Plan 3. Activity Intolerance
Nursing Diagnosis Statement: Activity Intolerance related to imbalance between oxygen supply and demand as evidenced by dyspnea on exertion, fatigue, and inability to perform daily activities.
Related Factors/Causes:
- Imbalance between oxygen supply and demand
- Generalized weakness
- Sedentary lifestyle
- Anxiety about dyspnea during activity
Nursing Interventions and Rationales:
- Assess the patient’s current activity level and tolerance to establish a baseline and set realistic goals.
- To improve cardiovascular endurance, implement a gradual exercise program, starting with low-intensity activities and progressively increasing as tolerated.
- Teach energy conservation techniques to reduce oxygen demand, such as sitting while performing tasks or breaking activities into smaller segments.
- Encourage the use of assistive devices (walkers, shower chairs) to minimize energy expenditure during daily living activities.
- Administer prescribed oxygen therapy during activities as needed to support increased oxygen demand.
Desired Outcomes:
- The patient will demonstrate improved activity tolerance, as evidenced by an increased ability to perform daily activities without excessive fatigue or dyspnea.
- The patient will report decreased shortness of breath during routine activities.
Nursing Care Plan 4. Anxiety
Nursing Diagnosis Statement: Anxiety related to dyspnea and fear of suffocation as evidenced by expressed feelings of apprehension, restlessness, and increased heart rate.
Related Factors/Causes:
- Fear of suffocation
- Lack of knowledge about managing dyspnea
- Previous negative experiences with breathlessness
- Chronic health conditions causing dyspnea
Nursing Interventions and Rationales:
- Establish a trusting relationship with the patient to create a supportive environment and reduce anxiety.
- Teach relaxation techniques such as deep breathing, progressive muscle relaxation, or mindfulness meditation to help manage anxiety symptoms.
- Provide education about the patient’s condition and management strategies to increase understanding and sense of control.
- Encourage the patient to express fears and concerns related to dyspnea to address underlying anxiety triggers.
- Administer anti-anxiety medications as prescribed and monitor their effectiveness in reducing anxiety symptoms.
Desired Outcomes:
- The patient will demonstrate reduced signs of anxiety, including decreased heart rate and respiratory rate.
- The patient will report feeling more in control of their breathing and less anxious about dyspnea episodes.
Nursing Care Plan 5. Ineffective Airway Clearance
Nursing Diagnosis Statement: Ineffective Airway Clearance related to excessive mucus production and ineffective cough as evidenced by dyspnea, abnormal breath sounds, and inability to clear secretions.
Related Factors/Causes:
- Excessive mucus production
- Ineffective cough
- Inflammation of airways
- Retained secretions
- Impaired ciliary function
Nursing Interventions and Rationales:
- Assess breath sounds and cough effectiveness regularly to monitor for changes in airway clearance.
- Teach and assist with effective coughing techniques, such as huffing and controlled coughing, to promote secretion clearance.
- Perform chest physiotherapy or postural drainage as appropriate to mobilize secretions and improve airway clearance.
- Encourage adequate hydration to thin secretions and facilitate their removal.
- Administer prescribed medications (e.g., mucolytics, bronchodilators) to reduce mucus viscosity and improve airway patency.
Desired Outcomes:
- The patient will demonstrate improved airway clearance as evidenced by clear breath sounds and effective cough.
- The patient will report decreased dyspnea and improved ability to expectorate secretions.
Conclusion
Shortness of breath is a complex symptom that requires careful assessment and individualized care planning. Nurses can significantly improve patient outcomes and quality of life by understanding the underlying causes, performing thorough assessments, and implementing evidence-based interventions. Remember that ongoing evaluation and adjustment of the care plan are essential to ensure optimal management of dyspnea.
References
- Berliner, D., Schneider, N., Welte, T., & Bauersachs, J. (2016). The Differential Diagnosis of Dyspnea. Deutsches Ärzteblatt International, 113(49), 834–845.
- Faull, O. K., Marlow, L., Finnegan, S. L., & Pattinson, K. T. S. (2018). Chronic breathlessness: re-thinking the symptom. European Respiratory Journal, 51(1), 1702238.
- Kamal, A. H., Maguire, J. M., Wheeler, J. L., Currow, D. C., & Abernethy, A. P. (2011). Dyspnea Review for the Palliative Care Professional: Assessment, Burdens, and Etiologies. Journal of Palliative Medicine, 14(10), 1167–1172.
- Parshall, M. B., Schwartzstein, R. M., Adams, L., Banzett, R. B., Manning, H. L., Bourbeau, J., Calverley, P. M., Gift, A. G., Harver, A., Lareau, S. C., Mahler, D. A., Meek, P. M., & O’Donnell, D. E. (2012). An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea. American Journal of Respiratory and Critical Care Medicine, 185(4), 435–452.
- Spathis, A., Booth, S., Moffat, C., Hurst, R., Ryan, R., Chin, C., & Burkin, J. (2017). The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease. NPJ Primary Care Respiratory Medicine, 27(1), 27.
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