Nursing Interventions For Impaired Gas Exchange

When a client is experiencing impaired gas exchange, it can be a sign of respiratory distress. In order to treat this condition, nurses must assess the underlying cause and then implement intervention measures to resolve the problem.

Assess for appropriate underlying causes of impaired gas exchange.

Assess for underlying causes.
Pulse oximetry, arterial blood gases, and chest X-rays may be performed to determine whether there are any medical conditions causing impaired gas exchange.
Watch closely for signs of respiratory distress: decreased urine output, increased respiratory rate and depth (indicating increased work of breathing), cyanosis or pallor (indicating low CO levels), tachycardia (increased heart rate) or hypotension (decreased systemic perfusion).

Assess for signs of respiratory distress.

Assess for signs of respiratory distress.
Tachypnea, rapid breathing, tachycardia, and dyspnea are all common signs of respiratory distress.

Auscultate lung sounds every shift.

To auscultate lung sounds, place the bell of the stethoscope over the auscultation site. You should hear breath sounds in both lungs. These should be equal and clear, but not bronchial or crackles. Listen to breath sounds in each axilla and in the back as well; listen for wheezing, ronchi (noisy breathing), rhonchi (bronchial breathing), prolonged expiration, diminished breath sounds with inspiration or expiration

Reassure client with anxiety and help them to relax.

Use a calm, caring voice.
Explain what is happening and why.
Ask the client about their concerns and explain the cause of their anxiety.
Reassure them that they are safe and reassure them that you will help them feel better.
Give them a sense of control over the situation by letting them know what you are going to do, such as taking their temperature or listening to their lungs.

Monitor the vital signs every 4 hours.

Vital signs are a good indication of how the body is responding to the environment. They are also used to monitor general condition, response to treatment and side effects of therapy. Vital signs may be monitored every 4 hours during exercise, sleep and when client is resting (e.g., in bed).

Perform abdominal or lung percussion, or postural drainage to mobilize secretions.

Perform chest percussion. This technique is used to loosen mucus from the lungs, and it may be performed with a device called a chest percussor.

Perform lung or abdominal percussion. This technique is used to loosen mucus from the lungs and can be done manually or with an instrument known as a bellows.

Postural drainage. This technique involves massaging secretions out of your patient’s airways as they sit up in bed and hold their breath by coughing gently into their hands (or turning away from you).

Administer oxygen as prescribed, monitor O2 saturation and observe for changes in client’s respiratory status.

Instruct the client to take slow, deep breaths.

Monitor the oxygen saturation level. If it is low, administer high concentration O2 through a nonrebreather mask with appropriate connections or by holding an oxygen cylinder close to your client’s face (with an assistant monitoring carefully). If it is high, remove high concentration O2 from your client’s face. If his/her oxygenation remains normal and breathing is adequate despite strong smells of alcohol or other substance abuse/intoxication, continue to monitor his/her respiratory status closely until other interventions are completed.

Encourage deep breathing and coughing exercises.

Encourage deep breathing exercises and coughing. Deep breathing helps to clear the lungs of mucus and other respiratory secretions, so it is an important part of improving gas exchange. Coughing also helps to clear the lungs by bringing up phlegm (mucus) into the throat where it can be swallowed or expectorated (coughed up).

When doing these exercises, make sure you are in a safe environment—away from smokers or people who have been exposed to second-hand smoke and pollution. Deep breathing exercises can be done while lying down on your back or sitting in a chair; they do not require much effort on your part. To cough effectively, sit upright with your chin tucked slightly toward your chest so that any phlegm that may accumulate in the upper regions of your airway will move downward rather than moving upward into your trachea (windpipe). You should then take two or three quick breaths before exhaling forcefully through pursed lips for about ten seconds; repeat this process five times if needed.