Difficulty maintaining adequate ventilation through inspiration and/or expiration

• Anxiety
• Body position that inhibits lung expansion
• Excessive airway secretions
• Excessive fatigue burden
• Increased physical exertion
• Ineffective cough
• Ineffective overweight self-management
• Pain
• Respiratory muscle fatigue

• Chronic obstructive pulmonary diseases
• Congenital abnormalities
• Critical illness
• Decreased pulmonary compliance
• Heart diseases
• Increased airway resistance
• Increased serum hydrogen concentration
• Musculoskeletal impairment
• Neurological immaturity
• Neurological impairment
• Neuromuscular diseases
• Respiration disorders
• Spinal cord injuries

• Age
• Weight
• History of respiratory disorder
• Respiratory status, including rate and depth of respiration, symmetry of chest expansion, use of accessory muscles, presence of cough, anterior-posterior chest diameter, palpation for fremitus, percussion of lung fields, auscultation of breath sounds, and pulmonary function studies
• Cardiovascular status, including heart rate and rhythm, blood pressure, and skin color, temperature, and turgor
• Neurologic and mental status, including level of consciousness and emotional level
• Preexisting conditions
• Knowledge, including current understanding of physical condition and physical, mental, and emotional readiness to learn

• Abdominal paradoxical respiratory pattern
• Adventitious respiratory sounds
• Altered chest excursion
• Altered respiratory depth
• Altered respiratory rhythm
• Altered tidal volume
• Bradypnea
• Cyanosis
• Decreased expiratory pressure
• Decreased inspiratory pressure
• Decreased minute ventilation
• Decreased vital capacity
• Diminished respiratory sounds
• Dyspnea
• Excessive use of accessory respiratory muscles
• Hypercapnia
• Hyperventilation
• Hypoventilation
• Hypoxemia
• Hypoxia
• Increased anterior-posterior chest diameter
• Nasal flaring
• Orthopnea
• Prolonged expiration phase
• Pursed-lip breathing
• Subcostal retraction
• Tachypnea
• Uses three-point position

• Patient's respiratory rate will stay within 5 breaths/minute of baseline.
• Patient respiratory rate will be within normal limits.
• Arterial blood gas (ABG) levels will return to baseline.
• Patient will demonstrate adequate breathing pattern with easy, unlabored respirations.
• Patient will report feeling comfortable when breathing.
• Patient will report feeling rested each day.
• Patient will demonstrate diaphragmatic pursed-lip breathing.
• Patient will achieve maximum lung expansion with adequate ventilation.
• Patient will demonstrate skill in conserving energy while carrying out activities of daily living (ADLs).

Suggested NOC Outcomes

• Assess and record respiratory rate and depth at least every 4 hours to detect early signs of respiratory compromise.
• Auscultate breath sounds at least every 4 hours to detect decreased or adventitious breath sounds; report changes.
• Monitor ABG values and pulse oximetry readings to evaluate oxygenation and respiratory status.
• Observe for signs of respiratory distress (nasal flaring, tachypnea, retractions, grunting, and use of accessory muscles for breathing).
• Assist patient into a comfortable position, for example, by supporting the upper extremities with pillows, providing an overbed table with a pillow to lean on, and elevating head of bed. These measures promote comfort, chest expansion, and ventilation of basilar lung fields.
• Perform chest physiotherapy to aid mobilization and secretion removal if ordered. Percussion, vibration, and postural drainage enhance airway clearance and respiratory effort.
• Provide rest periods between breathing enhancement measures to avoid fatigue.
• Help patient with ADLs as needed to conserve energy and avoid overexertion and fatigue.
• Administer oxygen as ordered. Supplemental oxygen helps reduce hypoxemia and relieve respiratory distress.
• Suction airway as needed. Retained secretions alter the ventilatory response, thus reducing oxygen, leading to hypoxemia.
• Schedule necessary activities to provide periods of rest. This prevents fatigue and reduces oxygen demands.
• Teach patient about:
  • pursed-lip breathing
  • abdominal breathing
  • performing relaxation techniques
  • taking prescribed medications (ensuring accuracy of dose and frequency and monitoring adverse effects)
  • scheduling activities to avoid fatigue and provide for rest periods
  • smoking cessation. These measures allow patient to participate in maintaining health status and improve ventilation.
• Refer patient for evaluation of exercise potential and development of individualized exercise program. Exercise promotes conditioning of respiratory muscles and patient's sense of well-being.

Suggested NIC Interventions

• Patient's respiratory rate remains within established limits.
• Patient's ABG levels return to and remain within established limits.
• Patient indicates, either verbally or through behavior, feeling comfortable when breathing.
• Patient reports feeling rested each day.
• Patient performs diaphragmatic pursed-lip breathing.
• Patient demonstrates maximum lung expansion with adequate ventilation.
• When patient carries out ADLs, breathing pattern remains normal.

• Patient's expressions of comfort in breathing, emotional state, understanding of medical diagnosis, and readiness to learn
• Physical findings from pulmonary assessment
• Interventions carried out and patient's responses to them
• Evaluations for expected outcomes

• Aboussouan, L. S., & Mireles-Cabodevila, E. (2017). Sleep-disordered breathing in neuromuscular disease: Diagnostic and therapeutic challenges. Chest, 152(4), 880-892.
• Maines, E., Baggio, L., Gugelmo, G., Morandi, G., & Bordugo, A. (2017). Newborn with rhizomelia and difficulty breathing. Skeletal Radiology, 46(2), 231.
• Rai, S., & Ionescu, A. A. (2017). A 44-year-old, Caucasian, male nonsmoker with worsening difficulty in breathing and decreased exercise tolerance. Breathe, 13(2), 117-122.
• Ratnovsky, A., Gino, O., & Naftali, S. (2017). The impact of breathing pattern and rate on inspiratory muscles activity. Technology & Health Care, 25(5), 823-830.