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Hyperventilation Nursing Guide

This guide provides an overview and nursing considerations for hyperventilation syndrome utilizing the nursing process. 

Content Reviewed by Ann Dietrich, MD, FAAP, FACEP.   

Hyperventilation Etiology and Epidemiology 

Hyperventilation syndrome is characterized by excessive rapid or deep breathing (hyperventilation) without an organic cause. It results in decreased carbon dioxide levels (hypocapnia) and increased pH (respiratory alkalosis), leading to symptoms such as paresthesia, dizziness, syncope, and altered perception. The condition often originates from psychological factors like anxiety, panic disorders, or phobias, affecting 5% to 10% of the general medical population. It is more common in younger females but can occur in any age or gender group. There is a significant relationship with panic disorders; about half of those with panic disorder are diagnosed with hyperventilation syndrome. 

Hyperventilation ICD-10 Code: F45.8 

  • Other somatoform disorders 

Diagnosis 

Diagnosis is primarily clinical, based on symptom presentation and exclusion of other causes. Common symptoms include: 

  • Shortness of breath 
  • Frequent sighs 
  • Chest tightness 
  • Tingling and trembling 
  • Muscle stiffness 
  • Dizziness and syncope 
  • Tachycardia and tachypnea 
  • Blurred vision and headaches 
  • Abdominal pain 

Diagnostic Tests 

Typical diagnostic workup includes: 

  • Chest X-ray (usually normal) 
  • Blood gas (to rule out metabolic causes) 
  • Electrocardiogram (may show signs related to hyperventilation) 
  • Cardiac enzymes (no cardiac injury) 
  • Pulse oximetry (near 100%) 
  • CT Angiogram (to exclude pulmonary embolism if needed) 
  • Hyperventilation provocation test (HVPT) 

Management 

Traditional rebreathing techniques (using a paper bag) are no longer recommended. Current treatments may involve: 

  • Breathing exercises: Such as diaphragmatic breathing and maximal exhalation maneuvers (first line) 
  • Supportive counseling: Including psychiatric treatment 
  • Antidepressants: To decrease frequency and severity of episodes 
  • Benzodiazepines: To reduce anxiety, infrequently used because of addictive potential and side effects 

Hyperventilation Nursing Care Plan 

Assessment 

  • Regularly assess vital signs and pulse oximetry. 
  • Monitor respiratory status: rate, depth, effort, breath sounds. 
  • Check for signs of electrolyte imbalance. 
  • Evaluate mental status and muscular function. 
  • Monitor serum electrolyte levels as ordered. 

Nursing Diagnoses 

  • Anxiety 
  • Ineffective breathing pattern 
  • Risk for falls 
  • Risk for electrolyte imbalance 

Interventions 

  • Anxiety: 
    • Use a soft, calm tone. 
    • Provide clear, simple instructions during acute anxiety episodes. 
    • Encourage discussion of feelings and anxiety triggers. 
  • Ineffective breathing pattern: 
    • Consider respiratory therapy consult. 
    • Assist with comfortable positioning to ease breathing. 
  • Risk for falls: 
    • Use the call bell for assistance. 
    • Place items within easy reach. 
    • Follow organizational policies for fall risk identification. 
  • Risk for electrolyte imbalance: 
    • Encourage proper dietary intake. 
    • Replenish electrolytes as ordered. 

Expected Outcomes 

  • Anxiety: Individual will express feelings of anxiety and report reduction in anxiety. 
  • Ineffective breathing pattern: Individual will return to normal breathing patterns and report comfort while breathing. 
  • Risk for falls: Individual will understand fall precautions and remain free of falls. 
  • Risk for electrolyte imbalance: Individual will maintain normal electrolyte and fluid balance. 

Patient/Caregiver Education 

  • Educate about the relationship between panic/anxiety and hyperventilation syndrome. 
  • Inform that breathing into a paper bag is no longer recommended. 
  • Reassure that symptoms are often temporary and should pass. 
  • Instruct to rest if symptoms occur and seek medical help if symptoms worsen. 

FAQs

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2025

References 

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