Client has history of MI x 2, dyslipidemia and asthma Questions: Based on the client case, what are the symptoms predictive of excess fluid volume? Answer: SOB, difficulty breathing, lightheadedness, headache When treating clients with impaired gas exchange, providers should avoid administration of: diuretics central nervous system depressants steroids anticoagulants Preferred bed position to support lung function in clients with impaired gas exchange is legs elevated head and neck elevated degrees arms supported prone position a and b b and c c and d Clients with impaired gas exchange are at risk of Pulmonary edema Pulmonary congestion Altered mental status Increased heart rate All of the above List at least 3 tips for preventing impaired gas exchange Stop smoking Promote cough and sputum clearing Engage in diaphragmatic and pursed lip breathing techniques Use medications as instructed Change bed positions often References: Doenges, Marilynn E.
Davis, Haugen, Nancy, et al. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself.
One simple, noninvasive test that your doctor may recommend is called a spirometry. It measures how much air you exhale and how fast you exhale it. It can also tell how well your lungs deliver oxygen to your blood. The goals of treatment for respiratory insufficiency include:. For a list of organizations that provide information and support for patients with respiratory diseases, visit our Resources page. Reference 1. National Institutes of Health.
What is COPD? National Heart, Lung, and Blood Institute website. Accessed February 1, Asthma and rare genetic conditions, such as cystic fibrosis, can also lead to COPD.
Increased dead space and reflex bronchoconstriction in areas adjacent to the infarct result in hypoxia ventilation without perfusion. Monitor for alteration in BP and HR. BP, HR, and respiratory rate all increase with initial hypoxia and hypercapnia. However, when both conditions become severe, BP and HR decrease, and dysrhythmias may occur.
Observe for nail beds, cyanosis in the skin; especially note the color of the tongue and oral mucous membranes. Central cyanosis of tongue and oral mucosa indicates severe hypoxia and is a medical emergency Pahal et al.
Peripheral cyanosis in extremities may or may not be serious. Monitor for signs of hypercapnia. Hypercapnia is the buildup of carbon dioxide in the bloodstream. Signs of hypercapnia include headaches, dizziness, lethargy, reduced ability to follow instructions, disorientation, and coma. Monitor oxygen saturation continuously, using a pulse oximeter. Pulse oximetry is a useful tool to detect changes in oxygenation. Note blood gas ABG results as available and note changes.
Some patients, such as those with COPD, have a significant decrease in pulmonary reserves, and additional physiological stress may result in acute respiratory failure. Monitor the effects of position changes on oxygenation ABGs , venous oxygen saturation [SvO 2 ], and pulse oximetry. Putting the most compromised lung areas in the dependent position where perfusion is greatest potentiates ventilation and perfusion imbalances. Certain conditions affect lung expansion. Obesity may restrict the downward movement of the diaphragm, increasing the risk for atelectasis, hypoventilation, and respiratory infections.
Labored breathing is present in severe obesity as a result of excessive weight of the chest wall. Malnutrition may also reduce respiratory mass and strength, affecting muscle function. Check on Hgb levels. Low levels reduce the uptake of oxygen at the alveolar-capillary membrane and oxygen delivery to the tissues. Monitor chest x-ray reports. Chest x-ray studies reveal the etiological factors of the impaired gas exchange. Take note of the quantity, color, and consistency of the sputum. Retained secretions weaken gas exchange.
Overhydration may impair gas exchange in patients with heart failure. On the other hand, insufficient hydration may reduce the ability to clear secretions in patients with pneumonia and COPD.
Assess the home environment for irritants that impair gas exchange. Help the patient adjust the home environment as necessary e. Slumped positioning causes the abdomen to compress the diaphragm and limits full lung expansion. If the patient has unilateral lung disease, position the patient correctly to promote ventilation-perfusion. Gravity and hydrostatic pressure cause the dependent lung to become better ventilated and perfused, which increases oxygenation. The good side should be down when the patient is positioned on the side e.
However, when conditions like lung hemorrhage and an abscess are present, the affected lung should be placed downward to prevent drainage to the healthy lung. Turn the patient every 2 hours. Monitor mixed venous oxygen saturation closely after turning. Turning is important to prevent complications of immobility, but in critically ill patients with low hemoglobin levels or decreased cardiac output , turning on either side can result in desaturation.
Ambulation facilitates lung expansion, secretion clearance and stimulates deep breathing. If the patient is obese or has ascites, consider positioning in reverse Trendelenburg position at 45 degrees for periods as tolerated.
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