Impaired Gas Exchange: A Case Study

Impaired gas exchange is a nursing diagnosis for a patient suffering current or future problems with oxygen/carbon dioxide balance (unknown, 2012). Gas exchange is the passage of oxygen and carbon dioxide in opposite directions across the alveolocapillary membrane (Miller-Keane, 2003). With impaired gas exchange a patient can have an excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane (Gulanick & Myers 2014). The structure and organization of the lung is meant to maximize its surface area to increase gas diffusion. Having such a large surface area increases the amount of gas that can diffuse into and out of the lungs. Normally a balance exists between ventilation and perfusion. The relationship

Factors that affect gas exchange include high altitudes and hypoventilation (reduced CO2 in the blood). In the dependent regions where perfusion is the greatest older patients have a decrease in pulmonary blood flow and diffusion. A chronic condition like COPD put these patients at a higher risk for hypoxia (decreased amount of oxygen reaching the tissues). Other patient and people at risk for impaired gas exchange include, smokers, obesity, and long periods of immobility (Gulanick & Myers 2014). Assessing a patient for impaired gas exchange a nurse can assess respirations, noting the rhythm, depth, breathing effort, and use of accessory muscles. Hypoxia is associated with signs of increased breathing effort. Asses the lungs for decreased ventilation, use pulse oximetry to monitor oxygen saturation, monitor for changes in BP and HR. Caring for a patient with impaired gas exchange it is important to, position the patient for optimal respiratory excursion (if possible 45 degrees when supine). Change the patient’s position every 2 hours to promote secretion