Defining characteristics and related factors of the nursing diagnosis for ineffective breathing pattern

Prado, Patricia Rezende do; Bettencourt, Ana Rita de Cássia; Lopes, Juliana de Lima

doi:10.1590/0034-7167-2018-0061

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Brasil

Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 72 (1) • Jan-Feb 2019 • https://doi.org/10.1590/0034-7167-2018-0061 copy

Defining characteristics and related factors of the nursing diagnosis for ineffective breathing pattern

Características definitorias y factores relacionados del diagnóstico de enfermería estándar respiratorio ineficaz

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify in the literature the defining characteristics and related factors of the nursing diagnosis "ineffective breathing pattern".

Method:

Integrative review with the steps: problem identification, literature search, evaluation and analysis of data and presentation of results.

Results:

Twenty articles and two dissertations were included. In children, the most prevalent related factor was bronchial secretion, followed by hyperventilation. The main defining characteristics were dyspnea, tachypnea, cough, use of accessory muscles to breathe, orthopnea and adventitious breath sounds. Bronchial secretion, cough and adventitious breath sounds are not included in the NANDA-International (NANDA-I). For adults and older adults, the related factors were fatigue, pain and obesity and the defining characteristics were dyspnea, orthopnea and tachypnea.

Conclusion:

This diagnosis manifests differently according to the patients’ age group. It was observed that some defining characteristics and related factors are not included in the NANDA-I. Their inclusion can improve this nursing diagnosis.

Descriptors:
Nursing Diagnosis; Respiratory System; Signs and Symptoms; Risk Factors; Nursing

Authors and year	Quality of the study	Study type	Sample	Results
Monteiro, Silva and Lopes (2006)⁽⁸8 Monteiro FPM, Silva VM, Lopes MVO. Diagnósticos de enfermagem identificados em crianças com infecção respiratória aguda. Rev Eletr Enferm [Internet]. 2006 [cited 2018 Oct 28];8(2):213-21. Available from: doi: https://doi.org/10.5216/ree.v8i2.7036 https://doi.org/10.5216/ree.v8i2.7036... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	78 children under 5 years old.	DC: - Adventitious breath sounds (96.2%, n=75). - Dyspnea (74.4%, n=58). - Shortness of breath (69.2%, n=54). - Cough (60.3%, n=47). - Changes in respiratory rate and pattern (59.0%, n=46). - Use of accessory muscles to breathe (25.6%, n=20). RF: - Bronchial secretion (98.7%, n=77). - Hyperventilation (74.4%, n=58).
Silveira, Lima and Lopes (2008)⁽⁹9 Silveira UA, Lima LHO, Lopes MVO. [Defined characteristics of the nursing diagnoses ineffective airway clearance and ineffective breathing pattern in asthmatic]. Rev Rene [Internet]. 2008 [cited 2018 Oct 28];9(4):125-33. Available from: http://www.redalyc.org/html/3240/324027964015/ Portuguese. http://www.redalyc.org/html/3240/3240279... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	42 children up to 5 years old with diagnosis of asthma.	DC: - Tachypnea (61.9%, n=26). - Dyspnea (50.0%, n=21). - Orthopnea (40.5%, n=17). - Use of accessory muscles to breathe (35.7%, n=15). - Nasal flaring (4.8%, n=2). - Increase in anterior-posterior chest diameter(4.8%, n=2). - Altered chest excursion (2.4%, n=1). - Pursed-lip breathing (2.4%, n=1).
Cavalcante, Mendes, Lopes and Lima (2010)⁽¹⁰10 Cavalcante JCBC, Mendes LC, Lopes MVO, Lima LH. [Clinical indicators of ineffective breathing pattern in children with asthma]. Rev Rene [Internet]. 2010[cited 2018 Oct 28];11(1):66-75. Available from: http://dx.doi.org/10.15253/rev%20rene.v11i1.4476 Portuguese. http://dx.doi.org/10.15253/rev%20rene.v1... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	147 children with asthma.	DC: - Dyspnea (56.4%, n=83). - Abnormal breathing pattern (50.3%, n=74). - Orthopnea (34.0%, n=50). - Use of accessory muscles to breathe (32.7%, n=48). - Increase in anterior-posterior chest diameter(8.16%, n=12). - Nasal flaring (3.4%, n=5). - Pursed-lip breathing (3.4%, n=5). - Use of three-point position (2.04%, n=3). - Altered chest excursion (2.04%, n=3).
Chagas, Lima, Oliveira and Luz (2011)⁽¹¹11 Chagas KLM, Lima LHO, Oliveira EAR, Luz GOA. [Nursing Diagnosis in children with signs and symptoms of asthma: a description study]. Rev Rene [Internet]. 2011[cited 2018 Oct 28];12(2):302-8. Available from: http://www.periodicos.ufc.br/rene/article/viewFile/4206/3253 Portuguese. http://www.periodicos.ufc.br/rene/articl... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	30 children up to 5 years old.	DC: - Dyspnea (96.7%, n=29). - Altered breathing depth (73.3%, n=22). - Use of accessory muscles to breathe (56.7%, n=17). - Tachypnea (33.3%, n=10). - Nasal flaring (6.7%, n=2). RF: - Respiratory muscle fatigue (73.3%, n=22). - Obesity (3.3%, n=1).
Andrade, Chaves, Silva, Beltrão and Lopes (2012)⁽¹²12 Andrade LZC, Chaves DBR, Silva VM, Beltrão BA, Lopes MVO. Respiratory nursing diagnoses for children with acute respiratory infection. Acta Paul Enferm [Internet]. 2012[cited 2018 Oct 28];25(5):713-20. Available from: http://dx.doi.org/10.1590/S0103-21002012000500011 http://dx.doi.org/10.1590/S0103-21002012... ⁾	Good (7 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	151 children up to 5 years old.	DC: - Adventitious breath sounds (77.5%, n=117). - Cough (70.2%, n=106). - Dyspnea (55.6%, n=84). - Tachypnea (54.3%, n=82). - Abnormal breathing pattern (54.3%, n=82). - Use of accessory muscles to breathe (43.7%, n=66). - Orthopnea (32.5%, n=49). - Nasal flaring (3.3%, n=5). - Pursed-lip breathing (0.7%, n=1). RF: - Bronchial secretion (89.4%, n=135). - Anxiety (22.5%, n=34). - Pain (16.6%, n=25). - Chest wall deformity (2.6%, n=4).
Pascoal, Lopes, da Silva, Beltrão, Chaves, Santiago and Herdman (2014)⁽¹³13 Pascoal LM, Lopes MVO, Silva VM, Beltrão BA, Chaves DBR, Santiago JMVM, et al. Ineffective breathing pattern: defining characteristics in children with acute respiratory infection. Int J Nurs Knowl. 2014;25(1):54-61. doi: 10.1111/j.2047-3095.2013.01249.x https://doi.org/10.1111/j.2047-3095.2013... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Prospective cohort study.	136 children from 0 to 5 years old with acute respiratory infection.	DC: - Altered breathing depth (75%, n=99). - Dyspnea (75%, n=99). - Orthopnea (61%, n=80.0). - Tachypnea (61%, n=80.0). - Use of accessory muscles to breathe (61%, n=80.0).
Beltrão, Herdman, Pascoal, Chaves, Silva, and Lopes (2015)⁽¹⁴14 Beltrão BA, Herdman TH, Pascoal LM, Chaves DBR, Silva VM. Ineffective breathing pattern in children and adolescentes with congenital heart disease: accuracy of defining characteristics. J Clin Nurs [Internet]. 2015;24(17-18):2505-13. doi: 10.1111/jocn.12838. https://doi.org/10.1111/jocn.12838... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.		DC: - Dyspnea (45.9%, n=28). -Altered breathing depth (36.1%, n=22). - Orthopnea (27.9%, n=17). - Tachypnea (19.7%, n=12). - Use of accessory muscles to breathe (18.0%, n=11). - Increase in anterior-posterior chest diameter (18.0%, n=11). - Use of three-point position (6.6%, n=4). - Bradypnea (4.9%, n=3).
Pascoal, Lopes, Silva, Beltrão, Chaves, Nunes and Castro (2016)⁽¹⁵15 Pascoal LM, Lopes MV, Silva VM, Beltrão BA, Chaves DB, Nunes, Castro. Prognostic clinical indicators of short-term survival for ineffective breathing pattern in children with acute respiratory infection. J Clin Nurs. 2016;25(5-6):752-9. doi: 10.1111/jocn.13064 https://doi.org/10.1111/jocn.13064... ⁾	Good (7 out of 10 points in the Newcastle-Ottawa scale for cohort studies).	Prospective cohort study	136 children.	DC: - Altered breathing depth (66.3%, n=65). - Nasal flaring (4.0%, n=4). - Bradypnea (1.0%, n= 0,76). - Increase in anterior-posterior chest diameter (26,8%, n=30). - Dyspnea (43.1%; n=51). - Altered chest excursion (1,5%, n=1.7). - Orthopnea (31.5; n=37.8). - Pursed-lip breathing (1.45%, n=2). - Tachypnea (55.3%, n=63). - Use of accessory muscles to breathe: (36.9%, n=43.3).
Pascoal, Lopes, Silva, Chaves, Beltrão, Nunes and Moura (2016)⁽¹⁶16 Pascoal LM, Lopes MV, da Silva VM, Chaves DB, Beltrão BA, Nunes MM, et al. Clinical Differentiation of Respiratory Nursing Diagnoses among Children with Acute Respiratory Infection. J Pediatr Nurs [Internet]. 2016;31(1):85-91. doi: 10.1016/j.pedn.2015.08.002 https://doi.org/10.1016/j.pedn.2015.08.0... ⁾	Good (7 out of 10 points in the Newcastle-Ottawa scale for cohort studies).	Cohort study.		DC: - Cough (88.7%). - Abnormal breathing (68.7%). - Adventitious breath sounds (65.1%). - Tachypnea (55.8%). - Dyspnea (45.7%). - Use of accessory muscles to breathe (38.4%). - Orthopnea (34.1%). - Diminished vesicular breath sounds (34.0%). -Increase in anterior-posterior chest diameter(27.7%).
Chaves (2011)⁽²⁸28 Chaves DBR. Árvores de decisão para inferência de desobstrução ineficaz de vias aéreas e padrão respiratório ineficaz de crianças com infecção respiratória aguda [Dissertation on the Internet]. Fortaleza (CE): Universidade Federal de Fortaleza, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Enfermagem; 2011 [cited 2018 Oct 28]. 96 p 2011[cited ?]. Available from: http://www.repositorio.ufc.br/handle/riufc/3992 http://www.repositorio.ufc.br/handle/riu... ⁾	Good (8 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	249 children with diagnosis of ARF.	DC: - Altered breathing depth(73.9%, n=184). - Dyspnea (68.3%, n=170). - Tachypnea (57.0%, n=142). - Orthopnea (54.2%, n=135). - Use of accessory muscles to breathe (51.8%, n=129).
Carvalho (2013)⁽²⁹29 Carvalho, OMC. Medidas de acurácia dos indicadores clínicos dos diagnósticos de enfermagem respiratórios em crianças com asma [Dissertation on the Internet]. Fortaleza (CE): Universidade Federal de Fortaleza, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Enfermagem; 2013[cited 2018 Oct 28]. 114 p. Available from: http://www.repositorio.ufc.br/handle/riufc/8500 http://www.repositorio.ufc.br/handle/riu... ⁾	Good (7 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	205 children. From 01 to 05 years old.	DC: - Altered breathing depgh (91.2%, n=187). - Use of three-point position (1%, n=2). - Nasal flaring (3.4%, n=7). - Pursed-lip breathing (0.5%, n=1). - Dyspnea (99%, n=203). - Altered chest excursion (1%, n=2). - Orthopnea (91.2%, n=187). - Tachypnea (85.4%, n=175). - Use of accessory muscles to breathe (84.9%, n=174).

Authors and year	Quality of the study	Type of study	Sample	Results
Carlson-Catalano, Lunney, Paradiso, Bruno, Luke, Martin, Massoni and Pachter (1998)⁽¹⁷17 Carlson-Catalano J, Lunney M, Paradiso C, Bruno J, Luke BK. Martin T, et al. Clinical Validation of Ineffective Breathing Pattern, Ineffective Airway Clearance, and Impaired Gas Exchange. Image J Nurs Sch [Internet]. 1998 [cited 2018 Oct 28];30(3):243-48. Available from: https://doi.org/10.1111/j.1547-5069.1998.tb01299.x https://doi.org/10.1111/j.1547-5069.1998... ⁾	-	Clinical validation.	76 adult patients, 45 medical and 31 surgical.	DC: - Dyspnea. RF: - Anxiety (15%, n=8). - Pain (17%, n=9). - Fatigue (38%, n=20). - Hyperventilation (8%, n=4). - Obesity (4%, n=2). - Musculoskeletal impairment (6%, n=3). - Bronchial secretion (21%, n=11).
Arruda and Garcia (2000)⁽¹⁸18 Arruda AJCG, Garcia TR. [Nursing diagnoses related to oxygenation, atributted to trauma victims admitted to ICU]. Rev Bras Enferm [Internet]. 2000 [cited 2018 Oct 28];53(3):363-74. Available from: http://dx.doi.org/10.1590/S0034-71672000000300004 Portuguese. http://dx.doi.org/10.1590/S0034-71672000... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	22 patients.	DC: - Tachypnea (31.8%, n=7). - Dyspnea (9.1%, n=2). RF: - Anxiety (35.3%, n=6). - Hypoventilation syndrome (17.6%, n=3).
Galdeano, Rossi and Pezzuto (2004)⁽¹⁹19 Galdeano LE, Rossi LA, Pezzuto TM. [Nursing diagnosis of patients in the preoperatory period of cardiac surgery]. Rev Esc Enferm [Internet]. 2004 [cited 2018 Oct 28];38(3):307-16. Available from: http://dx.doi.org/10.1590/S0080-62342004000300009 Portuguese. http://dx.doi.org/10.1590/S0080-62342004... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	17 adults.	DC: - Dyspnea (100.0%, n=12). - Orthopnea (66.6%, n=8). - Shortness of breath (16.6%, n=2). RF: - Decreased energy/fatigue (100.0%, n=12). - Body position (66.6%, n=8). - Obesity (33.3%, n=4).
Oliveira and Freitas (2009)⁽²⁰20 Oliveira MF, Freitas MC. [Frequent nursing diagnoses and interventions for women under critical care]. Rev Bras Enferm [Internet]. 2009 [cited 2018 Oct 28]; 62(3):343-48. Available from: http://dx.doi.org/10.1590/S0034-71672009000300002 Portuguese. http://dx.doi.org/10.1590/S0034-71672009... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	28 charts.	DC: - Irregular minute ventilation (71.4%, n=20). - Dyspnea (71.4%, n=20). - Increased chest excursion (71.4%, n=20).
Silva, Bettencourt, Diccini, Belasco and Barbosa (2009)⁽²¹21 Silva MR, Bettencourt ARC, Diccini S, Belasco A, Barbosa DA. [Nursing diagnoses for patients with acquired immunodeficiency syndrome]. Rev Bras Enferm [Internet]. 2009[cited 2018 Oct 28];62(1):92-9. Available from: http://dx.doi.org/10.1590/S0034-71672009000100014 Portuguese. http://dx.doi.org/10.1590/S0034-71672009... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	60 patients	DC: - Decrease in expiratory and inspiratory pressure (70.0%, n=42). - Dyspnea (51.6%, n=31). RF: - Hypoventilation syndrome (51.6%, n=31). - Neurological/perception impairment (45.0%, n=27). - Neuromuscular dysfunction (40.0%, n=24).
Lucena, Santos, Pereira, Almeida, Dias and Friedrich (2011)⁽²²22 Lucena AF, Santos CT, Pereira AGS, Almeida MA, Dias VLM, Friedrich MA. Clinical Profile and Nursing Diagnosis of Patients at Risk of Pressure Ulcers. Rev Lat Am Enfermagem [Internet]. 2011 [cited 2018 Oct 28];19(3):523-30. Available from: http://dx.doi.org/10.1590/S0104-11692011000300011 http://dx.doi.org/10.1590/S0104-11692011... ⁾	Good (6 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	194 hospitalizations of adult patients in clinical and surgical units at risk of developing PU.	RF: - Neuromuscular and/or musculoskeletal impairment (34.0%, n=18).
Moreira, Caetano, Barros and Galvão (2013)⁽²³23 Moreira RAN, Caetano JA, Barros LM, Galvão MTG. Nursing diagnoses, related factors and risk factors during the postoperative period following bariatric surgery. Rev Esc Enferm USP [Internet]. 2013 [cited 2018 Oct 28];47(1):165-72. Available from: http://dx.doi.org/10.1590/S0080-62342013000100021 http://dx.doi.org/10.1590/S0080-62342013... ⁾	Good (7 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	20 patients after bariatric surgery.	RF: - Obesity (100.0%, n=20). - Fatigue (55.0%, n=11). - Respiratory muscle fatigue (45.0%, n=9). - Anxiety (10.0%, n=2).
Souza, Mata, Carvalho and Chianca (2013)⁽²⁴24 Souza CC, Mata LRF, Carvalho EC, Chianca TCM. Nursing diagnoses in patients classified as priority level I and II according to the Manchester protocol. Rev Esc Enferm USP [Internet]. 2013 [cited 2018 Oct 28];47(6):1318-23. Available from: doi:10.1590/s0080-623420130000600010 https://doi.org/10.1590/s0080-6234201300... ⁾	Good (7 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	40 charts.	DC: - Tachypnea (100.0%, n=40). - Dyspnea (66.7%, n=27). - Use of accessory muscles to breathe (22.2%, n=9). RF: - Hyperventilation (100.0%, n=40). - Pain (77.8%, n=31).
Barros, Moreira, Frota and Caetano (2015)⁽²⁵25 Barros LM, Moreira RAN, Frota NM, Caetano JA. Identification of the nursing diagnoses of the cardiovascular/pulmonary responses class in patients subject to bariatric surgery. Aquichán. 2015;15(2):200-9. doi:10.5294/aqui.2015.15.2.4 Portuguese. https://doi.org/10.5294/aqui.2015.15.2.4... ⁾	Good (7 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	58 adult patients.	DC: - Dyspnea (68.2%, n=39). - Orthopnea (59.0%, n=34). RF: - Obesity (86.4%, n=50) - Fatigue (77.3%, n=45). - Pain (63.6%, n=37). - Respiratory muscle fatigue (4.5%, n=3). - Anxiety (4.5%, n=3).
Sousa, Pascoal, Nascimento, Matos, Beltrão, Silva and Lopes (2016)⁽²⁶26 Sousa VEC, Pascoal LV, Nascimento RV, Matos TFO, Silva VM, Lopes MVO. Ineffective breathing pattern in cardiac postoperative patients: diagnostic accuracy study. Appl Nurs Res. 2016;32:134-38. doi: 10.1016/j.apnr.2016.07.005 https://doi.org/10.1016/j.apnr.2016.07.0... ⁾	Good (7 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study.	98 patients.	DC: - Tachypnea (30.6%, n=30). - Dyspnea (27.6%, n=27). - Orthopnea (25.5%, n=25). - Prolonged expiration phase (14.3%, n=14). - Altered chest excursion (9.2%, n=2). - Bradypnea (7.1%, n=7). - Pursed-lip breathing (4.1%, n=4). -Increase in anterior-posterior chest diameter (1.0%, n=1). - Use of accessory muscles to breathe (1.0%, n=1).
Galvão, Gomes, Figueiredo and Bezerra (2016)⁽²⁷27 Galvão PCC, Gomes ET, Figueiredo TR, Bezerra SMMS. Nursing diagnosis applied to patients with decompensated heart failure. Cogitare Enferm [Internet]. 2016 [cited 2018 Oct 28];21(2):1-8. Available from: http://revistas.ufpr.br/cogitare/article/view/44646/28162 http://revistas.ufpr.br/cogitare/article... ⁾	Good (7 out of 10 points in the Newcastle-Ottawa scale for cross-sectional studies).	Cross-sectional study	62 patients for acute CHF treatment.	DC: - Dyspnea (48.4%, n=30). - Orthopnea (8.1%, n=5). RF: - Hyperventilation (91.7%, n=22). - Respiratory muscle fatigue (33.3%, n=8). - Fatigue (77.4%, n= 48). - Pain (25.0%, n=6). - Obesity (12.5%, n=3).

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[1] Corresponding Author: Patricia Rezende do Prado E-mail: patyrezendeprado@gmail.com