Shallow respirations occur when a diminished volume of air enters the lungs during inspiration. To compensate, patients often breathe rapidly; however, as respiratory muscles fatigue or weaken, this compensation fails, leading to inadequate gas exchange. Consequences include dyspnea, cyanosis, confusion, agitation, loss of consciousness, and tachycardia. Shallow respirations can be acute or chronic and are an important sign of respiratory distress or neurologic deterioration.

Pathophysiology

Shallow respirations may result from:

• Central respiratory control dysfunction (e.g., brain injury, coma)

• Neuromuscular disorders (e.g., ALS, myasthenia gravis, Guillain-Barré syndrome)

• Increased airflow resistance (e.g., asthma, bronchiectasis, pulmonary edema)

• Respiratory muscle fatigue or weakness

• Pain or postoperative chest splinting

• Voluntary or drug-induced alterations (opioids, sedatives, anesthetics)

• Prolonged immobility

Emergency interventions

• Assess airway, breathing, and circulation (ABCs) immediately.

• For airway obstruction: perform back blows, abdominal thrusts (children under caution), or suction secretions.

• Administer oxygen via face mask or resuscitation bag.

• If patient loses consciousness: insert artificial airway and prepare for intubation and mechanical ventilation.

• Monitor tidal volume, minute volume, ABGs, oxygen saturation, heart rate, and blood pressure.

• Be alert for tachycardia, hypotension, or deteriorating ABG results as indicators for urgent intervention.

History and Physical Examination

History:

• Ask about onset, duration, and triggers of shallow respirations.

• Explore chronic illnesses, trauma, recent surgery, respiratory disorders, neuromuscular diseases, and drug or toxin exposure.

• Assess changes in appetite, weight, activity level, and behavior.

Physical Examination:

• Assess level of consciousness and orientation.

• Observe for spontaneous movements, muscle strength, and deep tendon reflexes.

• Inspect the chest for deformities, abnormal movements, and intercostal retractions.

• Examine extremities for cyanosis and clubbing.

• Palpate for diaphragmatic expansion and tactile fremitus.

• Percuss for hyperresonance or dullness.

• Auscultate breath and heart sounds.

• Examine abdomen for distention, tenderness, or masses.

Measuring Lung Volumes:

Use a Wright respirometer to measure tidal volume and minute volume via endotracheal tube, tracheostomy, or face mask.

Medical causes

Other Causes: Drugs (opioids, sedatives, anesthetics), post-surgical pain, prolonged bed rest.

Special considerations

• Position patient upright to ease breathing.

• Use humidified oxygen, bronchodilators, mucolytics, or antibiotics as ordered.

• Chest physiotherapy, incentive spirometry, or intermittent positive pressure breathing may be required.

• Turn the patient frequently and monitor for lethargy (rising CO₂).

• Keep emergency airway equipment at the bedside.

Patient counseling

• Teach coughing and deep breathing exercises.

• Provide emotional support and caregiver training.

• Advise on hydration and secretion management.

Pediatric considerations

• Shallow respirations in children often indicate life-threatening conditions.

• Causes include infant respiratory distress syndrome, epiglottitis, diphtheria, aspiration, croup, bronchiolitis, cystic fibrosis, bacterial pneumonia.

• Airway obstruction can occur rapidly due to narrow airways; use back blows/chest thrusts, not abdominal thrusts.

• Monitor for apnea, administer oxygen, hydration, humidification, and perform chest physiotherapy as needed.

Geriatric considerations

• Aging may cause chest wall stiffness or deformity, leading to shallow respirations.

• Carefully evaluate for underlying pulmonary or neuromuscular disease.

References

1. Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008.

2. Colyar MR. Well-Child Assessment for Primary Care Providers. Philadelphia, PA: F.A. Davis; 2003.

3. Lehne RA. Pharmacology for Nursing Care. 7th ed. St. Louis, MO: Saunders Elsevier; 2010.

4. McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights, MO: Mosby Elsevier; 2010.

5. Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.