5. Ask if they are “short of breath” and note any dyspnea.

Sometimes anxiety can cause dyspnea, so watch the patient for “air hunger,” which is a sign that
the cause of shortness of breath is physical.

6. Assess for the use of accessory muscle.

Work of breathing increases greatly as lung compliance decreases.

7. Monitor for diaphragmatic muscle fatigue or weakness (paradoxical motion).

Paradoxical movement of the abdomen (an inward versus outward movement during inspiration)
is indicative of respiratory muscle fatigue and weakness.

8. Observe for retractions or flaring of nostrils.

These signs signify an increase in respiratory effort.

9. Assess the position that the patient assumes for breathing.

Orthopnea is associated with breathing difficulty.

10. Utilize pulse oximetry to check oxygen saturation and pulse rate.
Pulse oximetry is a helpful tool to detect alterations in oxygenation initially; but, for CO2 levels,
end-tidal CO2 monitoring or arterial blood gases (ABGs) would require obtaining.

11. Inquire about precipitating and alleviating factors.

Knowledge of these factors is useful in planning interventions to prevent or manage future
episodes of breathing problems.

12. Assess ability to mobilize secretions.

The incapability to mobilize secretions may contribute to a change in breathing patterns.

13. Observe the presence of sputum for amount, color, consistency.

These may be indicative of a cause for the alteration in breathing patterns.

14. Send specimen for culture and sensitivity testing if sputum appears to be discolored.
This may signify infection.

15. Evaluate the level of anxiety.

Hypoxia and the sensation of “not being able to breathe” are frightening and may worsen
hypoxia.

16. Note for changes in the level of consciousness.

Restlessness, confusion, and/or irritability can be early indicators of insufficient oxygen to the
brain.

17. Evaluate skin color, temperature, capillary refill; observe central versus peripheral
cyanosis.
Lack of oxygen will cause blue/cyanosis coloring to the lips, tongue, and fingers. Cyanosis to the
inside of the mouth is a medical emergency!
18. Assess for thoracic or upper abdominal pain.
Pain can result from shallow breathing.