Aims: The aims of this study were to validate the signs and symptoms of the respiratory nursing diagnoses impaired gas exchange, ineffective airway clearance and ineffective breathing pattern in patients under mechanical ventilation; to verify whether intubation time and ventilatory modalities were related factors for respiratory nursing diagnoses; to verify the occurrence of shared signs and symptoms in the diagnoses and compare them with North American Nursing Diagnosis Association's proposition and to ascertain whether respiratory nursing diagnoses occur in isolated or associated patterns. Show Background: The need for mechanical ventilation is common in several patients admitted to intensive care units. Therefore, critical care nurses should identify the respiratory nursing diagnoses of high incidence. Design and methods: Descriptive observational study, with 177 evaluations of surgical and medical critically ill adult patients undergoing invasive mechanical ventilation. The study adopted Fehring's Modified Clinical Diagnostic Validity Model, with a suggested alteration. Results: The critical signs and symptoms were the same as proposed by North American Nursing Diagnosis Association, when the diagnoses were separately identified, although no particular sign and symptom was found for ineffective breathing pattern. Impaired gas exchange and ineffective airway clearance were identified as having 88 (49.7%) evaluations sharing the critical signs and symptoms. Intubation time and ventilation modality were related factors for the development of ineffective airway clearance and ineffective breathing pattern. Conclusion: The critical signs and symptoms of impaired gas exchange were abnormal blood gases and hypoxemia. For ineffective airway clearance, they were rhonchi and decreased breath sounds. No highlights were found for ineffective breathing pattern signs and symptoms. Validation by experts has confirmed these findings. The interface between ineffective airway clearance and impaired gas exchange was confirmed by the presence of the shared critical signs and symptoms. Relevance to clinical practice: Studies like this are relevant to clinical practice because they evaluate the adequacy of Taxonomy II for patients under mechanical ventilation in clinical practice, thus allowing for the intensive care nurses to go from one mechanical and routine practice to a critical, reflexive practice, committed to professional progress. What is respiratory depression? Respiratory depression (hypoventilation) is a breathing disorder characterized by slow and ineffective breathing. During a normal breathing cycle, you inhale oxygen into your lungs. Your blood carries the oxygen around your body, delivering it to your tissues. Your blood then takes the carbon dioxide, a waste product, back to your lungs. The carbon dioxide exits your body when you exhale. During hypoventilation, the body can’t adequately remove carbon dioxide. This can lead to poor use of oxygen by lungs. The result is a higher level of carbon dioxide and too little oxygen available to the body. Hypoventilation is different from hyperventilation. Hyperventilation is when you breathe too quickly, lowering levels of carbon dioxide in the blood. Symptoms of respiratory depression vary. Mild or moderate symptoms may include:
As the condition progresses and your carbon dioxide level increases, you may develop:
Fast breathing isn’t typical with hypoventilation. However, some people experience faster breathing as their body attempts to blow out excess carbon dioxide. Respiratory depression can occur for several reasons. Possible causes of hypoventilation include:
Hypoventilation can also occur as a side effect of certain medications. Large doses of central nervous system depressant drugs may slow down the respiratory system. Medications that can have this effect on the body include:
See a doctor if you have symptoms of respiratory depression. Your doctor will ask about your symptoms and medications. Then they will complete a physical examination and tests to make a diagnosis. Your doctor may order a series of tests to determine the cause of respiratory depression. Tests include:
Respiratory depression is a treatable condition. Treatments vary depending on the cause. When medication triggers hypoventilation, stopping the medication may restore normal breathing. Other possible treatments for hypoventilation include:
If left untreated, hypoventilation can cause life-threatening complications, including death. Respiratory depression occurring from a drug overdose can lead to respiratory arrest. This is when breathing completely stops, which is potentially fatal. Ongoing episodes of hypoventilation can also cause pulmonary hypertension, which can cause right-sided heart failure. Following your treatment plan can prevent complications from developing. Hypoventilation can interfere with your quality of life. Early identification and treatment may help your body maintain a healthy level of oxygen and carbon dioxide and prevent complications.
An ineffective breathing pattern is defined as inspiration and/or expiration that does not provide adequate oxygenation. This diagnosis is related to the observed rate and depth of breathing, as well as abnormal chest expansion, and accessory muscle use that results in a breathing pattern that does not supply adequate ventilation to the body. The ABCs; airway, breathing, and circulation, are the highest priority of nurses in caring for patients. An ineffective breathing pattern can arise from an array of causes and can occur suddenly. Nurses must be vigilant in observing acute changes and preventing the deterioration of patients and the possibility of respiratory failure. Causes of Ineffective Breathing Pattern (Related to)
Signs and Symptoms (As evidenced by)Subjective: (Patient reports)
Objective: (Nurse assesses)
Expected Outcomes
Nursing Assessment for Ineffective Breathing Pattern1. Assess medical history for possible causes of ineffective breathing. 2. Assess breath sounds and other vital signs. 3. Monitor for anxiety or change in mental status. 4. Review ABGs. 5. Assess for pain. 6. Assess for oversedation. 7. Assess for secretions or ability to cough. 8. Obtain sputum specimen as ordered. Nursing Interventions for Ineffective Breathing Pattern1. Apply oxygen. 2. Request RT support. 3. Reposition the patient. 4. Teach the patient pursed-lip breathing. 5. Encourage the use of an incentive spirometer. 6. Keep a cool, calm, relaxing environment. 7. Medicate for pain or anxiety. 8. Promote energy conservation. 9. Encourage smoking cessation. 10. Suction secretions or administer expectorants. 11. Teach splinting of the chest & abdomen for deep breathing and coughing. References and Sources
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