NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00032 |
|---|---|
| Label | Ineffective breathing pattern |
| Spanish label | Patrón respiratorio ineficaz |
| Domain | 4. Activity / rest |
| Class | 4. Cardiovascular / pulmonary responses |
| Type | Problem-focused |
| Status | Current |
What it means
It describes a way of breathing that doesn't move air well: too fast, too slow, too shallow or with too much effort. The problem is how air moves in and out, not what happens inside the lung, and it can often be corrected by treating pain, positioning or anxiety.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Chest or abdominal pain that limits expansion: thoracotomy, rib fractures, upper abdominal surgery.
- Anxiety or panic attacks with hyperventilation.
- Obesity, ascites or late pregnancy restricting the diaphragm.
- Respiratory muscle weakness or fatigue: neuromuscular disease, COPD exacerbation.
- Sedation from opioids or anesthesia.
- Mild to moderate asthma attack with rapid breathing and prolonged expiration.
What to assess
- Respiratory rate counted for a full minute, plus rhythm and depth.
- Accessory muscle use, retractions, nasal flaring and paradoxical breathing.
- Oxygen saturation and, if available, ABGs.
- Ability to speak in full sentences.
- Pain with breathing and sedation level.
- Posture: whether the patient needs to sit leaning forward to breathe.
- Chest expansion: whether it is symmetric and moves equally on both sides.
- Skin and lip color, and level of consciousness (drowsiness or agitation).
Defining characteristics
Assessment findings that support the diagnosis. They go in the "as evidenced by" part of the statement.
- Sustained adult respiratory rate above 20 or below 12 breaths/min.
- Shallow breathing with little chest rise.
- Use of neck and shoulder muscles to breathe.
- Intercostal or subcostal retractions.
- Nasal flaring.
- Pursed-lip breathing.
- Prolonged expiratory phase.
- Reports feeling short of breath or tired from breathing.
- Decreased or unequal chest expansion.
- Sits leaning forward with arms braced (tripod position).
- Speaks in short phrases because of breathlessness.
Related factors
The causes nursing can act on. They go in the "related to" part of the statement.
- Pain on inspiration or coughing.
- Anxiety that speeds up breathing.
- Respiratory muscle fatigue.
- Positioning that compresses the chest or abdomen, such as supine positioning in a patient with obesity.
- More sedation than needed.
- Lack of knowledge of breathing techniques.
- Prolonged bed rest.
At-risk populations
- Patients recovering from thoracic or upper abdominal surgery.
- Older adults, who have less respiratory muscle strength.
- People with obesity.
- Women in the third trimester of pregnancy.
- Infants and young children, whose normal respiratory rates differ from adults'.
Associated conditions
- COPD and asthma.
- Rib fractures and thoracotomy.
- Neuromuscular diseases: Guillain-Barré syndrome, myasthenia gravis, amyotrophic lateral sclerosis.
- High spinal cord injury.
- Opioid or sedative therapy.
- Ascites and abdominal distension.
How to write it (PES)
Ineffective breathing pattern related to pain on inspiration after thoracotomy and respiratory muscle fatigue as evidenced by respiratory rate of 28 breaths/min, shallow breathing and accessory muscle use.
Ineffective breathing pattern (00032).
What disrupts breathing mechanics that nursing can modify: pain, fatigue, positioning, anxiety.
Measured rate, depth and signs of effort. If saturation is normal the diagnosis still holds: the focus here is how the patient breathes.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Patient maintains a respiratory rate of 12 to 20 breaths/min without accessory muscle use within the next 8 hours.
- Oxygen saturation of 94% or higher, or 88-92% with COPD and CO₂ retention, or the target set by the provider.
- Patient performs 10 deep breaths per hour with the incentive spirometer while awake.
- Patient reports less shortness of breath.
- By the end of the shift, patient speaks in full sentences without pausing to breathe.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Place the patient in semi-Fowler's or Fowler's position (30-45°) unless contraindicated. | Lowers the diaphragm and improves lung expansion. |
| Manage pain before breathing exercises and coughing. | Pain is a common cause of shallow breathing. |
| Teach diaphragmatic and pursed-lip breathing. | Makes breathing slower and more effective and reduces air trapping. |
| Use the incentive spirometer every hour postoperatively. | Prevents atelectasis and gives an objective measure of progress. |
| Give oxygen as prescribed and monitor saturation. | Corrects hypoxemia while the cause is being treated. |
| Monitor sedation level and respiratory rate in patients on opioids. | A rate below 10 breaths/min with drowsiness requires immediate notification. |
| Stay with the patient and coach their breathing during anxiety attacks. | Reducing hyperventilation resolves the dizziness and tingling. |
| Get the patient out of bed as soon as possible, alternating activity and rest. | Sitting up and walking improve lung expansion; rest periods keep the respiratory muscles from tiring out. |
| Notify the provider if work of breathing increases, saturation drops, or drowsiness or confusion appears. | These signal that breathing is failing and the patient may need ventilatory support. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 0415Respiratory Status
- 0403Respiratory Status: Ventilation
- 0802Vital Signs
NIC interventions
- 3350Respiratory Monitoring
- 3320Oxygen Therapy
- 3140Airway Management
- 3160Airway Suctioning
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Rib fractures after a crash
Patient. 52-year-old man with three fractured right ribs after a motorcycle crash. He has been under observation in the ED for 18 hours and says he can't take a deep breath.
Assessment
- Respiratory rate 28 breaths/min, shallow breathing.
- SpO2 91% on room air.
- Right-sided pain of 8/10 on inspiration.
- Using neck muscles to breathe; the right side of the chest moves less.
- Speaks in 4- to 5-word phrases.
- Heart rate 104 bpm; awake and oriented.
Nursing diagnosis
Ineffective breathing pattern related to pain on inspiration as evidenced by respiratory rate of 28 breaths/min, shallow breathing, accessory muscle use, decreased right chest expansion and SpO2 of 91% on room air.
Goal
Within the next 8 hours, patient maintains a respiratory rate of 12 to 20 breaths/min without accessory muscle use and SpO2 of 94% or higher.
Interventions
- Place in Fowler's position at 45° with a pillow to support the injured side.
- Give prescribed analgesia and reassess pain at 30 minutes.
- Give oxygen as prescribed and monitor saturation continuously.
- Teach diaphragmatic breathing and hourly incentive spirometer use.
- Monitor sedation level and respiratory rate after each opioid dose.
Evaluation
At 8 hours he is breathing at 20 breaths/min, no longer uses accessory muscles, reports pain of 4/10 and maintains SpO2 of 95% on nasal cannula. He still needs oxygen, so the diagnosis stays active and is reassessed in 24 hours.
How it differs from similar diagnoses
- Impaired gas exchange (00030): Used when the problem is the transfer of oxygen and CO₂ at the alveolus (hypoxemia, abnormal ABGs), even if mechanics are normal.
- Ineffective airway clearance (00031): The problem is secretions blocking the airway: ineffective cough, adventitious sounds, crackles.
- Impaired spontaneous ventilation (00033): The patient cannot sustain breathing on their own and needs ventilatory support.
Common mistakes
- Using it when the issue is secretions: that is ineffective airway clearance.
- Writing "related to pneumonia": pneumonia is the condition; the related factor is, for example, pleuritic pain or fatigue.
- Counting respirations for 15 seconds and multiplying by four.
- Ruling it out because saturation is normal: mechanics can be impaired before oxygen levels drop.
- Applying adult normal values to an infant or child.
Assessment scales
Used in these conditions
Other diagnoses in the Cardiovascular / pulmonary responses class
Domain 4, Activity / rest. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for ineffective breathing pattern?
00032, in Domain 4 (Activity/rest), Class 4 (Cardiovascular/pulmonary responses).
What's the difference between ineffective breathing pattern and impaired gas exchange?
Ineffective breathing pattern describes how the patient breathes; impaired gas exchange describes whether oxygen and CO₂ move properly in the lungs. They can coexist.
Can I use it for an anxious patient who is hyperventilating?
Yes, if the anxiety is changing the rate and depth of breathing.
Does the patient need low oxygen saturation for this diagnosis?
No. It is supported by rate, depth and signs of effort. Saturation may be normal, especially if the patient is on oxygen.
What is a normal respiratory rate for an adult?
12 to 20 breaths/min at rest. In children and infants the ranges are higher and change with age.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Ineffective breathing pattern (00032) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1, source 2, source 3. Reviewed November 2, 2026.