Impaired Gas Exchange Symptoms Care Plan | Nursing Diagnosis Writing
Gas exchange occurs between the alveoli and the pulmonary capillaries through the process of diffusion. The diffusion of oxygen and carbon dioxide happens inertly as per their concentration differences through the alveolar-capillary membrane.
For gases to be exchanged through the alveoli into the blood in the pulmonary capillaries, the difference in concentration must be maintained. Nonetheless, the balance of concentration between the two mediums can be altered by certain conditions resulting in impaired gas exchange.
Conditions that often cause impaired gas exchange include pneumonia, pulmonary edema, and acute respiratory distress syndrome. Also, high altitudes, the altered oxygen-carrying capacity of the blood from reduced hemoglobin, and hypoventilation cause impaired gas exchange.
Moreover, chronic obstructive pulmonary disease and the impact of excessive fat mass on lung function puts patients at greater risk for hypoxia. Patients with pulmonary problems, smokers, and lengthy periods of immobility, chest, and upper abdominal incisions are equally at the risk for impaired gas exchange.
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Impaired Gas Exchange Nursing Care Plan Goals and Outcomes
These are the usual goals and expected outcomes for the impaired gas exchange care plan.
- The patient maintains maximum gas exchange as evidenced by normal mental status, unlabored respirations at 12 to 20 per minute, oximetry results within the normal range, baseline HR for the patient, and blood gases within the normal range.
- Patients verbalize their understanding of oxygen and other therapeutic interventions.
- Patients keep clear lung fields and remain free of signs of respiratory distress.
- Patients show resolution or absence of symptoms of respiratory distress.
- Patients participate in procedures to optimize oxygenation and in management regimen within a level of capability or condition.
Impaired as Exchange Care Plan Diagnosis
A care plan should forestall the prevailing factors that help to diagnose the existence of impaired gas exchange. As such, here are the signs and symptoms that demonstrate the presence of impaired gas exchange.
- Nasal flaring
- Abnormal breathing rate, depth, and rhythm
- A headache after waking up
- Elevated blood pressure and heart rate
- Somnolence and visual disturbances
Nursing Assessment for Impaired Gas Exchange symptoms
The patient’s general appearance may give clues to respiratory status. Therefore, the caregiver can observe the patient’s response to activity to get cue points during the performance of assessment related to impaired gas exchange. The following are assessments that help to determine if an individual has signs of impaired gas exchange.
- Assess the respiratory rate, effort, and depth including the use of accessory muscles, nasal flaring, and abnormal breathing patterns: Hasty and shallow breathing patterns and hypoventilation often affect gas exchange. Increased respiratory rate, nasal flaring, abdominal breathing, use of accessory muscle, and a panic look on the patient’s eyes may be associated with hypoxia.
- Assess the patient’s lung areas for decreased ventilation and auscultate presence of adventitious sounds: Irregularities of breathing sounds may be an indication of impaired gas exchange. The presence of crackles and wheezes are signs of airway obstruction that may lead to or worsen existing hypoxia. On the other hand, diminishing breath sounds are associated with poor ventilation.
- Monitor and evaluate the signs and symptoms of atelectasis: bronchial or tubular breath sounds, crackles, restricted diaphragm excursion, diminished chest excursion, and tracheal shift to affected side: The collapse of alveoli heightens shunting – perfusion without ventilation, which resulting in hypoxemia.
- Observe for nail beds, cyanosis in the skin especially note the color of the tongue and oral mucous membranes: Central cyanosis of the tongue and oral mucosa shows severe hypoxia and is a medical emergency. Peripheral cyanosis in extremities may or may not be as serious.
- Observe for signs and symptoms of pulmonary infarction: bronchial breath sounds, consolidation, fever, cough, hemoptysis, pleural effusion, pleural friction rub, and pleuritic pain: Enlarged dead space and reflex bronchoconstriction in neighboring areas to the infarct result in hypoxia.
- Assess blood gas (ABG) outcomes as available and note the changes: Increased PaCO2 and declined PaCO2 are top signs of respiratory acidosis and hypoxemia. When the patient’s condition worsens, the respiratory rate will lessen and PaCO2 will start to increase. However, patients with COPD have a significant decrease in pulmonary reserve and extra physiological stress often results in acute respiratory failure.
- Monitor and assess oxygen concentration always using pulse oximeter: Pulse oximetry comes in handy in detecting changes in oxygenation. An oxygen concentration of <90% – normal is 95% to 100% or a limited pressure of oxygen of <80 – normal is 80 – 100 shows significant oxygenation problems.
- Assess the patient’s ability to cough out secretions. Take note of the quantity, color, and consistency of the sputum: Retained secretions weaken gas exchange.
- Assess the patient’s hydration status: Overhydration may cause impaired gas exchange in patients, especially the ones with heart failure. On the other hand, inadequate hydration may lessen the ability to clear secretions in patients with pneumonia and COPD.
- Assess chest x-ray reports: The chest x-ray studies may show the etiological factors of the impaired gas exchange.
- Assess the patient’s nutritional status: Certain conditions such as obesity may affect lung expansion. Obesity restricts downward movement of the diaphragm, which increases the risk for hypoventilation, atelectasis, and respiratory infections. If labored breathing is evident in severe obesity it is as a result of excessive weight of the chest wall. Conversely, malnutrition may also reduce respiratory mass and strength, thereby impacting muscle function.
- Assess for dizziness, headaches, lethargy, reduce ability to follow instructions, coma, and disorientation: These are the common signs of hypercapnia.
- Assess for alteration in HR and BP: HR, BP, and respiratory rate all increase with initial hypoxia and hypercapnia: However, when both conditions become severe, HR and BP decrease, and dysrhythmias may occur.
- Monitor and assess the patient’s behavior and mental status for the onset of restlessness, agitation, confusion, and extreme lethargy: Changes in behavior and mental status can be early signs of impaired gas exchange. The cognitive alteration may happen with chronic hypoxia.
- Monitor the impact of position changes on oxygenation and pulse oximetry: Having the most compromised lung areas in the dependent position – where perfusion is greatest potentiates ventilation and perfusion imbalances.
Nursing Interventions for Impaired Gas Exchange
A caregiver can take up the following therapeutic interventions for impaired gas exchange:
- Position patient with head of the bed elevated, in a semi-Flower’s position – head of the bed to be at least 45 degrees when supine as tolerated: The upright position or semi-Flower’s position increases thoracic capacity, full descent of diaphragm while increasing lung expansion to prevent the abdominal contents from flocking.
- Encourage or help with ambulation as per physician’s order: Ambulation facilitates lung expansion, stimulates deep breathing, and secretion clearance.
- If the patient is acutely dyspnea, consider having the patient lean forward over a bedside table, if tolerated: Leaning forward can help in decreasing dyspnea, perhaps because gastric pressure allows for better contraction of the diaphragm.
- Avoid high concentration of oxygen in patients with COPD unless ordered: Hypoxia stimulates the drive to breathe in the patient who chronically retains carbon dioxide. When administering oxygen, close monitoring is imperative to avert unsafe increases in the patient’s PaCO2, which could result in apnea.
- For patients that should be ambulatory, provide extension tubing or a portable oxygen apparatus: These measures often improve exercise tolerance by maintaining enough oxygen levels during activity.
- Assist the patient in taking a deep breath and performing controlled coughing. Get the patient to inhale deeply, hold the breath for several seconds, and cough 2-3 times with mouth open while tightening the upper abdominal muscle as tolerated: A technique like this can help increase sputum clearance and lessen cough spasms. Under controlled coughing the diaphragmatic muscles are used, thus making the cough more forceful and effective.
- Suction as necessary: Suction is done to clear secretions in case the patient is not able to effectively clear the airway. An airway obstruction blocks ventilation thereby impairs gas exchange.
- Encourage slow deep breathing using an incentive spirometer as indicated: A slow deep breathing technique promotes deep inspiration, thereby increasing oxygenation and prevents atelectasis.
- Provide reassurance and lessen anxiety: Anxiety heightens respiratory rate, dyspnea, and work of breathing.
- Administer humidified oxygen through an appropriate device, watch for the onset of hypoventilation as evidenced by increased somnolence once initiating or increasing oxygen therapy: A patient with chronic lung disease may need a hypoxic drive to breathe and may hypoventilate during oxygen therapy.
- If a patient is allowed to take meals, provide oxygen to the patient but in a different way: More oxygen will be consumed during the meal taking sessions. The original oxygen delivery system should be put back immediately after every meal.
- Maintain the oxygen administration device as ordered while attempting to maintain oxygen saturation at 90% or more: Supplemental oxygen may be needed to maintain PaO2 at the required level.
- For postoperative patients, help with splinting the chest: Splinting maximizes deep breathing and coughing efforts.
- Administer medications as prescribed: The type of medications depends on the etiological factors of the problem. For instance, antibiotics for pneumonia, thrombolytics for pulmonary embolus, and analgesics for thoracic pain.
- Consider the need for intubation and mechanical ventilation: Prompt intubation and mechanical ventilation are recommended to avert full decompensation of the patient. Mechanical ventilation, on the other hand, offers supportive care by maintaining sufficient oxygenation and ventilation.
- Instruct the patient to limit contact to persons with respiratory infections: This will reduce the risk of spread of droplets between patients.
These are some of the impaired gas exchange interventions that caregivers can use in managing his or her patients. Should you need impaired gas exchange symptoms writing services, do not hesitate to contact us immediately for top-notch services.
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