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This is a sample of a Nursing Care Plan for Asthma Impaired Gas Exchange
Cues:
- Patient reports difficulty breathing, wheezing, and tightness in the chest.
- Increased respiratory rate.
- Audible wheezing on auscultation.
- Use of accessory muscles for breathing.
- Anxiety and restlessness.
- Decreased oxygen saturation levels.
Nursing Diagnosis
- Impaired Gas Exchange related to airway constriction and inflammation as evidenced by dyspnea, wheezing, and decreased oxygen saturation.
Scientific Basis
Asthma is a chronic inflammatory disease characterized by reversible airflow obstruction, bronchial hyperresponsiveness, and airway inflammation. During an asthma exacerbation, bronchial smooth muscle constriction and inflammation lead to decreased airflow, impairing gas exchange.
Goal & Outcome Criteria
Patient will demonstrate improved gas exchange as evidenced by normal respiratory rate, clear breath sounds, absence of wheezing, and oxygen saturation within normal limits (>92%).
Nursing Actions
- Administer prescribed bronchodilators and corticosteroids to relieve bronchoconstriction and reduce airway inflammation.
- Assist patient with controlled breathing techniques such as pursed-lip breathing to optimize oxygenation.
- Position patient in semi-Fowler’s position to facilitate lung expansion and reduce respiratory effort.
- Monitor oxygen saturation continuously and administer supplemental oxygen as prescribed to maintain levels above 92%.
- Encourage fluid intake to help thin respiratory secretions and promote expectoration.
- Provide education on triggers, medications, and self-management strategies to prevent future exacerbations.
Evaluation
- Assess respiratory status regularly.
- Document changes in respiratory rate, breath sounds, and oxygen saturation levels.
- Evaluate patient’s understanding and compliance with prescribed treatment regimen.
- Reassess and modify care plan as needed based on patient response.
