Nursing care plan = Impaired gas exchange

[Kayla26x]

So i currently have a placement in critical care unit and am needing to develop a nursing care plan for my ventilated post cardiac surgery patient and am having so much trouble ):

My diagnosis is impaired gas exchange which is evidenced by decreased pa02.

My current interventions are

- respiratory assessment hourly including oscultation

- ETT placement by chest xray

- Maintain vent settings as per drs orders

- Suction as required

- Elevate head of bead

So i feel like this isnt actually assisting my patient in any way in relation to increasing his Pa02 levels. What other recommendations for interventions are there? :/

[Corey Narry, MSN, RN, NP]

You'll have to think along the lines of why your patient is hypoxic (decreased PaO2). When I was a nursing student (back in the late 80's lol), we had to state our nursing diagnosis as such: Impaired gas exchange related to .... as evidenced by decreased PaO2. What is your "related to" in this case? increased pulmonary secretions? bilateral crackles on chest auscultation? bilateral expiratory wheezing on chest auscultation? ventilator dysynchrony? Once you've determined the "related to", it will be easier to come up with interventions.

increased pulmonary secretions? you would suction prn, listen to breath sounds prn, check with provider for orders for CXR and albuterol/atrovent +/- mucolytic, elevate head of bed

bilateral crackles? likely pulmonary edema which would tend to require more "dependent" nursing interventions such as diuretic, increased PEEP or FiO2, serial CXR's. You would still add respiratory assessment prn and hourly.

bilateral wheezing? likely bronchospasm so you would ask physician for bronchodilator

ventilator dysynchrony or agitation? you would titrate your sedative infusion based on RASS goal, offer reassurance, assess comfort, etc.