Dyspnea Nursing Diagnosis and Nursing Care Plan

Dyspnea Nursing Care Plans Diagnosis and Interventions

Dyspnea NCLEX Review and Nursing Care Plans

Respiration is considered as one of the primary vital signs that are monitored by the healthcare providers for their patients. Out of all the vital functions in the body, respiration is unique because its regulation is not only led by automatic centers at the brainstem but also from voluntary signals coming from the cortex.

Untoward instances encountered in the control of respirations, the ventilator pump, or gas exchange mechanism will result to an uncomfortable breathing also known as Dyspnea. Although the initial goal is to remedy the physiologic disturbances (e.g., gas exchange), addressing chronic cardiopulmonary disorders also plays a role for better management and monitoring of patients with dyspnea.

Signs and Symptoms of Dyspnea

• breathlessness
• tightness in the chest
• air hunger
• difficulty in breathing deeply
• feelings of suffocation
• decrease in oxygen saturation levels

Causes and Risk Factors of Dyspnea

The causes and risk factors of dyspnea revolve around the following encountered problems on the mechanisms of breathing:

1. Heightened ventilatory demand. The symptoms of dyspnea are observed when hyperpnea happens while at rest, in the absence of any form of increased physical activity.
2. Respiratory muscle abnormalities. Any abnormalities or weaknesses of the muscles of respiration can cause deviations between the respiratory outputs versus the achieved ventilation. This is particularly observed, for example, on patients with Chronic Obstructive Pulmonary Disease (COPD). In COPD, there is an over-inflation of the lungs and increased thoracic expansion resulting to suboptimal ventilations and development of dyspnea.
3. Abnormal ventilator impedance. In instances wherein ventilation is increasingly impeded, the level of effort needed to achieve the required output also rises. This can be true for certain respiratory conditions, such as asthma, wherein there is constriction of the patients’ airways, resulting to increased airway resistance.
4. Abnormal breathing patterns. Abnormalities involving the lung tissues has dyspnea as its most common symptom. The accounted rapid shallow breathing from these conditions is a reflex response because of the activation and stimulation of the pulmonary vagal receptors.
5. Blood-gas abnormalities. Dyspnea associated with changes in the blood-gas exchange can be observed for the following conditions. A decrease in the partial pressure of oxygen concentrations in the blood (hypoxemia) allows for respiratory effort to increase through stimulation of the chemoreceptors. A low oxygen concentration in the tissues of the body (hypoxia) has direct dyspneic effect as well. In instances of hypercapnia (increased carbon dioxide concentrations), more effort is exerted by the respiratory system because of variations in the hydrogen ion exchanges in the alveoli.

• Anxiety disorders
• Asthma
• Pulmonary embolism
• Heart failure
• Anemia
• Pneumonia
• Anaphylaxis
• Sudden blood loss
• Pregnancy

Some conditions that may cause long-term dyspnea are mentioned below:

• Chronic obstructive pulmonary disease
• Obesity
• Cardiomyopathy
• Congestive heart failure
• Pulmonary hypertension
• Sarcoidosis
• Lung cancer
• Tuberculosis

Complications of Dyspnea

Complications of dyspnea coincide with the worsening of the underlying condition. Some of the associated complications are as follows:

1. Edema or swelling of the ankles and feet. This often associated with renal problems and therefore progressing to the accumulation of fluid in the lungs.
2. Orthopneic dyspnea. Difficulty breathing when lying flat may signal a worsening condition and would warranty immediate medical intervention.
3. Hyperthermia accompanied by cough and chills. This could indicate the worsening of an infection that may lead to systemic compromise and the development of Sepsis, a life-threatening condition.
4. Wheezing. Presence of wheezing accompanied by dyspnea would mean tightening of the patient’s airways and fluid accumulation. If left untreated, this may lead to respiratory compromise and eventually respiratory failure and arrest.

Diagnosis of Dyspnea

Diagnosing dyspnea involves recognizing the issues of the respiratory system and the underlying causes attributed to the condition. This can be initially assessed through a complete medical history and physical examination. However, the assessments and tests mentioned below will further aid in the initial confirmation of dyspnea.

• Lung function test – involves measurement of the lung’s capacity and volume to hold and withhold air. An example of this measurement is through a spirometer wherein the patient inhales deeply and exhales through the tool, measuring the volume of air the rate of how fast the test is accomplished.

• Pulse oximetry – Involves use of a machine, usually attached in the patient’s earlobe or finger, that measures the oxygen saturation in the capillary bed.

• Blood tests – diagnostic tools that are utilized in finding the reasons for a patient’s dyspnea. Examples of which are:
  • complete blood counts to check for infection or anemia
  • bleeding and clotting parameters to check for bleeding, or presence of clot
  • blood urea nitrogen and creatinine levels to measure for kidney function or when compromise will cause congestion
  • Chest x-ray or CT scan – visually help the healthcare provider in assessing for the causes of dyspnea like pneumonia, malformations of the structures of the respiratory system, or the presence of clots, to name a few.
  • Electrocardiogram (ECG) – because of the connection of the heart on respirations, assessment with an ECG is beneficial so as to rule out any deviations that may be causing the dyspnea to begin with.

  Treatment for Dyspnea

  The goal of treatment for dyspnea is the control of the pathological mechanisms that relate to the condition.

  1. Reduction of respiratory demand. This could be achieved through either reduction of the metabolic load or decrease in central drive. Examples are exercise training or supplemental oxygen therapy.
  2. Reduction of ventilator impedance. This could be achieved through the counterbalance of lung hyperinflation or reduction of resistive load. Examples are continuous positive airway pressure (CPAP) or use of medications.
  3. Improvement of inspiratory muscle function. Examples of interventions include improvement of nutrition and proper patient positioning.
  4. Alterations of central perception. Examples are desensitization and patient education.

  The different treatment options for dyspnea revolve around treating the underlying condition with a combination of supplemental, pharmacological, and medical regimens.

  These treatments either address the various pathological mechanisms that are present in dyspnea. The treatment options are:

  1. Exercise training – This decreases lactic acid production and improves the aerobic capacity of the patient.
  2. Supplemental oxygen therapy – This reduces the hypoxic drive coming from the peripheral chemoreceptors, thereby assisting in controlling the respiratory rate and depth.
  3. Pharmacologic therapy
  4. Opioids – This type of medication acts on the neural signals that control respirations and therefore alleviating the intensity and effort of breathing.
  5. Anxiolytic – This type of medication relieves dyspnea by depressing hypoxic or hypercapnic pathways and the emotional attributes of dyspnea.
  6. Steroids – Relieves shortness of breath through reduction of edema and inflammation.
  7. Bronchodilators – Reduces resistive load (in asthmatics) and reverses bronchoconstriction (as in COPD).
  8. Beta 2-adrenergic agonists, anticholinergics and Beta 2-agonist – These medications assist in lowering air volumes in the lungs.
  9. Alter respiratory afferent signals
  10. Vibration – This intervention, when applied in the outer chest wall, suppresses the signals from the respiratory center in the brainstem, and thereby decreasing respiratory effort.
  11. Inhaled medications – Inhaled agents may help with relieving the discomfort brought about by dyspnea through the relaxation of respiratory tissues.
  12. Application of CPAP – This treatment is often utilized on asthmatics suffering acute bronchoconstriction. It helps by counterbalancing the effect of inspiratory threshold and reduction of dissociations in respirations.
  13. Nutritional supplementation – Adequate nutrition offers reduction of energy requirements and support of the respiratory demand associated with dyspnea.
  14. Positioning – Changes in position assists the patient for better lung expansion (e.g., leaning forward position).
  15. Cognitive-behavioral approach – These may include relaxation techniques, distraction approaches that will help with anxiety-related dyspnea.
  16. Desensitization – Desensitization in controlled environments allows for the patient to cope with stressors and increasing threshold.

  Dyspnea Nursing Diagnosis

  Nursing Care Plan for Dyspnea 1

  Dyspnea Nursing Diagnosis: Ineffective Breathing Pattern related to underlying condition as evidenced by abnormal breathing rate, rhythm and depth, and the use of respiratory accessory muscles.

  Desired Outcome: Patient will maintain an effective breathing pattern as shown by normal and relaxed breathing and absence of dyspnea.

  Nursing Care Plan for Dyspnea 2

  Dyspnea Nursing Diagnosis: Ineffective Airway Clearance related to the increased production of secretions as evidenced by abnormal breath sounds and inability to clear airway secretions.

  Desired Outcome: The patient will maintain clear airways as shown by normal breath sounds and enhanced removal of secretions.

  Nursing Care Plan for Dyspnea 3

  Dyspnea Nursing Diagnosis: Impaired Gas Exchange related to hypoventilation and altered oxygen carrying-capacity of the blood as evidenced by abnormal arterial blood gases, altered mental state, and delayed capillary refill of nail beds.

  Desired Outcome: Patient maintains optimal gas exchange as shown by arterial blood gases within normal range, recommencement of usual mental status and capillary refill within 2-3 seconds.

  Nursing Care Plan for Dyspnea 4

  Dyspnea Nursing Diagnosis: Risk for decreased Cardiac Output related to increased pulmonary blood pressure, as evidenced by irregular heartbeat, heart rate of 122, dyspnea upon exertion, leg edema, and fatigue

  Desired outcome: The patient will be able to maintain adequate cardiac output.

  Nursing Care Plan for Dyspnea 5

  Dyspnea Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

  Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

  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. (2022). 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.

  Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.