questions about breath pattern ineffective

1. why ineffective breathing occurs in asthma? - were you told this patient had asthma? i looked at the other data you pm'd to me. this patient also has pneumonia. read about the pathophysiology of asthma in the online merck manual: http://www.merck.com/mmpe/sec05/ch048/ch048a.html

2. why the cues occur? - because of the pathophysiology of the underlying medical disease or condition. the cues (clue, symptom) are manifestations of the disease process

3. how they indicate that breathing is ineffective? - they match with the defining characteristics of the nursing diagnosis of ineffective breathing pattern. the cues are evidence, or proof, of the existence of inspiration and/or expiration that does not provide adequate ventilation (the definition of ineffective breathing pattern) occurring in this patient.

ineffective breathing pattern is inspiration and/or expiration that does not provide adequate ventilation (page 138, nanda international nursing diagnoses: definitions and classifications 2009-2011). it has to do with the act of breathing or inhaling and exhaling air, the respiratory rate and rhythm and how the chest wall expands and moves to assist in the act of breathing. things that cause problems with breathing (related factors for this diagnosis) are:

• anxiety
  
• body position
  
• bony deformity
  
• chest wall deformity
  
• cognitive impairment
  
• fatigue
  
• hyperventilation syndrome
  
• musculoskeletal impairment
  
• neurological dysfunction
  
• obesity
  
• pain
  
• perception impairment
  
• respiratory muscle fatigue
  
• spinal cord injury
  

the defining characteristics (signs, symptoms, cues) of this nursing diagnosis are:

• alterations in depth of breathing
  
• altered chest excursion
  
• assumption of 3-point position
  
• bradypnea
  
• decreased expiratory pressure
  
• decreased inspiratory pressure
  
• decreased minute volume
  
• decreased vital capacity
  
• dyspnea
  
• increased anterior-posterior diameter
  
• nasal flaring
  
• orthopnea
  
• prolonged expiration phase
  
• pursed lip breathing
  
• tachypnea
  
• timing ratio
  
• use of accessory muscles to breathe
  

your patient's cues, or symptoms, of ineffective breathing pattern are

• using accessory muscles [to breathe]
  
• prolonged expiratory phase 1:3
  
• speaking in phrases - as described, this is not a symptom of ineffective breathing pattern
  
• tachypnea
  
• tachycrotic - ??? - do you mean tachycardia? tachycardia is not a symptom of ineffective breathing pattern
  
• audible wheeze - is not a symptom of ineffective breathing pattern
  
• hyperresonance on percussion - is not a symptom of ineffective breathing pattern
  

i'm not being mean here, but as a student you have a lot to learn. you wanted my help and then felt that what i was telling you was incorrect because we are in different countries. some things are universal. assessment takes a long time to master and your instructor has a lot more experience. in the pm i sent you i correctly classified wheezing and hyperresonance as symptoms. the scenario listed them, but you needed to recognize that they were abnormal symptoms that the patient was having and that they are contributing to the patient's nursing problems(s). the reason is because they are abnormal findings during the assessment of the patient. it is not normal to have wheezes or hyperresonance. wheezing indicates narrowing of the air passages. hyperresonance is a loud, booming sound that is heard over a hyperinflated lung and is an indication of air trapped in the alveoli or the pleural space as in a pneumothorax.

diagnosing is very much like solving crimes except we do not know what crime has been committed. like detectives we spend a lot of time searching for clues (assessing and observing the patient). from that activity we are always looking for abnormal data (symptoms). that abnormal data becomes the clues leading us to decide what the nursing problems (nursing diagnoses) are that the patient has. once we know the nursing problem we can do something about it (nursing interventions). that is how the nursing process works. what your instructor did with this assignment is tell you what the nursing problem was and give you a lot of the symptoms. you need to pick out the specific symptoms that apply to this problem and proceed to develop interventions to solve the problem.