Shortness of Breath Nursing Diagnosis and Nursing Care Plans

Shortness of Breath Nursing Care Plans Diagnosis and Interventions

Shortness of Breath NCLEX Review and Nursing Care Plans

Often known as dyspnea, shortness of breath is the sensation of not being able to get enough air into the lungs. There is also a feeling of tightening in the chest during this time. Shortness of breath or difficulty of breathing is a symptom of a variety of medical diseases, most commonly heart or lung disease.

Dyspnea can, however, be a symptom of other conditions such as asthma, allergies, or nervousness.

However, transient dyspnea might occur after a strenuous workout or other physical activity.

Signs and Symptoms of Shortness of Breath

Shortness of Breath is characterized by difficult breathing. After strenuous activity, it may last for 1 or 2 minutes. A person may feel like there is not enough air into the lungs in mild cases.

In severe circumstances, however, it can be like the feeling of suffocating. Overexertion, time spent at high altitude, or a symptom of a variety of illnesses can all cause dyspnea.

Shortness of Breath can be identified by observing the following symptoms:

  • Dyspnea (shortness of breath) caused by physical activity or a medical condition
  • As a result of breathing issues, feeling suffocated or smothered
  • A struggle to breathe
  • Chest tightness
  • Breathing that is quick and shallow
  • Heart palpitations
  • Wheezing
  • Coughing

It’s understandable if someone experiences shortness of breath after a vigorous workout. However, It is advised to seek medical help if any of the following symptoms are present:

  • After strenuous activity, I took a short breath sooner than usual.
  • Out of breath after an activity that used to be easy before.
  • Dyspnea for no apparent reason.

Causes of Dyspnea

Short-term shortness of breath is frequently brought on by exercise. Following severe exercise, a person may find it difficult to get enough oxygen to meet their body’s needs. It’s natural to need a few minutes to regain breath in these situations.

This will usually improve with rest, and breathing will be normal again in a matter of minutes. Shortness of breath can be caused by a variety of medical disorders. Conditions that cause sudden breathlessness should always be treated as an emergency.

Short-term shortness of breath can be caused by a variety of factors, which may include:

Chronic dyspnea can be caused by a variety of factors, including:

  • COPD (chronic obstructive pulmonary disease) includes emphysema and chronic bronchitis.
  • Interstitial Lung Disease
  • Heart Disease
  • Difficulty in maintaining physical fitness
  • Lung cancer
  • Obesity
  • Pulmonary hypertension
  • Pleural effusion

Asthma can be a long-term illness or a life-threatening emergency. This can vary depending on the severity of the disease.

Risk Factors for Shortness of Breath

  • Existing medical conditions – dyspnea is the most common symptom of asthma. People with asthma may experience dyspnea if they are exposed to allergens such as pollen or mold. Different types of obstructive lung disorders are referred to as COPD. Emphysema and chronic bronchitis are two of them.
  • Pollutants in the environment – these include chemicals, fumes, dust, and smoke that can make breathing difficult for patients. Tobacco smoking, for example, is highly preventable pollution. According to the COPD Foundation, while not everyone with dyspnea has COPD, 90 percent of people with COPD had smoked at some point in their lives.

Diagnosis of Shortness of Breath

Doctors and nurses will assess the airway, breathing, and circulation  (ABCs) to see if emergency treatment is required. If this isn’t the case, a series of tests will be performed to figure out what’s causing the dyspnea. These may include the following:

  • Physical examination – to check the pulse, rate of breathing, BMI, and body temperature. A high temperature could indicate that a fever is producing dyspnea, while an irregular pulse could indicate a cardiac problem.
  • Spirometry – used to determine the patient’s lung capacity and airflow. This can assist in determining the kind and severity of a person’s respiratory difficulties.
  • Imaging scans – to obtain a more specific diagnosis of dyspnea and to assess the health of the person’s heart, lungs, and related systems, doctors may order chest X-rays and computed tomography (CT) images. An electrocardiogram (ECG) can reveal any indicators of a heart attack or other electrical issue in the heart.
  • A review of the patient’s medical history
  • Blood tests

Treatment for Shortness of Breath

  1. Medical management of the existing health condition. Dyspnea is usually treated by addressing the underlying cause, such as asthma, COPD, etc. This may include oxygen supplementation, repositioning the patient, removal of thick secretions, etc.
  2. Lifestyle changes. If the dyspnea is caused by obesity and a difficulty in regulating the fitness level, eating a well-balanced diet and exercising regularly will help alleviate symptoms. Current research says that moderate weight loss, even without exercise, can help obese patients to lessen dyspnea symptoms.
  3. Pulmonary Rehabilitation. A pulmonologist, who specializes in the health of the lungs and respiratory system, is needed to treat COPD and other lung disorders. To avoid being out of breath, it is required to have supplemental oxygen in the form of a portable tank. Researchers have recently found that pulmonary rehabilitation can help those with dyspnea symptoms. This is a supervised exercise and breathing technique program designed to help overcome lung problems.
  4. Cardiac Rehabilitation. Dyspnea is one of the symptoms of heart failure. The heart is too weak to pump enough oxygenated blood to meet the body’s needs if there is heart failure. Heart failure and other heart-related disorders can be managed with cardiac rehabilitation. In severe situations of heart failure, an artificial pump may be required to help the heart function.

Prevention of Shortness of Breath

Dyspnea can be avoided or at least mitigated by preventing or controlling the various causes. Smoking is the most evident cause of dyspnea or shortness of breath. Smoking cessation  is critical for avoiding not just dyspnea, but many other respiratory issues. The following steps will help in preventing dyspnea and optimizing lung health:

  • Stop smoking. Join smoking cessation programs and groups to help in the journey towards a smoke-free lifestyle.
  • Whenever possible, avoid secondhand smoke.
  • Other environmental triggers, such as chemical odors and wood smoke, should be avoided.
  • Start a weight loss plan. Losing weight can help strengthen the cardiovascular and respiratory systems by reducing stress on the heart and lungs and making exercise simpler.
  • At altitudes above 5,000 feet, take time acclimating to higher altitudes, ease into activities gradually.
  • Treat health conditions that cause dyspnea. Adhering to treatment plans to manage these conditions will help to prevent dyspnea.
  • Avoid air pollution and airborne chemicals by using a mask to filter irritants, and make sure that there is a well-ventilated workplace.
  • Avoid overexertion or intense physical activity that can cause short-term dyspnea.

Nursing Diagnosis for Shortness of Breath

Nursing Care Plans for Shortness of Breath 1

Ineffective Breathing Pattern 

Nursing Diagnosis: Ineffective Breathing Pattern related to airway obstruction, secondary to asthma, as evidenced by dyspnea, bradypnea, nasal flaring, and use of accessory muscles when breathing.

Desired Outcomes:

  • The patient will be able to demonstrate calm breathing at a normal rate and depth and the absence of dyspnea.
  • The patient will be able to maintain an effective breathing pattern.
  • The patient will have respiratory rates within the normal range.
  • The patient will be able to verbalize comfort when breathing.
Shortness of Breath Nursing InterventionsRationale
Assess the patient every 4 hours, check and record the patient’s breathing rate and depth.    Adults breathe at a pace of 10 to 20 breaths per minute on average. When there is a change in breathing patterns, it is critical to act quickly to recognize early indicators of respiratory system damage.
Determine the patient’s ABG levels in accordance with facility policy.This keeps track of the patient’s oxygenation and ventilation levels.
Observe the patient’s breathing habits.      Breathing patterns that are unusual could indicate an underlying sickness or dysfunction. Cheyne-Stokes respiration is a symptom of bilateral brain damage or metabolic disorders in the deep cerebral or diencephalon. The failure of the respiratory centers in the pons and medulla is linked to apneusis and ataxic breathing.
Encourage the patient to perform deep breaths. Demonstrate deep breathing techniques which may include emphasizing slow inhalation, holding end inspiration for a few seconds,  performing passive exhalation, and using an incentive spirometer.Deep inhalation is encouraged by these procedures, which enhances oxygenation and prevents atelectasis. Controlled breathing techniques may also help tachypneic patients breathe more slowly. Air trapping is avoided by exhaling slowly.  
Advise the patient with chronic respiratory disease to practice diaphragmatic breathing.This approach relaxes muscles while also increasing oxygen levels in the patient.  
Examine whether or not inspiratory muscle exercise is appropriate for the patient.Inspiratory muscle exercise is a training that enhances respiratory muscle control and inspiratory muscle strength.  
Encourage the patient to take regular breaks in between activities and teach the patients how to pace themselves.Shortness of breath might be exacerbated by increased activity. Ensure that the patient gets plenty of rest in between heavy activity.

Shortness of Breath Nursing Care Plan 2

Ineffective Airway Clearance

Nursing Diagnosis: Ineffective Airway Clearance related to copious and persistent bronchial secretions secondary to pertussis, as evidenced by dyspnea, increased mucus secretions, and productive cough.

Desired Outcome:

  • The patient will be able to maintain clear and open airways as evidenced by normal breath sounds, normal depth, and rate of respirations.
  • The patient will demonstrate the ability to effectively cough up secretions after treatments and deep breathing exercises.
  • The patient will demonstrate increased air exchange.
  • The patient will be able to classify methods to improve the removal of secretions.
  • The patient will recognize the significance in changes of sputum such as the color, characteristics, and amount.
  • The patient will be able to identify and avoid necessary factors that limit effective airway clearance.
Shortness of Breath Nursing InterventionsRationale
Educated the patient about the proper coughing and breathing techniques.    Teach the patient how to cough and breathe properly (For example, take a deep breath, hold it for 2 seconds, then cough twice or three times in a row.) to maintain a clear airway.
Encourage the patient to perform effective coughing. Educate the patient on the use of quad and huff techniques, incentive spirometry.These methods will help in loosening the mucus and aid in the effective removal of secretions by coughing up effectively.  
Educate the patient about the importance of proper positioning. Discuss the significance of ambulation, as well as the use of a pillow or hand splint when coughing.  If the patient can tolerate it, put the patient in an upright Fowler’s position. To avoid sliding down in bed, check the patient’s position on a regular basis.  This position will help the patient to breath properly by increasing oxygenation.  
Encourage the patient to increase oral fluid intake. Encourage the patient to drink 3 liters of water per day, within the limits of cardiac reserve and renal function.This will help in loosening the mucus and will help in the removal of secretions.

Shortness of Breath Nursing Care Plan 3

Impaired Gas Exchange

Nursing Diagnosis: Impaired Gas Exchange related to changes in oxygen supply, destruction of the alveoli, and changes in the alveolar-capillary membrane, secondary to chronic obstructive pulmonary disease (COPD), as evidenced by dyspnea, SpO2 level of 78%, confusion, and restlessness.

Desired Outcomes:

  • The patient will be able to demonstrate improved breathing and will show normal oxygenation of tissues as measured by normal arterial blood gasses (ABG) results, and will have no signs of respiratory distress.
  • The patient will be able to participate in the treatment plan to the best of his/her ability.
Shortness of Breath Nursing InterventionsRationale
Evaluate the patient and keep track of the breathing rate and depth. The usage of accessory muscles, pursed-lip respiration, and incapacity to speak or converse should also be noted.To determine the severity of respiratory discomfort or the length of time a disease has been present.  
Assess the patient and check the color of the skin and mucous membranes on a regular basis.Cyanosis can be either peripheral (as in the nail beds) or central (as in the lips or earlobes). Advanced hypoxemia is indicated by duskiness and central cyanosis.
Observe the patient for changes in consciousness and mental condition.    Hypoxia is characterized by restlessness, agitation, and worry. Worsening ABGs accompanied by disorientation or somnolence are signs of hypoxia-induced brain dysfunction.
Monitor the patient’s vital signs and heart rate.  The effects of systemic hypoxemia on heart function might manifest as tachycardia, dysrhythmias, and changes in blood pressure.
Examine the patient’s breath sounds, note any areas of reduced airflow or unusual sounds.    Because of reduced airflow or areas of consolidation, breath sounds may be weak. Wheezes could suggest bronchospasm or secretory retention. Interstitial fluid or cardiac decompensation may be indicated by scattered moist crackles.
Position the patient properly. Elevate the head of the bed and get the patient into a position that will make breathing easier. As tolerated, include periods of time in a prone position. Encourage deep, slow, or pursed-lip breathing as needed or tolerated by the patient.To reduce airway collapse, dyspnea, and labor of breathing, an upright position and breathing exercises can help increase oxygen supply. To raise Pao2, lie down in a prone position.  
Examine the patient’s sleeping habits, take note of any complaints, and see if the patient appears to be well-rested. Allow for uninterrupted sleep by providing a calm environment, group care, or monitoring activities; limit stimulants such as caffeine; encourage a comfortable position while attempting to sleep in bed.Multiple external stimuli, as well as the presence of dyspnea, might make it difficult to relax and sleep.  
Monitor the patient’s oxygen saturation and adjust oxygen as needed to keep Sp02 within the target range, which is usually between 88 and 92 percent in a COPD patient. .A pulse oximetry measurement of less than 88 percent may require oxygen administration, whereas a reading of 92 percent or above may necessitate oxygen titration or discontinuation.

Shortness of Breath Nursing Care Plan 4

Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to the imbalance oxygen supply and demand due to ineffective work of breathing secondary to COPD as evidenced by dyspnea during exercise, breathing difficulty, and excessive decrease or increase in respiratory rate.

Desired Outcomes:

  • The patient will be able to report decreased episodes of shortness of breath when performing an activity.
  • The patient will be able to give a rate of 3 or less on a scale of 0-10 on perceived breathing exertion.
Shortness of Breath Nursing InterventionsRationale
Assess the patient’s respiratory response to activities, including breathing rate and depth, oxygen saturation, and the usage of auxiliary muscles for breathing.Patients with COPD may experience hypoxia during increased exercise and may require oxygen therapy to avoid hypoxemia, which puts them at risk for exacerbations of the disease.
Determine the patient’s nutritional needs.During physical exertion, adequate energy reserves are required.
Maintain the patient’s recommended level of activity.It aids in the development of tolerance and the reduction of dyspnea episodes.
Allow the patient to have at least 90 minutes of uninterrupted rest in between activities.Resting undisturbed lowers oxygen consumption and provides for optimal physiological recuperation.
Educate the patient on how to perform Active range of motion (ROM) exercises and assist the patient while doing the exercise.Aids in the development of stamina and the avoidance of the difficulties that come with limited movement.
Instruct the patient on energy-saving strategies such as keeping frequently used objects close at hand, sitting down to complete chores, frequently changing positions, and maintaining a steady pace of work.These methods lower oxygen consumption, allowing for longer periods of exercise.  
Teach the patient breathing exercises like diaphragmatic and pursed-lip breathing to improve their breathing capacity.These strategies lengthen the exhalation duration, which reduces carbon dioxide retention.  
Assist the patient in getting a referral to a pulmonary rehabilitation program if necessary.  The patient can learn about diet, breathing and relaxation techniques, medication information, avoiding exacerbations, and strategies to live better with COPD through this program.

Shortness of Breath Nursing Care Plan 5

Fatigue

Nursing Diagnosis: Fatigue related to labored breathing, respiratory distress, and hypoxia, secondary to pneumonia, as evidenced by dyspnea, increased pulse rate, increased respiratory rate, and restlessness.

Desired Outcome: The patient will be able to show signs of decreased fatigue as evidenced by improved sleeping habits, calmness, ability to perform daily activities, and a calmer demeanor.

Shortness of Breath Nursing InterventionsRationale
Assess the patient’s vital signs every four hours. Keep track of the frequency of breathing work.Identifying and notifying changes in vital signs enable the nurse to conduct prompt action to identify a solution to the problem and reduce weariness.
Assess the patient for changes in the level of consciousness, note any presence of shortness of breath, tachycardia, irritability, weariness, and restlessness are all indications of hypoxiaDetermining these symptoms as soon as possible facilitates timely management and the reduction of weariness.    
As the child’s condition improves, encourage basic, peaceful, age-appropriate play activities.Physical and mental comfort improves one’s overall well-being, promotes relaxation, and reduces oxygen consumption and fatigue.
Allow scheduled and integrated nursing care to provide for uninterrupted rest and sleep. Create a calm and relaxing atmosphere with proper ventilation.Rest is encouraged to cope with dyspnea. Stress and anxiety levels need to be reduced through frequent rest periods.  
Allow for the presence of a significant other during nursing care and other procedures.Because the presence of significant individuals reduces worry and anxiety, allowing them to be with the patient may help reduce shortness of breath due to anxiety towards nursing care especially prior and during procedures.  

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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