the first thing you should be doing to understand this diagnosis is to start by looking at the nanda information about it from the taxonomy. nanda provides you with the information you need to know. this information will be in a nursing diagnosis reference book or possibly a care plan book. it is posted right below the title of the diagnosis on this webpage: [color=#3366ff]impaired gas exchange
. the definition of the diagnosis is the true problem that describes it: excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane
(pg. 94, nanda-i nursing diagnoses: definitions & classification 2007-2008
). that means the problem is meant to be dealing with situations occurring in the alveoli of the lung. recall from anatomy that the alveoli are the terminal elastic, thin-walled air sacs of the lungs surrounded by tiny capillaries which is where carbon dioxide and oxygen are actually exchanged during respiration. if you look further at the nanda information for this diagnosis you will find that there are only two related factors, or causes, for this situation to occur. they are
- alveolar-capillary membrane changes
- not as confusing as it sounds, it quite simply means that the membrane, or tissue, that separates the wall of the air sac (alveoli) and the capillary (vessel) walls has changed from it's normal anatomical structure and has become abnormal, or pathological, because there is disease present. this occurs in lung conditions such as one of the copds, fibrosis, tb, invasive cancer and others where permanent damage to the alveoli take place that is not reversible resulting in loss of valuable surface area that is used for oxygen/carbon dioxide gas exchange
- ventilation perfusion imbalance
- what this means is that an imbalance between oxygen and carbon dioxide exchange exists and there is either more oxygen or more carbon dioxide being exchanged than is normally supposed to occur. the usual reason for this is some sort of temporary blockage at the level of the alveoli. do not make the mistake of diagnosing a blockage in the bronchioles as being responsible for impaired gas exchange because oxygen and carbon dioxide are not exchanged in the blood vessels of the bronchi. ventilation perfusion imbalances occur when the alveoli are clogged with debris, exudates or built up sputum as in pneumonia, congestive heart failure or atelectasis following surgery.
now, in order to choose any diagnosis, a patient must have specific signs and symptoms of that diagnosis. you discover those symptoms by doing an assessment of the patient. but, what are the signs and symptoms of impaired gas exchange
you might ask? what signs and symptoms do you look for when you do your assessment? here again, the nanda taxonomy can help you. the taxonomy for this diagnosis lists the defining characteristics (nanda language for signs and symptoms) for impaired gas exchange.
you will also find them listed on the weblink i provided for you, but i am going to list them here from my same reference i quoted above:
- abnormal arterial blood gases
- abnormal arterial ph
- abnormal breathing (rate, rhythm, depth)
- abnormal skin color (pale, dusky)
- cyanosis (in neonates only)
- decreased carbon dioxide
- headache upon awakening
- nasal flaring
- visual disturbances
now, your patient has asthma and an upper respiratory track infection. what do you know about the pathophysiology of asthma? it is a reversible
airway obstruction due to bronchospasms that results in increased mucus secretions and edema of the respiratory mucosa. the inflammatory response is running amok and gunk (my term for sputum) builds up in the alveoli as fast as the patient can cough it out. this creates a ventilation perfusion imbalance. there is dyspnea, diaphoresis, tachycardia, cyanosis and confusion sometimes along with other symptoms. those are 5 defining characteristics of impaired gas exchange.
it gives you the diagnostic statement of impaired gas exchange related to ventilation perfusion imbalance due to asthma and urti as evidenced by dyspnea, diaphoresis, tachycardia, cyanosis and confusion.
other symptoms of asthma, which i did not list so as not to confuse you, will point the way to another respiratory nursing diagnosis.
to find more information about asthma and it's pathophysiology, signs, symptoms and treatment, see the links on this thread:
this thread contains the pathophysiology of the inflammatory response, something you will need to know again and again when any medical diagnosis with an "-itis" shows up.
hope that answers your questions and gets you started on your assessment and care plan. there is information on constructing care plans on this thread: