(risk for) impaired gas exchange?

[NuggetsHuman, BSN, RN]

Hi All,

Rather random question that I'm having a hard time finding an answer for.

I want to do a nursing diagnosis of "risk for impaired gas exchange" because my patient has stage 4 lung cancer widespread bilaterally, history of smoking, exposure to second hand smoke, etc. and is likely to have impaired of oxygenation as her cancer progresses. She's s/p suboccipial craniotomy to remove a cerebellar mass brain metastasis.

I've already got risk for falls r/t alterations in gait/balance/coordination; risk for situational low self esteem r/t decreased independence; acute pain r/t craniotomy; and risk for infection r/t a bunch of concomittant factors.

She does not currently have any s/sx of impaired gas exchange: 36.5°C temp, 87 bpm HR, 18 breaths per minute unlabored, 100/52 BP (which is not alarming to the unit nurse), SpO2 98% room air. Breath sounds diminished at bases bilaterally. Effectively clears her own airway. Unfortunately I only have a PaCO2 for labs, which is 26, high end of normal. (No pH or HCO3 available to me.)

Is there such a thing as RISK FOR impaired gas exchange? Or should I be barking up a different tree?

Thanks.

[LubbDubb77, BSN, RN]

I would do something else since the pt does not currently have ventilation-perfusion imbalance.

[J.Adderton, BSN, MSN]

I think this is a very appropriate diagnosis because 1) presents of advanced stage 4 lung ca and 2) history of smoking

It is likely with stage 4 lung cancer patient is already experiencing shortness of breath with ADL or even usual activity. Also consider the following: size/location of tumors and if compression or obstructing parts of the lung, is patient coughing? She already has diminished lung sounds which indicates consolidation, inflammation ect. Is she anemic? If so, this could further impede gas exchange, does she still smoke or do people in household smoke?

I hope this helps!

[Wuzzie]

On 6/23/2019 at 2:04 PM, NuggetsHuman said:

Unfortunately I only have a PaCO2 for labs, which is 26, high end of normal.

What range do you use because in my neck of the woods that would be a low PaCO2?

[JKL33]

Is Risk for impaired gas exchange a current approved dx? I tried to search and didn't see it unless I overlooked it.

Anyway, if not, my question would be about the technical correctness (according to NANDA-I) of adding "risk for" to another dx (when an official "Risk for" dx doesn't exist). Can't find a great answer about that...only this so far.

It doesn't seem like a wrong idea to have a nursing dx for something that is essentially a likely functional complication of a particular medical diagnosis; interventions would mostly revolve around careful surveillance/assessment/monitoring for the purposes of early recognition of deterioration.

[murseman24, MSN, CRNA]

On 6/27/2019 at 6:34 AM, Wuzzie said:

What range do you use because in my neck of the woods that would be a low PaCO2?

I think he/she means the serum CO2 on a chem panel (surrogate for bicarb)

[murseman24, MSN, CRNA]

I think you're good to go if you tie it to emphysema and state the area for gas exchange has been reduced.