ASSESSMENT
EXPLANATION OF THE
PROBLEM
Subjective:
“admits a cough and
shortness of breath on
exertion. “as patient
report.
Objective:







cough
respiratory
distress
mild wheezing
tachypnea
BP 90/50
HR 128
RR 22
STO:
It is considered the state in
which the rate, depth,
timing, and rhythm, or the
pattern of breathing is
altered. When the
breathing pattern is
ineffective, the body is
most likely not getting
enough oxygen to the cells.
Histoplasmosis can damage
lungs to the point that the
air sacs begin filling with
fluid. This prevents good air
exchange and can deplete
the oxygen in your blood.
SOURCE/S
Nursing Diagnosis:
Ineffective Breathing
pattern r/t viral
infection.
OBJECTIVES
https://nurseslabs.com
/ineffective-breathingpattern/
https://www.mayoclinic.org
/diseasesconditions/histoplasmosis/

RATIONALE
Dx:
Within 45 mint of
effective nursing
interventions, the
patient will:

NURSING INTERVENTIONS
Verbalized
awareness of
causative
factors
demonstrate
appropriate
coping
behaviors
and methods
like proper
breathing &
coughing to
improve
breathing
pattern.

STO:
Assess and record
respiratory rate and
depth at least every 4
hours.

Assess ABG levels.

Observe for breathing
patterns, sound,
Rates and Depths of
Respiration

to detect early signs of
respiratory
compromise.

to monitors
oxygenation and
ventilation status.

To note for respiratory
abnormalities that
may indicate early
respiratory
compromise and
hypoxia.

Its help improve the
expansion of the lungs,
enabling the patient to
breathe more
effectively.
Tx:

EVALUATION
Elevate the head of
the bed. Assist the
patient to assume
semi-Fowler’s
position.
(Goal Met) if
Within 45 mint of
effective nursing
interventions, the
patient was:
 Verbalized
awareness
of causative
factors

demonstrate
appropriate
coping
behaviors
and
methods like
proper
breathing &
coughing to
improve
breathing
pattern.
LTO:
Within 8 hours of
effective nursing
interventions, the
patient will

patient
maintains an
effective
breathing
pattern, as
evidenced by
relaxed
breathing at
normal rate and
depth and
absence of
respiratory
distress.



Administer
supplemental oxygen,
as prescribed.
Ambulate patient as
tolerated with
doctor’s order three
times daily..


To increase the oxygen
level.
Ambulation can
further break up and
move secretions that
block the airways.

To elicit a relaxation
response that
decreases the effects
of stress on pain.

This method relaxes
muscles and increases
the patient’s oxygen
level.
Promoted deep
breathing.
Edx:

Encourage
diaphragmatic
breathing for
patients.

Instructed patient to
do deep breathing
exercise.

To prevent fatigue
Encourage small
frequent meals.

This prevents crowding
of the diaphragm.

LTO:
(Goal Met) if
Within 8 hours of
effective nursing
interventions, the
patient will

patient
maintains an
effective
breathing
pattern, as
evidenced by
relaxed
breathing at
normal rate and
depth and
absence of
respiratory
distress.

Educate patient
about medications:
indications, dosage,
frequency, and
possible side effects.
Incorporate review of
metered-dose inhaler
and nebulizer
treatments, as
needed.

This information
promotes safe and
effective medication
administration.