Nursing Diagnosis HELP!

[Starfish1]

Can someone give me a straight forward way to see differences between Ineffective Airway Clearance and Impaired Gas Exchage?

Ineffective I know would have to do with secretions

we are currently on respiratory and cardiac and I have a test tomorrow and there will be questions on this topic, is there an easy way to decide which would go with which, especially the gas exchange diagnosis? thanks!

[Daytonite, BSN, RN]

Sure. Impaired Gas Exchange is specifically targeting what is going on in the alveoli of the lungs. That's the little air sacs in the lung tissue itself. Ineffective Airway Clearance is talking about the gunk obstructing the larger airways like the bronchus and the trachea.

If you look at the taxonomy information and the defining characteristics (symptoms) for these two diagnoses, you will see that for Impaired Gas Exchange the symptoms are for hypoxia and hypercarbia. These can only occur when something has happened in the alveoli where the capillaries are--where carbon dioxide and oxygen are actually exchanged. Other symptoms include abnormal ABGs. Two things cause gas exchange to be impaired in the alveoli: (1) permanent anatomical changes as in diseases like COPD and fibrosis (alveolar-capillary membrane changes), and (2) built up products of reversible illness as in infections (ventilation perfusion imbalance).

Along with COPD and infections you often get mucus production going on causing Ineffective Airway Clearance as well. You get the wheezing and rales and sputum production. This is all gunk in the airways larger than the alveoli.