Impaired gas exchange is a disruption of the oxygen and carbon dioxide exchange in the lung tissues. This nursing diagnosis can be a serious health threat usually closely associated with other nursing diagnoses like ineffective breathing pattern or ineffective airway clearance.
Causes
Impaired gas exchange can result from any condition that compromises a patient’s airway, blood flow, or respiratory effectiveness.
Airway compromise can be caused by a physical blockage, such as a foreign body lodged in the airway.
Reductions in blood flow resulting in impaired gas exchange can be related to cardiac or pulmonary problems such as a pulmonary embolism or heart failure. Diseases that affect the ability for blood to carry oxygen can also result in impaired gas exchange.
Respiratory effectiveness can be affected by chronic conditions that affect the lungs like chronic obstructive pulmonary disorder. Certain drugs, including opiates, can depress a patient’s respiratory rate and depth resulting in impaired gas exchange as well.
Signs and Symptoms
Impaired gas exchange can manifest with a variety of signs and symptoms. In a physical assessment, a patient with impaired gas exchange may present with one or more of the following;
- Dyspnea
- Altered respiratory patterns
- Restlessness
- Lethargy
- Cyanosis
- Diaphoresis
Confusion, irritability, or impending sense of doom are also potential signs of impaired gas exchange. Some patients may also experience visual disturbances or headaches.
Lab values and vital signs can also point to potential impaired gas exchange. Increased heart rate and decreased oxygen saturation can be expected in the vital signs of a patient with impaired gas exchange. Abnormal arterial blood gas values or blood pH may also be present.
Nursing Care Plans for Impaired Gas Exchange
Nursing Care Plan 1
Nursing Diagnosis: Impaired gas exchange related to alveolar-capillary membrane changes secondary to COPD as evidenced by oxygen saturation 79%, heart rate 112 bpm, and patient reports of dyspnea.
Desired Outcome: Within 1 hour of nursing interventions, the patient will have oxygen saturation of greater than 90%.
| Intervention | Rationale |
| Assess for lung sounds for indications of atelectasis | Hypoxemia can be caused by the collapse of alveoli. |
| Check vital signs every 15 minutes and assess for changes in heart rate and blood pressure | As hypoxemia/hypercapnia progresses heart rate and blood pressure rise at first, and then decrease as the gas exchange impairment becomes more severe. |
| Use a continuous pulse oximeter to monitor oxygen saturation | A continuous pulse oximeter allows for close monitoring of the patient’s oxygen status and evaluation of interventions. |
| Administer 2 liters per minute of oxygen through a nasal cannula as ordered | Supplemental oxygen can help maintain oxygen saturation at a normal level. High concentrations of oxygen should typically be avoided for patients with COPD. |
| Assess the patient’s willingness to refer to pulmonary rehabilitation | Patients who suffer from chronic respiratory disorders can benefit from pulmonary rehabilitation training. |
Nursing Care Plan 2
Nursing Diagnosis: Impaired gas exchange related to decreased ventilation secondary to opioid use as evidenced by respiratory rate of 6 respirations per minute, oxygen saturation 70%, and extreme lethargy.
Desired Outcome: Within 1 hours of nursing interventions, the patient will have improved ventilation and gas exchange as evidenced by oxygen saturation within normal range, and respiratory rate greater than 8.
| Intervention | Rationale |
| Assess the lungs for decreased ventilation and adventitious lung sounds | Breath sounds can help determine or confirm the cause of impaired gas exchange. Poor ventilation is associated with diminished breath sounds. |
| Administer appropriate reversal agents as ordered | Reversal agents will diminish the respiratory depression caused by opiates. |
| Anticipate the need for intubation and mechanical ventilation | Early intervention is recommended to prevent total decompensation. Oxygenation and ventilation may need to be supported mechanically. |
Nursing Care Plan 3
Nursing Diagnosis: Impaired gas exchange related to ventilation perfusion imbalance secondary to hypovolemic shock as evidenced by cyanosis, heart rate 162 bpm, and oxygen saturation 76%.
Desired Outcome: Within 2 hours of nursing interventions, the patient will demonstrate improved gas exchange as evidenced by heart rate and oxygen saturation within normal range.
| Intervention | Rationale |
| Assess for changes in level of consciousness or activity level | Increased agitation and restlessness are signs of decreased brain perfusion. |
| Provide reassurance and assess for increased anxiety | Hypoxic patients can become anxious and irritable. Feelings of anxiousness can increase respiratory rate and cause difficulty breathing and should be avoided if possible. |
| Place the patient in trendelenburg position if tolerated | Trendelenburg position places the head, lungs, and vital organs in a dependent position and increases blood flow and perfusion. |
| Prepare to administer fluid bolus as ordered | Fluid resuscitation will treat the underlying cause of the impaired gas exchange and improve oxygenation status. |
Nursing Care Plan 4
Nursing Diagnosis: Impaired gas exchange related to altered oxygen-carrying capacity of blood secondary to sickle cell anemia as evidenced by irritability, dusky skin color, and oxygen saturation 84%.
Desired Outcome: Within 1 hour of nursing interventions, the patient will demonstrate improved gas exchange as evidenced by oxygen saturation greater than 90%.
| Intervention | Rationale |
| Assess respirations for rate and quality, as well as use of accessory muscles | Increased breathing effort is a sign of hypoxia. Changes in breathing patterns can indicate changes in oxygenation status. |
| Monitor vital signs for oxygen saturation and changes in heart rate, blood pressure, or cardiac rhythm | Hypoxemia can cause heart rate and blood pressure changes and dangerous dysrhythmias. |
| Change the patient’s position every two hours. | Frequent repositioning promotes drainage and movement of lung secretions. |
| Educate the patient in how to perform therapeutic breathing and coughing techniques | Appropriate breathing and coughing techniques mobilize secretions and increase air exchange and oxygenation. |
References and Sources
- Doenges, Marilynn E., et al. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care. F.A. Davis, 2005.
- Gulanick, Meg, and Judith L. Myers. Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier/Mosby, 2014.
- Herdman, T. Heather, and Shigemi Kamitsuru. Nursing Diagnoses: Definitions and Classification 2018-2020. Thieme, 2018.
