Shortness of Breath (Dyspnea) Nursing Diagnosis & Care Plan

Dyspnea often called shortness of breath (SOB), is used to describe difficult or labored breathing often with an increased respiratory rate. Shortness of breath is not a disease but a symptom. Dyspnea can be acute or chronic depending on the causative factor. Related factors include:

  • Body positions that prevent lung expansion
  • Presence of bronchial secretions
  • Generalized weakness
  • Respiratory muscle fatigue
  • Hyperventilation
  • Obesity
  • Age
  • History of smoking
  • Conditions that may obstruct the airway or impair the gas exchange
  • Excess fluid buildup in the heart or lungs

Shortness of breath (SOB) is the feeling of running out of breath and not being able to breathe in and out deeply or quickly enough. This is due to multiple interactions of signals and receptors in the upper airway, lungs, and chest wall.

The following conditions may cause dyspnea:

The Nursing Process

Dyspnea can be quite distressing for patients. It may increase their levels of anxiety which makes them feel even more dyspneic. Vital signs including oxygen saturation should be obtained immediately and frequently. A thorough history and physical examination may reveal any ongoing psychiatric, cardiovascular, pulmonary, or musculoskeletal conditions that can cause dyspnea. Treatment depends on the underlying cause.

Ineffective Airway Clearance Care Plan

Ineffective airway clearance associated with shortness of breath (dyspnea) can be caused by obstruction or narrowing of the airway.

Nursing Diagnosis: Ineffective Airway Clearance

  • Obstruction in the airway 
  • Narrowing of the airway
  • Blood backing up in the lungs
  • Fluid accumulation in the lungs
  • Increased mucus production
  • Inability to cough or clear secretions

As evidenced by:

  • Irregular breathing pattern 
  • Shallow and rapid breaths
  • Chest tightness
  • A feeling of choking or suffocation
  • Breathlessness
  • Alterations in oxygen saturation
  • Alterations in respiratory rate
  • Alterations in respiratory rhythm
  • Alterations in respiratory depth
  • Changes in arterial blood gas
  • Use of accessory muscles
  • Abnormal chest X-ray
  • Adventitious breath sounds

Expected outcomes:

  • Patient will maintain a patent airway
  • Patient will be able to attain oxygen saturation of 95-100%
  • Patient will demonstrate clear breath sounds
  • Patient will demonstrate the ability to clear their airway

Ineffective Airway Clearance Assessment

1. Determine the causative factors.
Shortness of breath is a symptom, not a disease. Focusing on the causative factor (obstruction or narrowing of the airway) resulting in ineffective airway clearance will guide treatment.

2. Assess the patient’s respiratory status.
Closely monitor and document respiratory rate, depth, pattern, and O2 saturation as ordered.

3. Observe for other dyspnea-related symptoms.
Coughing, grabbing of the neck, skin color changes, and difficulty in speaking can signal obstruction in the airway.

4. Listen to the breath sounds.
A restriction of airflow in the trachea (windpipe) or the throat causes a wheezing-like sound. High-pitched sounds are caused by narrowed airways.

5. Review arterial blood gas (ABGs).
ABGs reflect conditions that influence the respiratory, circulatory, and metabolic systems.

Ineffective Airway Clearance Interventions

1. Place the patient on the side or elevate the head of the bed.
Place the patient on their side or raise the head of the bed for optimal breathing and to prevent obstruction caused by secretions.

2. Suction secretions from the airway as needed.
Suctioning is essential for normal breathing as it removes mucus from the airway. if secretions are left in the airway, they may become infected and cause a chest infection.

3. Administer medications as prescribed.
Bronchodilators dilate the lung passageways while mucolytics and expectorants help remove chest congestion by thinning and loosening mucus in the airways.

4. Teach coughing and deep breathing exercises.
Breathing exercises will improve gas exchange, clear the lungs, and reduce the risk of pneumonia. Teach the patient to take deep breaths and cough to mobilize and expel secretions every hour when awake.

5. Promote smoking cessation.
Smoking damages the alveoli and airways in the lungs. Encourage smoking cessation and offer resources to quit.

6. Collaborate with respiratory therapists (RT).
Respiratory therapists are knowledgeable about respiratory medications and interventions and assist the doctors in the insertion of airway tools (such as ET tubes) when required.

Ineffective Breathing Pattern Care Plan

Ineffective breathing pattern associated with dyspnea is caused by alterations in the gas exchange (inspiration and expiration mechanisms) resulting in insufficient ventilation.

Nursing Diagnosis: Ineffective Breathing Pattern

  • Anxiety
  • Acute Pain
  • Fatigue
  • Respiratory muscle fatigue
  • Hyperventilation
  • Obesity
  • Body positions that prevent lung expansion
  • Chest wall and diaphragm deformities
  • Presence of bronchial secretions
  • Age
  • History of smoking
  • Conditions that impair inspiration and expiration mechanisms (such as spinal cord injuries)
  • Pneumothorax

As evidenced by:

  • Irregular breathing pattern 
  • Shallow rapid breaths
  • Asymmetric respirations
  • Pursed lip breathing
  • Grunting
  • Nasal flaring
  • Mouth breathing
  • Gasping for air
  • Chest retractions
  • Breathlessness
  • Alterations in oxygen saturation
  • Alterations in respiratory rate
  • Alterations in respiratory rhythm
  • Alterations in respiratory depth
  • Changes in arterial blood gas
  • Use of accessory muscles

Expected outcomes:

  • Patient will demonstrate a regular respiratory rate and rhythm
  • Patient will maintain an oxygen saturation of 95-100%
  • Patient will demonstrate clear breath sounds
  • Patient will demonstrate respirations without the use of accessory muscles, nasal flaring, or grunting

Ineffective Breathing Pattern Assessment

1. Identify the causative factors.
Decipher between a physical or emotional cause (such as anxiety, pain, infection, etc.) to effectively relieve the shortness of breath resulting in an ineffective breathing pattern.

2. Observe for other respiratory symptoms.
Irregular breathing (hyperventilating), nasal flaring, mouth breathing, gasping for air, and use of accessory muscles are symptoms of an ineffective breathing pattern that require immediate attention.

3. Obtain a chest x-ray.
An ineffective breathing pattern requires investigation for respiratory infections, lung trauma, chronic airway changes, cancer, etc., to manage effectively.

Ineffective Breathing Pattern Interventions

1. Relax the respiratory muscles.
Morphine reduces the rate of breathing and anti-anxiety drugs can promote relaxation which prevents hyperventilation.

2. Promote bronchodilation.
Bronchodilation produced by beta-adrenergic agonist drugs relaxes the smooth muscles of the airways.

3. Apply oxygen.
For oxygen saturation levels below 95% or altered ABGs, apply oxygen to improve ventilation and perfusion.

4. Educate on chronic conditions.
Asthma, COPD, emphysema, CHF, and more require specific interventions to control respiratory distress. Educate on the use of inhalers and medications, lifestyle modifications, breathing exercises, and diet changes.

Anxiety Care Plan

Anxiety associated with dyspnea can be caused by the triggered fight-or-flight response resulting in hyperventilation and shortness of breath.

Nursing Diagnosis: Anxiety

  • Fight or flight response of the body
  • Anxiety
  • Stress
  • Panic attacks
  • Decreased carbon dioxide in the blood

As evidenced by:

  • Increased tension
  • Gasping for air
  • Hyperventilation
  • A feeling of choking or suffocation
  • Restlessness
  • Dizziness
  • Lightheadedness
  • Diaphoresis

Expected outcomes:

  • Patient will be able to verbalize the causes of their anxiety
  • Patient will be able to manifest a regular breathing pattern and rhythm
  • Patient will be able to demonstrate a respiratory rate and oxygen saturation within normal limits

Anxiety Assessment

1. Assess the patient’s anxiety level.
Shortness of breath can both be caused by and exacerbated by anxiety. As the anxiety increases, shortness of breath worsens.

2. Anticipate hyperventilation.
Anxiety results in shallow and quick breaths in the upper lungs (hyperventilation), which causes the release of too much CO2.

Anxiety Interventions

1. Provide reassurance.
Anxiety coupled with dyspnea can be alarming for the patient. Remind them they are safe and provide reassurance in a calm, patient manner. Stay with them until the panic dissipates.

2. Consider mental health support.
Patients with a chronic history of anxiety or panic episodes may need therapy or counseling in learning to recognize and cope with anxiety to prevent episodes of dyspnea.

3. Teach mindful breathing.
Mindful breathing is paying close attention to how the breath enters and exits the body to decrease stress and anxiety. Teach the patient to deliberately inflate the chest and abdomen while breathing via the diaphragm. Exhale slowly through the nose counting for several seconds. Belly breathing results in slower, controlled breathing.

4. Administer anti-anxiety medications as ordered.
Benzodiazepines induce relaxation and decrease the feeling of anxiety to reduce symptoms of dyspnea.

References and Sources

  1. Dewit, S. C., Stromberg, H., & Dallred, C. (2017). Medical-surgical nursing: Concepts & practice (3rd ed.). Elsevier Health Sciences.
  2. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
  3. Do Prado, P. R., de Cássia Bettencourt, A. R., & Lopes, J. D. (n.d.). Related factors of the nursing diagnosis ineffective breathing pattern in an intensive care unit. PubMed Central (PMC).
  4. Hashmi, M. F., Modi, P., Basit, H. B., & Sharma., S. S. (2022, May 1). Dyspnea – StatPearls – NCBI bookshelf. National Center for Biotechnology Information.
  5. Ignatavicius, MS, RN, CNE, ANEF, D. D., Workman, PhD, RN, FAAN, M. L., Rebar, PhD, MBA, RN, COI, C. R., & Heimgartner, MSN, RN, COI, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed., pp. 1386-1388). Elsevier.
  6. Silvestri, L. A., Silvestri, A. E., & Grimm, J. (2022). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier Inc.
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Kathleen Salvador is a registered nurse and a nurse educator holding a Master’s degree. She has more than 10 years of clinical and teaching experience and worked as a licensed Nursing Specialist in JCI-accredited hospitals in the Middle East. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care.