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Impaired Gas Exchange Pneumonia

The patient presented with shortness of breath and difficulty breathing even after minor activity. Nursing diagnoses included impaired gas exchange related to altered alveolar-capillary membrane changes from pneumonia. Goals were to improve respiratory status and decrease rate from 33 to 29 breaths per minute. Interventions included education, positioning, monitoring, breathing exercises, rest, and supplemental oxygen as needed. After 8 hours the goal was partially met as evidenced by the patient's understanding and decreased respiratory rate.

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Shanice Bedecir
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131 views2 pages

Impaired Gas Exchange Pneumonia

The patient presented with shortness of breath and difficulty breathing even after minor activity. Nursing diagnoses included impaired gas exchange related to altered alveolar-capillary membrane changes from pneumonia. Goals were to improve respiratory status and decrease rate from 33 to 29 breaths per minute. Interventions included education, positioning, monitoring, breathing exercises, rest, and supplemental oxygen as needed. After 8 hours the goal was partially met as evidenced by the patient's understanding and decreased respiratory rate.

Uploaded by

Shanice Bedecir
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Cabatingan, Angeli G.

Group 13

Cues/Needs Nursing Diagnosis Rationale Goals and Objectives Interventions Rationale Evaluation
Subjective Data: Impaired Gas An infection triggers Long Term Goal: Independent: After 8 hours of
“Mabilis ako Exchange related to alveolar The patient will be able >Explain to patient > To better nursing
mapagod. Kahit to altered alveolar- inflammation and to maintain a normal the disease process understand the interventions, the
pumunta lang ako capillary membrane edema. This respiratory rate (20-30 and management of disease, how it was goal was partially
sa CR pagbalik ko changes due to produces an area of breaths per minute) and symptoms acquired, how it can met, as evidenced
hinihingal na ko.” pneumonia disease low ventilation with breathe without be prevented. by:
process. normal perfusion. difficulty.
Capillaries become >Assist the patient in >To promote lung  Patient
engorged with blood, a comfortable expansion and verbalized
Objective Data: causing stasis. As the Objectives: position, sitting or decrease respiratory understandin
alveolocapillary After 8 hours of nursing semi-fowler’s effort. g of
>Tachypnea RR: 33 membrane breaks interventions, the patient causative
breaths per min down, alveoli fills will be able to: >Monitor respiratory > Early recognition factors and
>Dyspnea with blood and status, including rate, of deterioration in appropriate
>Peripehral exudates, resulting in a. verbalize pattern of respiratory function interventions
Cyanosis atelectasis. Shrunken understanding of respirations, and will avert further
alveoli can’t causative factors and breath sounds complications.  Decreased
accomplish gas appropriate interventions Respiratory
exchange rate from 33
b. participate in treatment > Demonstrate and > Helps patient breaths per
regimen within level of help the patient prolong expiration minute to 29
ability perform time and decreases breaths per
diaphragmatic and air trapping. minute.
pursed lip breathing.

(Source: Lippincott
Williams and > Advise the patient > To prevent
Wilkins’ to allow the patient overexhaustion and
Pathophysiology, to rest and limit reduces oxygen
p.211) activities consumption/
demands

Dependent:

> Administer > Maximizes


supplemental oxygen available oxygen,
as indicated especially while
ventilation is
reduced
>Administer
intravenous fluids >To monitor and
and medications and prevent potential
respiratory support complications.
as ordered.
(Sources:Handbook
for
Brunner &
Suddarths’ Textbook
of Medical –
Surgical Nursing,
10th Ed. p. 669-670

(Source: Lippincott
Williams and
Wilkins’
Pathophysiology,
p.215)

(Doenges, et. al.,


Nursing Care Plans,
11th Ed., p. 339-340)

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