Nursing Care Plan (NCP) for Impaired Gas Exchange

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Outline

Pathophysiology

Impaired gas exchange is the state in which there is an excess or deficit in oxygenation or in the elimination of carbon dioxide at the level of the alveolocapillary membrane.

Etiology

The most common cause for this condition is poor oxygen levels. This can be due to a compromised respiratory system or due to lung disease. Other risk factors include: age, smoking/tobacco use, kidney disease, trauma to the chest, cardiovascular disease

Desired Outcome

Patient will maintain proper gas exchange, o2 within normal limits, and labs within normal range.

Subjective Data

  • Restlessness
  • SOB/orthopnea 
  • Lightheadedness

Objective Data

  • Cyanosis
  • Coughing 
  • Hypoxia
  • Abnormal ABG
  • Hypercapnia 
  • Accessory muscle use 
  • Hypoxemia 
  • Decreased o2 
  • Shallow/rapid breathing 
  • Wheezing

 

Nursing Intervention (ADPIE) Rationale
Assess respiratory function- (respirations, o2 sat, skin color, vitals) baseline respiratory assessment. Can see if 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, pain medications)

bronchodilators- open up the airways to allow patient to breath better 

Steroids- helps with inflammation

Pain medications-helps with chest discomfort (but be careful of respiratory depression)

Give supplemental oxygen as needed  may need to give patient supplemental oxygen if they aren’t above 90%. Titrate as needed 
Cluster your Care as much as possible  doing too many activities (walking, talking, moving around) can exhaust a patient. Try to cluster as much as you can at once to allow them to rest. 
Cough/Deep breathing/Turn exercises as well as IS use  proper exercises that help get more oxygen to body’s cells and prevent poneumonia. 

IS- helps to keep the lungs clear. 

Suction equipment by bedside in 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 ABG’s/labs/possible chest x-ray  ABG’s- can indicate if patient has a metabolic or respiratory acidosis/alkalosis 

Labs- monitor hgb levels 

Chest x-ray

Writing a Nursing Care Plan (NCP) for Impaired Gas Exchange

A Nursing Care Plan (NCP) for Impaired Gas Exchange starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.

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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