Impaired Gas Exchange nursing diagnosis, care plan, interventions, clinical guide with Examples a student guide

Impaired Gas Exchange nursing diagnosis and care plan, provides nursing interventions and Rationales according to NANDA, and outlines a clinical guide to geriatric Impaired Gas Exchange nursing care plan, home care Impaired Gas Exchange nursing care plan and a teaching plan for Impaired Gas Exchange nursing care plan. 
Impaired Gas Exchange nursing diagnosis and care plan, provides nursing interventions and Rationales according to NANDA, and outlines a clinical guide to geriatric Impaired Gas Exchange nursing care plan, home care Impaired Gas Exchange nursing care plan, and a teaching plan for Impaired Gas Exchange nursing care plan. 

Impaired Gas Exchange

This article outlines an Impaired Gas Exchange nursing diagnosis and care plan, provides nursing interventions and Rationales according to NANDA, and outlines a clinical guide to geriatric Impaired Gas Exchange nursing care plan, home care Impaired Gas Exchange nursing care plan and a teaching plan for Impaired Gas Exchange nursing care plan.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor if you’re looking for medical advice.

What is gas exchange?

Gas exchange is the movement of oxygen and CO2 occurs in the alveoli in the pulmonary capillary bed. When a patient has impaired gas exchange your problem could originate in the respiratory tract, poor gas exchange can originate from many different areas. It takes place in the alveoli, not the nares, trachea, bronchi, or pharynx. Poor blood flow leads to poor gas exchange due to perfusion and lack of blood flow to areas of the body. Physiological dead air space is occurs in the nares, trachea, bronchi, pharynx and occurs as a result of oxygen is coming in but does not undergo perfusion

Impaired Gas Exchange nursing diagnosis and care plan, provides nursing interventions and Rationales according to NANDA, and outlines a clinical guide to geriatric Impaired Gas Exchange nursing care plan, home care Impaired Gas Exchange nursing care plan, and a teaching plan for Impaired Gas Exchange nursing care plan.
Impaired Gas Exchange nursing diagnosis and care plan, provides nursing interventions and Rationales according to NANDA, and outlines a clinical guide to geriatric Impaired Gas Exchange nursing care plan, home care Impaired Gas Exchange nursing care plan, and a teaching plan for Impaired Gas Exchange nursing care plan.

Impaired gas exchange characteristics include tachypnea, cyanosis, chronic clubbing, wheezing, dyspnea, orthopnea, aphasia

Ventilation is the movement of air between the atmosphere and the lungs. Ventilation in gas exchange involves inspiration (active) and expiration (passive), diaphragm is the principle muscle of inspiration, and surfactant

Perfusion is the flow of blood through the lungs, primarily in the pulmonary capillary bed. There is arterial blood that goes throughout the upper resp tract, and we are focusing primarily on alveoli. Here deoxygenated blood travels to the lungs through the pulm artery and oxygenated comes back through pulm veins. It is essential to understand that oxygen doesnt help maintain pH of blood, that is CO2 and bicarbonate and some CO2 binds to hemoglobin, some dissolves in blood, some attaches to bicarbonate where it is converted to carbonic acid to maintain 7.35-7.45.

Diffusion is the transfer of gas between lungs and blood. It involves the actual movement of gases in the alveoli across the alveolar capillary membrane. In this, oxyhemoglobin is the combo of hemoglobin and oxygen. Remember hemoglobin easily gives up oxygen as well as takes up oxygen and some certain conditions such as emphysema and fibrosis can lead to problems with difussion.

Cardiac problems can lead to respiratory problems and vice versa. Hence people with problems of the pulmonary artery can have a problem with perfusion, and blood cannot be properly oxygenated

Surfactant is important in terms of alveoli and their ability to stay open and fill with O2. It also plays a critica role in keeping the alveoli dry, sighing is what helps manufacture the surfactant. Hence, without surfactant there is a problem in opening the alveoli during inspiration

Hypoxia is as a result of inadequate supply of oxygen to the tissue that is below physiological levels despite adequate perfusion of the tissue by blood. However, when there is not enough O2 in the blood
-hypoxemia–>hypoxia

Hypoxemia is when oxygenation levels in the arterial blood drops below 60 mmHg. Clearly can lead to hypoxia if one is circulating enough blood but there isn’t enough oxygen

Causes of hypoxemia

COPD, chronic leads to clubbing of the nails, long term smoking, severe anemia (lack of iron and hemoglobin), can be a ventilation and perfusion problem (most common) high elevations, low (not taking in enough O2)/ high respiration rates
hypoxemia–> hypoxia

Ventilation and perfusion

  • alveolar ventilation: volume of air that enters the alveoli per min (V
  • perfusion: blood flow to the gas exchange portion of the lungs (Q)
  • V/Q ratio mismatch of this ration is from ventilation or diffusion–> impaired gas exchange–> hypoxemia

Perfusion without ventilation

Shunting occurs when we have blood flow moving through the pulm artery and capillary blood but it does not pick up adequate oxygen (atelactasis or collapsed alveoli, rib fractures, ventilation problems, shallow breaths, mucous plugs, chronic bronchitis, cystic fibrosis)

Ventilation without perfusion

alveoli dead air space is the same as anatomical dead air space, but here this is an abnormal problem such as pulmonary embolism

Solution to v s p or p s v (Ventilation without perfusion or perfusion without ventilation)

  1. give oxygen
  2. find underlying problem
  3. put up HOB
    -either way, pt is present with impaired gas exchange, will vary depending on which type the patient is suffering

Signs and Symptoms of impaired gas exchange

  • dyspnea, SOB
  • cough
  • hemoptysis: coughing up blood
  • abnormal breathing patterns: tachypnea, diabetic ketoacidosis, kusbal respirations (diabetic ketoacidosis leads to hypoxemia through kusbal resp trying to get rid of extra CO2)
  • hypoventilation
  • hyperventilation
  • cyanosis (late sign)
  • restlessness, impatience, confusion (early signs)
Impaired Gas Exchange nursing diagnosis and care plan, provides nursing interventions and Rationales according to NANDA, and outlines a clinical guide to geriatric Impaired Gas Exchange nursing care plan, home care Impaired Gas Exchange nursing care plan, and a teaching plan for Impaired Gas Exchange nursing care plan.
Impaired Gas Exchange nursing diagnosis and care plan, provides nursing interventions and Rationales according to NANDA, and outlines a clinical guide to geriatric Impaired Gas Exchange nursing care plan, home care Impaired Gas Exchange nursing care plan, and a teaching plan for Impaired Gas Exchange nursing care plan.

Restrictive Lung Disease

  • V/Q mismatch
  • Aspiration is the movement of fluid or solid particles into the lungs, resulting in bronchial inflammation and collapsed alveoli, problems distal to the obstruction. This can evolve into aspirative pneumonia
    • Aspiration precautions – keep HOB up, have suction ready, special dysphagia diet thickened, monitored eating people to worry about: elderly, CVA patients, neuromuscular problems causing dysphagia, seizure problems, altered mental status, someone that was given some sort of anesthetic agent until gag reflex is tested
  • Atelactasis – Atelactasis – restrictive lung disease looking at the alveoli that are collapsed. Multiple collapsed airless alveoli= pneumothorax. Can result in alveoli hypoventilation which is a problem with ventilation and shunting which leads to more significant impairment.
    • Types of atelectasis include compression and absorption.
    • Atelectasis: compression from large amount of fluid or air in the pleural space causes the collapse of the alveoli. CA in the pleural space creating excess fluid from the pleural space. Shunting situation
    • atelectasis: absorption results in obstruction in the airway that prevents air traveling down to the alveoli. This causes shunting because the alveoli are unable to fill with air. This will also decrease the amount of surfactant production further causing alveolar collapse. The greater the obstruction the greater the atelectasis. Ex that lead to this= mucous plug, aspiration, cystic fibrosis, people on bed rest, post op pt in which meds prevent the removal of secretions, those with decreased cough reflex, hypoventilation with ab/rib pain. Mobility enhancing oxygenation and more expansion of the lungs
    • The signs of compression atelectasis include dry cough, dyspnea, absent or diminished lung sounds
    • How can nurses stop atelectasis?
  1. Assessment
  2. Ambulation
  3. spiro meters
  4. turn, cough, deep breath
  • these promote good pulmonary function. One can have good perfusion but bad ventilation from atelectasis

Pulmonary vascular disorder is a result of c alveoli dead air space and perfusion.

Pulmonary vascular disorder: pulmonary embolism is a perfect example of alveolar dead air space, fat, air, blood clot, embolisms an is life threatening

Pulmonary vascular disorder: triad of virchow are three conditions that can lead to DVT, which can lead to pulmonary embolism. Think of people at risk for venous stasis- people on bed rest, immobility, obesity, and pregnancy (problem c valves), hypercoagulability state from birth control or people with CA perinea plastic syndrome, too many platelets

Preventing pulmonary embolism starts by working from a preventative stand pt and depends on the size of PE, small may be able to pass. Big may go to the pulmonary artery and cause death

Nurses preventing DVT and PE should

  1. Initiate venous stasis: hose and alternating pressure devices, ambulation

  2. Assess and treat the vascular injury: massage, pressure, positioning, control of vascular diseases

  3. Understand hypercoagulability: recognize anticoagulation with heparin, warfarin

What is Impaired Gas Exchange?

The NANDA-I definition of impaired gas exchange is Excess or deficit in oxygenation and carbon dioxide elimination at the alveolar-capillary membrane

Impaired Gas Exchange nursing diagnosis and care plan, provides nursing interventions and Rationales according to NANDA, and outlines a clinical guide to geriatric Impaired Gas Exchange nursing care plan, home care Impaired Gas Exchange nursing care plan, and a teaching plan for Impaired Gas Exchange nursing care plan.
Impaired Gas Exchange nursing diagnosis and care plan, provides nursing interventions and Rationales according to NANDA, and outlines a clinical guide to geriatric Impaired Gas Exchange nursing care plan, home care Impaired Gas Exchange nursing care plan, and a teaching plan for Impaired Gas Exchange nursing care plan.

impaired gas exchange nanda

The Defining Characteristics of impaired gas exchange include;

  • Abnormal arterial blood gases
  • Abnormal arterial pH
  • Abnormal breathing pattern
  • Abnormal skin color
  • Confusion
  • decrease in carbon dioxide (CO2) level
  • diaphoresis
  • dyspnea
  • headache on awakening
  • hypercapnia
  • hypoxemia
  • hypoxia
  • irritability
  • nasal flaring
  • restlessness, somnolence
  • tachycardia; visual disturbances

Associated Condition impaired gas exchange nanda

Alveolar-capillary membrane changes; ventilation-perfusion imbalance

NOC (ENursing Outcomes Classification)

Suggested NOC Outcomes by impaired gas exchange nanda

Respiratory Status: Gas Exchange, Ventilation

Example NOC Outcome with Indicators

Achieves appropriate Respiratory Status: Gas Exchange as evidenced by the following indicators: Cognitivestatus/Partial pressure of oxygen/Partial pressure of carbon dioxide/Arterial pH/Oxygen saturation. (Rate each indicator of Respiratory Status: Gas Exchange: 1 = severe deviation from the normal range, 2 = substantial deviation from normalrange, 3 = moderate deviation from the normal range, 4 = mild deviation from the normal range, 5 = no deviation from normal range)

Client Outcomes

Client Will (Specify Time Frame)

  • Demonstrate improved ventilation and adequate oxygenation as evidenced by blood gas levels within normal parameters for that client
  • Maintain clear lung fields and remain free of signs of respiratory distress
  • Verbalize understanding of oxygen supplementation and other therapeutic interventions NIC (Nursing Interventions Classification)

Suggested NIC Interventions

Acid-Base Management; Airway Management

Example NIC Activities Acid-Base Management

Monitor for symptoms of respiratory failure (e.g., low PaO2 and elevated PaCO2 levels and respiratory muscle fatigue); Monitor determinants of tissue oxygen delivery (e.g., PaO2, SaO2, and haemoglobin levels, and cardiac output) if available

Nursing Interventions and Rationales (impaired gas exchange nursing care plan NANDA)

  • Monitor respiratory rate, depth, and ease of respiration. Watch for the use of accessory muscles and nasal flaring. Normal respiratory rate is 14 to 16 breaths per minute in adults (Bickley & Szilagyi, 2017). A significant cardiovascular or respiratory alteration exists when the respiratory rate exceeds 30 breaths per minute, along with other physiological measures.
  • Auscultate breath sounds every 1 to 2 hours. The presence of crackles and wheezes may alert the nurse to airway obstruction, leading to or exacerbating existing hypoxia. In severe exacerbations of chronic obstructive pulmonary disease (COPD), lung sounds may be diminished or distant with air trapping (Bickley & Szilagyi, 2017).
  • The nurse should consider respiratory rate, work of breathing, and lung sounds along with PaO2 values, arterial oxygen saturation (SaO2), oxygen saturation continuously using pulse oximetry (SpO2), patient tidal volume, and minute ventilation. Presence of dyspnea, asynchronous chest and abdominal movements, accessory muscles, and agitation indicate potential oxygenation problems (Barton, Vanderspank-Wright, & Shea, 2016).
  • Monitor the client’s behavior and mental status for the onset of restlessness, agitation, confusion, and (in the late stages) extreme lethargy. Changes in behavior and mental status can be early signs of impaired gas exchange. In the late stages, the client becomes lethargic and somnolent (Lee, 2017).
  • Monitor oxygen saturation continuously using pulse oximetry (SpO2) (Lee, 2017). Note blood gas results as available. Oxygen saturation of less than 88% (normal is 95%–100%) or partial pressure of oxygen of less than 55 mm Hg (normal is 80–100 mm Hg) indicates significant oxygenation problems (Bein et al., 2016; Siela & Kidd, 2017). Pulse oximetry is useful for tracking and/or adjusting supplemental oxygen therapy for clients with COPD (GOLD, 2017).
  • Monitor venous oxygen saturation to determine an index of oxygen balance to reflect between oxygen delivery and oxygen consumption (Dirks, 2017).
  • Measurements of oxygenation supply in the macrocirculation include those made upstream from the tissue level. The parameters measured are arterial partial pressure of oxygen (PaO2), arterial oxygen content (CaO2), arterial oxygen saturation (SaO2) determined on the basis of arterial blood gas (ABG) analysis and pulse oximetry (SpO2), and ratio of PaO2 to fraction of inspired oxygen (FiO2) or the PF ratio. Measurements of oxygenation or oxygen extraction or consumption in the macrocirculation made downstream from tissues include tissue oxygen consumption, mixed venous oxygen saturation (SvO2) or central venous oxygen saturation (ScvO2), and blood levels of lactate (Siela & Kidd, 2017).
  • Observe for cyanosis of the skin, especially note the tongue’s colour and oral mucous membranes. EB: In central cyanosis, both the skin and mucous membranes are affected because of seriously impaired pulmonary function from unventilated or underventilated alveoli. Peripheral cyanosis (skin only) usually indicates vasoconstriction or obstruction to blood flow (Loscalzo, 2016). Central cyanosis of the tongue and oral mucosa indicates serious hypoxia and is a medical emergency. Peripheral cyanosis in the extremities may be caused by activation of the central nervous system or exposure to cold and may or may not be serious (Bickley & Szilagyi, 2017).
  • Position the client in a semirecumbent position with the head of the bed at a 30- to 45-degree angle to decrease the aspiration of gastric, oral, and nasal secretions (Grap, 2009; Siela, 2010; American Association of Critical Care Nurses, 2016, 2017; Vollman, Dickinson, & Powers, 2017). Evidence shows that mechanically ventilated clients have a decreased incidence of aspiration pneumonia if the client is placed in a 30- to 45-degree semirecumbent position as opposed to a supine position.
  • If the client has unilateral lung disease, position with head of bed at 30 to 45 degrees with “good lung down” in a side-lying position and affected lung up (Barton, Vanderspank-Wright, & Shea, 2016).
  • If the client is acutely dyspneic, consider leaning forward over a bedside table, resting elbows on the table if tolerated. Leaning forward can help decrease dyspnea, possibly because gastric pressure allows better contraction of the diaphragm (Langer et al., 2009; Mahler, 2014). This is called the tripod position and is used during times of distress, including when walking, leaning forward on the walker.
  • Help the client deep breathe and perform controlled coughing. Have the client inhale deeply, hold the breath for several seconds, and cough two or three times with the mouth open while tightening the upper abdominal muscles as tolerated. Controlled coughing uses the diaphragmatic muscles, making the cough more forceful and effective. If the client has excessive fluid in the respiratory system, see the interventions for Ineffective Airway clearance.
  • Monitor the effects of sedation and analgesics on the client’s respiratory pattern; use judiciously (Barton, Vanderspank-Wright, & Shea, 2016). Both analgesics and medications that cause sedation can depress respiration at times. However, these medications can be very helpful for decreasing the sympathetic nervous system discharge that accompanies hypoxia (Spruit et al., 2013).
  • Schedule nursing care to provide rest and minimize fatigue. The hypoxic client has limited reserves; inappropriate activity can increase hypoxia (Spruit et al., 2013).
  • Administer humidified oxygen through an appropriate device (e.g., nasal cannula or Venturi mask per the health care provider’s order); aim for an oxygen (O2) saturation level of 90% or above. Oxygen should be titrated to target a SpO2 of 94% to 98%, except with carbon monoxide poisoning (100% oxygen), acute respiratory distress syndrome (ARDS)(88%–95%), those at risk for hypercapnia (88%–92%), and premature infants (88%–94%) (Blakeman, 2013). Watch for the onset of hypoventilation as evidenced by increased somnolence. There is a fine line between ideal and excessive oxygen therapy; increasing somnolence is caused by retention of CO2, leading to CO2 narcosis (Wong & Elliott, 2009). Promote oxygen therapy during a COPD exacerbation. Supplemental oxygen should be titrated to improve the client’s hypoxemia with a target of 88% to 92% (GOLD,2017).
  • Once oxygen is started, ABGs should be checked 30 to 60 minutes later to ensure satisfactory oxygenation without CO2 retention or acidosis (GOLD, 2017). EBN: Use of high-flow nasal cannula oxygen therapy may improve gas exchange and oxygenation in acute hypoxemic respiratory failure (Lenglet et al., 2012; Sztrymf et al., 2012; Rittayamai, Tscheikuna, & Rujiwit, 2014; Siela & Kidd, 2017).
  • Supplemental oxygen can cause toxicity and should be administered at the lowest level that achieves an arterial saturation appropriate for a given patient (Budinger & Mutlu, 2013; Helmerhorst et al., 2015). Conservative oxygen strategies that target a goal of 88% to 92% SpO2 levels in patients receiving invasive mechanical ventilation appear justified (Panwar et al., 2016).
  • Assess nutritional status including serum albumin level and body mass index (BMI). Malnourishment in a client with COPD has a negative effect on the course of the disease; it can result in loss of muscle mass in the respiratory muscles, including the diaphragm, which can lead to respiratory failure (GOLD, 2017).
  • Assist the client to eat small meals frequently and use dietary supplements as necessary. Engage dietary issues by evaluating and creating an optimal nutrition plan. For some clients, drinking 30 mL of a supplement every hour while awake can be helpful.
  • If the client is severely debilitated from chronic respiratory disease, consider the use of a wheeled walker to help in ambulation.
  • Watch for signs of psychological distress including anxiety, agitation, and insomnia.▴ Refer the COPD client to a pulmonary rehabilitation program. Pulmonary rehabilitation is now considered a standard of care for client with COPD (Nici et al., 2009; Spruit et al., 2013; GOLD, 2017).Critical Care
  • Assess and monitor oxygen indices such as the PF ratio (FiO2:PO2) and venous oxygen saturation/oxygen consumption (SvO2 or ScvO2) (Headley & Giuliano, 2011; Dirks, 2017; Siela & Kidd, 2017; Lough, 2018).
  • Turn the client every 2 hours. Monitor mixed venous oxygen saturation closely after turning. If it drops below 10% or fails to return to baseline promptly, turn the client back into the supine position and evaluate oxygen status. If the client does not tolerate turning, consider use of a kinetic bed that rotates the client from side to side in a turn of at least 40degrees (St. Clair & MacDermott, 2017)
  • If the client has ARDS with difficulty maintaining oxygenation, then consider positioning the client prone with the upper thorax and pelvis supported. Monitor oxygen saturation and turn the client back to supine position if desaturation occurs. EB: Oxygenation levels have been shown to improve in the prone position, probably because of decreased shunting and better perfusion of the lungs (Gattinoni et al.,2013; Drahnak & Custer, 2015; Barton, Vanderspank-Wright, & Shea, 2016; Bein et al., 2016; Vollman, Dickinson, & Powers, 2017; Vollman, Sole, Quinn, 2017). Prone ventilation significantly reduced mortality in clients with severe acute hypoxemic respiratory failure, but not in clients with less severe hypoxemia (Sud et al., 2010; Gattinoni et al., 2013). A PaO2 lower than 150 mm Hg measured on at least 5 cm H2O positive end-expiratory pressure (PEEP) is a recommended threshold for the application of proning (Gattinoni et al., 2013). Note: If the client becomes ventilator-dependent, see the care plan for Impaired spontaneous Ventilation High levels of PEEP likely improve oxygenation and gas exchange (Suzumura et al., 2014; Barton, Vanderspank-Wright, & Shea, 2016).

Geriatric impaired gas exchange nursing care plan

  • Use central nervous system depressants and other sedating agents carefully to avoid decreasing respiration effort (rate and depth of breathing).
  • Maintain appropriate levels of supplemental oxygen therapy for clients with impaired gas exchange and hypoxemia (GOLD, 2017).

Home Care impaired gas exchange nursing care plan

  • Work with the client to determine what strategies are most helpful during times of dyspnea. Educate and empower the client to self-manage the disease associated with impaired gas exchange. EBN/EB: A study found that use of oxygen, self-use of medication, and getting some fresh air were most helpful in dealing with dyspnea (Thomas, 2009). Evidence-based reviews have found that self-management offers COPD clients effective options for managing the illness, leading to more positive outcomes (Spruit et al., 2013; GOLD, 2017).
  • Collaborate with health care providers regarding long-term oxygen administration for chronic respiratory failure clients with severe resting hypoxemia. Administer long-term oxygen therapy greater than 15 hours daily for PO2 less than 55 or SaO2 at or below 88% (GOLD, 2017).
  • Assess the home environment for irritants that impair gas exchange. Help the client adjust the home environment as necessary (e.g., install an air filter to decrease the level ofdust).
  • Refer the client to occupational therapy as necessary to assist the client in adapting to the home and environment and in energy conservation (GOLD, 2017).
  • Assist the client with identifying and avoiding situations that exacerbate impairment of gas exchange (e.g., stress-related situations, exposure to pollution of any kind, proximity to noxious gas fumes such as chlorine bleach). Irritants in the environment decrease the client’s effectiveness in accessing oxygen during breathing.
  • Refer to GOLD guidelines for management of home care and indications of hospital admission criteria (GOLD, 2017).
  • Instruct the client to keep the home temperature above 68°F (20°C) and to avoid cold weather. Cold air temperatures cause constriction of the blood vessels, which impairs theclient’s ability to absorb oxygen (Bickley & Szilagyi, 2017).
  • Instruct the client to limit exposure to persons with respiratory infections. Viruses, bacteria, and environmental pollutants are the main causes of exacerbations of COPD (GOLD, 2017).
  • Instruct the family in the complications of the disease and the importance of maintaining the medical regimen, including when to call a health care provider.
  • Refer the client for home health aide services as necessary for assistance with activities of daily living. Clients with decreased oxygenation have decreased energy to perform personal and role-related activities.
  • When respiratory procedures are implemented, explain equipment and procedures to family members and provide needed emotional support. Family members assuming responsibility for respiratory monitoring often find this stressful (Langer et al., 2009).
  • When electrically based equipment for respiratory support is implemented, evaluate home environment for electrical safety, proper grounding, and so on. Ensure that notification is sent to the local utility company, the emergency medical team, and police and fire departments. Notification is important to provide for priority service.
  • Assess family role changes and coping ability. Refer the client to medical social services as appropriate for assistance in adjusting to chronic illness. CEB: Inability to maintain the level of social involvement experienced before illness leads to frustration and anger in the client and may create a threat to the family unit (Langer et al., 2009).
  • Support the family of the client with chronic illness. Severely compromised respiratory functioning causes fear and anxiety in clients and their families. Reassurance from the nurse can be helpful (Rose et al., 2014)

 

Client/Family Teaching and Discharge Planning impaired gas exchange nursing care plan

  • Teach the client how to perform pursed-lip breathing and inspiratory muscle training and how to use the tripod position. Have the client watch the pulse oximeter to note improvement in oxygenation with these breathing techniques. CEB: Pursed lip breathing results in increased use of intercostal muscles, decreased respiratory rate, and improved oxygen saturation levels (Mahler, 2014). Pursed-lip breathing may relieve dyspnea in advanced COPD (Mahler, 2014). A systematic review found that inspiratory muscle training was effective in increasing endurance of the client and decreasing dyspnea (Langer et al., 2009). Inspiratory muscle training likely improves breathlessness during exercise and/or with activities of daily living in patients with COPD and congestive heartfailure (CHF) who exhibit inspiratory muscle weakness (Mahler, 2014).
  • Teach the client energy conservation techniques and the importance of alternating rest periods with activity. See nursing interventions for Fatigue.
  • Teach the importance of not smoking. Refer to smoking cessation programs, and encourage clients who relapse to keep trying to quit. Ensure that clients receive appropriate medications to support smoking cessation from the primary health care provider. EB: Patients should be referred to a comprehensive smoking cessation program, incorporating behavior change techniques that focus on enhancing patient motivation and confidence, patient education, and pharmacological and nonpharmacological interventions (GOLD, 2017).
  • Instruct the family regarding home oxygen therapy if ordered (e.g., delivery system, liter flow, safety precautions). Long-term oxygen therapy can improve survival, exercise ability, sleep, and ability to think in hypoxemic clients. Client education improves compliance with prescribed use of oxygen (GOLD, 2017).
  • Teach the client the need to receive a yearly influenza vaccine. Receiving a yearly influenza vaccine is helpful to prevent exacerbations of COPD (GOLD, 2017).
  • Teach the client relaxation techniques to help reduce stress responses and panic attacks resulting from dyspnea. EB: Relaxation therapy can help reduce dyspnea and anxiety (Langer et al., 2009).
  • Teach the client to use music, along with a rest period, to decrease dyspnea and anxiety (Mahler, 2014; Loscalzo, 2016).

References

American Association of Critical-Care Nurses. AACN Practice Alert—Prevention of ventilator-associated pneumonia in adults. [American Association of Critical Care Nurses; Retrieved

 

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Frequently asked questions in impaired gas exchange care plan

  1. Carbon dioxide is alkalosis or acidosis? acidosis
  2. What happens in impaired ventilation? narrowed/obstructed airways, inadequate muscle or nerve function, and poor gas diffusion in alveoli
  3. impaired gas exchange altered transport of oxygen condition examples
  • Asthma
  • Anemia
  • COPD
  • Inadequate muscle/nerve function
  • Obstructed Airways
  • Pneumonia
  1. Asthma is also known as reactive airway disease and is the inflammation and narrowing of bronchioles from an allergic reaction
  2. what are the Interventions for patients who cannot breathe properly? Cough deep breath, Raise HOB, Incentive Spirometer, Ambulation, and Pursed Lip Breathing
  3. What are the S/S of patients not breathing properly
  • Accessory muscle
  • Tripod position
  • Anxious/ restless/ confused
  • SOB
  • Prolonged capillary refill
  • Listen to lungs you’ll hear crackles, wheezing, rales, rhonchi, diminished sounds
    Cyanosis- LATE SIGN
  1. Who is at risk for impaired gas exchange? Infants and young children, The older adult, Tobacco users, Risk for aspiration, Bed rest and immobility, Immunosuppression and Chronic disease
  2. You can also get impaired oxygenation from? Anesthesia, bed bound, and pain medication
  3. If there is fluid in lungs, you will hear_ crackles
  4. If the airways are narrowed such as in asthma you will hear _ wheezing
  5. If they have COPD you will hear_sounds_ diminished
  6. Allen test is performed for TB
  7. What is the Diagnostic test for respiratory ventilation_ X ray, PFT, and Meds
  8. The patient has COPD for years and his ABGs usually show hypoxia and hypercapnia. Which ABG results show movement toward respiratory acidosis and further hypoxia indicating respiratory failure? pH 7.30, PaO2 45 mmHg, PaCO2 65 mmHg
  9. A college health nurse interprets the peak expiratory flow rate for a student who has asthma and finds that the student is in the yellow zone of his asthma action plan. The nurse should base her actions on which of the following information? (Select all that apply.)
    The student should use his quick-relief inhaler.
    C. The student’s peak flow is 50%
  10. Two hours after arriving on the medical-surgical unit, the client develops dyspnea. SaO2 is 91% and the client is exhibiting audible wheezing and use of accessory muscles. Which of the following medications should the nurse expect to administer? Beta2 Agonist
  11. A nurse is completing discharge teaching with a client who has a new prescription for prednisone for asthma. Which of the following client statements indicates a need for further teaching? I will take the medication on an empty stomach
  12. Emphysema is the loss of lung elasticity and hyperinflation of lung tissues, destruction of alveoli
    CO2 retention, respiratory acidosis
  13. chronic bronchitis is inflammation of bronchi and bronchioles due to exposure to irritants
  14. A nurse is assessing a client who has an acute respiratory infection that puts her at risk for hypoxemia.
    Which of the following findings are early indications that should alert the nurse that the client is
    developing hypoxemia? (Select all that apply.)
    Restlessness
    B. Tachypnea
    C. Bradycardia
    D. Confusion
    E. Pallor
  15. CORRECT: Restlessness is an early manifestation of hypoxemia, along with tachycardia, elevated
    blood pressure, use of accessory muscles, nasal flaring, tracheal tugging, and adventitious lung sounds.
    B. CORRECT: Tachypnea is an early manifestation of hypoxemia, along with tachycardia, elevated blood pressure, use of accessory muscles, nasal flaring, tracheal tugging, and adventitious lung sounds.
    E. CORRECT: Pallor is an early manifestation of hypoxemia, along with tachycardia, elevated blood pressure, use of accessory muscles, nasal flaring, tracheal tugging, and adventitious lung sounds.
  16. A nurse is caring for client who has pneumonia and has prescription for prednisone. The nurse should monitor the client for which of the following?
    fluid retention
    hyperglycemia
    fever
    black tarry stool

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