Nursing Care Plan (NCP) for Impaired Gas Exchange
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Outline
Lesson Objective for Impaired Gas Exchange Nursing Care Plan:
Imagine your body as a busy factory that needs a constant supply of oxygen to work properly. Your lungs are like two big delivery trucks that bring in oxygen and take away carbon dioxide, which is a waste gas. In “Impaired Gas Exchange,” these trucks have trouble doing their job. This means not enough oxygen gets in, and not enough carbon dioxide gets out.
Upon completion of this nursing care plan for impaired gas exchange, nursing students will be able to:
- Recognize Signs of Impaired Gas Exchange:
- Identify and differentiate signs and symptoms of impaired gas exchange, including alterations in respiratory rate, depth, and effort, as well as changes in oxygen saturation levels.
- Implement Respiratory Interventions:
- Demonstrate proficiency in implementing respiratory interventions, including oxygen therapy, ventilation support, and positioning techniques, to optimize gas exchange in patients with impaired respiratory function.
- Utilize Diagnostic Monitoring:
- Utilize diagnostic monitoring tools, such as arterial blood gas (ABG) analysis, pulse oximetry, and respiratory assessments, to assess the severity of impaired gas exchange and guide adjustments to the care plan.
- Collaborate in Multidisciplinary Care:
- Collaborate effectively with the multidisciplinary healthcare team, including respiratory therapists, physicians, and physical therapists, to ensure a coordinated approach to the management of impaired gas exchange and promote the patient’s respiratory well-being.
Pathophysiology
- Alveolar-Capillary Membrane Dysfunction:
- impaired gas exchange often begins with dysfunction of the alveolar-capillary membrane, the site where oxygen and carbon dioxide exchange occurs in the lungs. Conditions such as pneumonia, acute respiratory distress syndrome (ARDS), or pulmonary edema can compromise the permeability of this membrane.
- Ventilation-Perfusion Mismatch:
- Conditions leading to impaired ventilation or perfusion in the lungs can disrupt the optimal matching of airflow and blood flow. Examples include airway obstructions (e.g., asthma, chronic bronchitis) or pulmonary embolism, causing areas of the lung to be poorly ventilated or poorly perfused.
- Decreased Surface Area for Gas Exchange:
- Reduction in the available surface area for gas exchange, often due to conditions like emphysema or interstitial lung diseases, limits the exchange of oxygen and carbon dioxide. This results in decreased efficiency of respiratory function.
- Altered Oxygen-Carrying Capacity:
- Conditions affecting the oxygen-carrying capacity of blood, such as anemia or carbon monoxide poisoning, can lead to inadequate oxygen delivery to tissues despite normal lung function.
- Impaired Respiratory Muscle Function:
- Dysfunction of the respiratory muscles, as seen in conditions like myasthenia gravis or severe neuromuscular disorders, can compromise the ability to effectively move air in and out of the lungs, affecting gas exchange.
Etiology of Impaired Gas Exchange:
- Pulmonary Infections:
- Respiratory infections such as pneumonia, bronchitis, or tuberculosis can compromise the alveolar-capillary membrane, leading to impaired gas exchange.
- Chronic Respiratory Conditions:
- Chronic respiratory conditions, including chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung diseases, can result in structural changes in the lungs, causing ventilation-perfusion imbalances and impaired gas exchange.
- Cardiovascular Disorders:
- Cardiovascular disorders, such as heart failure or pulmonary embolism, can affect the circulation of blood through the pulmonary vasculature, leading to inadequate oxygenation of blood and impaired gas exchange.
- Neuromuscular Disorders:
- Neuromuscular disorders, such as myasthenia gravis or amyotrophic lateral sclerosis (ALS), can impact the function of respiratory muscles, affecting the ability to effectively move air in and out of the lungs.
Desired Outcome for Impaired Gas Exchange Nursing Care Plan:
- Improved Oxygenation:
- Achieve improved oxygenation, as evidenced by increased oxygen saturation levels within the target range and a reduction in signs of hypoxemia.
- Stabilized Respiratory Rate and Effort:
- Stabilize respiratory rate and effort within the patient’s baseline, promoting effective gas exchange and reducing respiratory distress.
- Enhanced Lung Function:
- Promote enhanced lung function, demonstrated by improved lung compliance, optimal ventilation-perfusion matching, and a reduction in airway resistance.
- Patient Education on Self-Management:
- Educate the patient on self-management strategies, including proper inhaler techniques, breathing exercises, and recognition of early signs of respiratory distress, empowering them to actively participate in maintaining optimal gas exchange.
Subjective Data
- Restlessness
- SOB/orthopnea
- Lightheadedness
Objective Data
- Cyanosis
- Coughing
- Hypoxia
- Abnormal ABG
- Hypercapnia
- Accessory muscle use
- Hypoxemia
- Decreased o2
- Shallow/rapid breathing
- Wheezing
Assessment for Impaired Gas Exchange:
- Patient History:
- Gather a comprehensive patient history, focusing on respiratory symptoms such as shortness of breath, cough, and sputum production. Inquire about the onset, duration, and progression of these symptoms.
- Explore relevant risk factors, including smoking history, exposure to environmental pollutants, and any pre-existing respiratory conditions.
- Physical Examination:
- Conduct a thorough physical examination with emphasis on the respiratory and cardiovascular systems. Auscultate lung sounds to identify abnormal breath sounds such as wheezing, crackles, or diminished breath sounds.
- Evaluate the respiratory rate, depth, and effort, noting any signs of increased work of breathing. Assess the patient’s general appearance and any visible signs of respiratory distress.
- Diagnostic Tests:
- Order and review diagnostic tests to gather objective data on the patient’s respiratory status. Perform arterial blood gas (ABG) analysis to assess oxygen and carbon dioxide levels in the blood.
- Utilize pulse oximetry to monitor oxygen saturation. Chest X-rays or CT scans may be indicated to identify structural abnormalities or infiltrates.
- Functional Assessment:
- Assess the patient’s functional capacity by inquiring about their ability to perform activities of daily living without experiencing excessive shortness of breath. Explore exercise tolerance and any factors that exacerbate or alleviate respiratory symptoms. Inquire about the impact of impaired gas exchange on the patient’s quality of life and overall well-being.
- Psychosocial Assessment:
- Consider the psychosocial aspects related to impaired gas exchange. Evaluate the patient’s emotional well-being, coping mechanisms, and support systems.
- Identify any factors contributing to anxiety or depression related to respiratory symptoms. Open communication is essential to address the holistic needs of the patient.
- Collaboration with Other Healthcare Professionals:
- Collaborate with respiratory therapists, pulmonologists, and other healthcare professionals to gain insights into the patient’s respiratory status.
- Review previous medical records, consultations, or specialty assessments that may provide additional information on the etiology and management of impaired gas exchange.
Nursing Intervention
| Nursing Intervention (ADPIE) | Rationale |
| Assess respiratory function- (respirations, o2 sat, skin color, vitals) | baseline respiratory assessment. Can see if the interventions you do are effective or if they are getting worse |
| Position patient in high Fowler’s position for increased oxygenation and ventilation | keeping the patient sitting upright helps with proper gas exchange and better oxygenation into the lungs |
| Administer medications as ordered (needed)
Bronchodilators, steroids, diuretics, pain medications) |
bronchodilators- open up the airways to allow the patient to breathe better
Steroids- help with inflammation Diuretics – can help with dyspnea related to fluid overload or heart failure Pain medications-helps with chest discomfort (but be careful of respiratory depression) |
| Give supplemental oxygen as needed | may need to give patients supplemental oxygen if they aren’t above 90%. Titrate as needed |
| Educate patient on pacing activities | Doing too many activities (walking, talking, moving around) can exhaust a patient. |
| Cough/Deep breathing/Turn exercises as well as IS use | proper exercises that help get more oxygen to the body’s cells and prevent pneumonia.
IS- helps to keep the lungs clear. |
| Suction equipment by the bedside in the emergency | in case the patient is having a hard time clearing their airway, it may be necessary to have suction available to help maintain oxygenation |
| Obtain ABGs/labs/possible chest x-ray | ABGs- can indicate if the patient has a metabolic or respiratory acidosis/alkalosis
Labs- monitor hgb levels Chest x-ray |
Evaluation for Impaired Gas Exchange Management:
- Respiratory Assessment:
- Regularly assess respiratory status, including respiratory rate, depth, and effort, to evaluate improvements in gas exchange. Monitor for any signs of respiratory distress or worsening impairment.
- Oxygenation Levels:
- Monitor oxygen saturation levels through pulse oximetry, assessing for improvements within the target range. Evaluate the effectiveness of oxygen therapy in maintaining adequate oxygenation.
- Diagnostic Tests:
- Utilize diagnostic tests, such as arterial blood gas (ABG) analysis, to assess blood gas values and respiratory acid-base balance. Evaluate trends in ABG results to determine the impact of interventions on gas exchange.
- Patient Self-Management:
- Evaluate the patient’s ability to implement self-management strategies, including inhaler use, breathing exercises, and adherence to prescribed medications. Assess their understanding of early signs of respiratory distress and appropriate actions.
- Multidisciplinary Collaboration:
- Collaborate with the healthcare team, including respiratory therapists, physicians, and physical therapists, to assess the patient’s overall respiratory function and ensure a coordinated approach to ongoing management. Evaluate the effectiveness of collaborative interventions.
References
https://www.mayoclinic.org/symptoms/hypoxemia/basics/definition/sym-20050930
https://my.clevelandclinic.org/health/diseases/17727-hypoxemia
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Transcript
Hey everyone. Today, we are going to be creating a nursing care plan for impaired gas exchange. So let’s get started. First, we’re going to go over the pathophysiology. So it is in the state where there’s an excess or a deficit in oxygenation or in the elimination of carbon dioxide at the level of the velar capillary membrane. Nursing considerations. You want to make sure you’re doing a full respiratory assessment, supplemental O2 as needed, administer medications, use coughing and deep breathing exercises, teach on an incentive spirometer, use cluster care, obtain ABGs and labs. Desired outcome. The patient will maintain proper gas exchange. O2 is going to be within normal limits and labs within normal range.
So we’re going to go ahead and see about this care plan. We’re going to be writing down some subjective data and some objective data. So what are we going to see in the patient? Some subjective data you might see or they may tell you is some shortness of breath and some lightheadedness. Things you will see in a patient are coughing, decreased O2 levels, and some shallow, rapid breathing. Some other things are restlessness, hypoxia, some abnormal ABGs, hypercapnia, accessory muscle use, hypoxemia, and some wheezing.
So some interventions that we’re going to do for these patients: we want to make sure we’re assessing their respiratory function. So you’re going to be checking their respirations, going to be checking their O2 sats and looking at their skin color. Is it blue? Is it pink? We’re going to be checking their vital signs. We want to make sure we’re getting a baseline of their assessment. And also it is a good way of seeing if any interventions that we’ve been doing have been working for the patient. Have they been effective? We want to make sure that we’re positioning the patient upright in high fowlers. This is going to help increase oxygenation and ventilation for the patient sitting upright and able to give proper gas exchange into the lungs where they need it. Some other interventions that we want to do is give certain medications As ordered one of those being bronchodilators, steroids, and also pain medication.
Bronchodilators. They’re going to help open up those airways to allow the patient to breathe much better. The steroids are going to help with the inflammation. T
The pain medication is going to help with some chest discomfort that the patient may be having. Just make sure with pain medication, especially with impaired gas exchange, that you’re mindful that it can cause respiratory depression. Another intervention is giving supplemental O2 as needed. So if the patient’s not able to breathe above 90%, we’re going to be giving them some O2 and you want to titrate that as needed. Another invention we’re going to be doing is making sure we’re clustering your care. This is super, super important with patients and impaired gas exchange can be because of too much activity that you’re doing with the walking, talking, just moving around can really, really exhaust a patient out. So try to do as much as you can for this patient in one trip to allow them to rest more often. Another intervention we’re going to be doing. We’re going to be teaching them about coughing and deep breathing. These exercises as well as incentive spirometer use are going to help get more oxygen into the body cells and also prevent pneumonia, which is a complication. The incentive spirometer use. That’s going to help keep those lungs open, keep them patent and keep those lungs clear. Another invention we’re going to be doing. Make sure you have suction equipment available. Make sure it’s at the bedside in case you need it in an emergency in case, for whatever reason, the patient’s having a hard time clearing their airway. It may be imperative to make sure that we help suction and get that out to keep their airway patent. Another intervention we want to be doing will be to get some AGS, any labs, and maybe a possible chest x-ray. AGS. They’re going to be indicating if the patient has any sort of metabolic or respiratory acidosis, or alkalosis. Getting some labs done is going to help monitor their hemoglobin levels. And the chest x-ray can indicate if the patient may have pneumonia, which is a complication.
So now we’re going to go over some key points here. Impaired gas exchange is a state in which there’s an excess or deficit in oxygenation or in the elimination of carbon dioxide at the alveolar-capillary membrane. Most common cause is decreased oxygen levels. Some subjective objective data: the patient will be short of breath, restless, coughing, hypoxic, hypercarbic, accessory muscle use, really using those muscles, shallow, rapid breathing, very, very common. Some wheezing and decreased O2 levels. We want to make sure we’re assessing the patient and teaching them those exercises. So a full respiratory assessment, making sure you’re positioning the patient in a high fowlers for better ventilation and oxygenation, teaching them about the cough, deep breathing and turning exercises that enable them to get more of that oxygen into their lungs, keep their lungs open using that incentive spirometer. We’re going to give them some medications, giving supplemental O2 as needed, and as always want to make sure we’re clustering their care as much as possible. And that is it for that care plan.
Great job guys. We love you guys. Go out and be your best selves. And as always happy nursing.
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Nursing Care Plans
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