Impaired Gas Exchange Nursing Diagnosis & Care Plans

Impaired gas exchange is a common nursing diagnosis that refers to a patient’s inability to effectively exchange oxygen and carbon dioxide in the lungs. This condition can be caused by a variety of factors, including chronic obstructive pulmonary disease (COPD), pneumonia, asthma, and other respiratory illnesses.

Causes of Impaired Gas Exchange

It is important to understand the common causes of impaired gas exchange. Here is a brief explanation of some key factors that can lead to this condition:

Respiratory Infections: Infections such as pneumonia, bronchitis, and tuberculosis can cause inflammation and fluid accumulation in the lungs, impairing the exchange of gases.

Chronic Obstructive Pulmonary Disease (COPD): COPD, which includes conditions like chronic bronchitis and emphysema, leads to airway obstruction and damage to the lung tissue, making it difficult for oxygen to enter the bloodstream and carbon dioxide to be expelled.

Asthma: Asthma is a chronic inflammatory disorder of the airways that causes recurrent episodes of wheezing, breathlessness, and coughing. During asthma attacks, the airways narrow, reducing the flow of air and affecting gas exchange.

Pulmonary Edema: This condition occurs when fluid accumulates in the lungs, typically due to heart problems like congestive heart failure. The excess fluid interferes with the alveoli’s ability to exchange gases effectively.

Pulmonary Embolism: A pulmonary embolism refers to a blood clot that blocks a pulmonary artery. This obstruction can disrupt blood flow to the lung tissue, leading to impaired gas exchange.

Atelectasis: Atelectasis is the partial or complete collapse of a lung or a portion of it. It can be caused by conditions such as shallow breathing, airway obstruction, or compression of the lung tissue. Atelectasis reduces the surface area available for gas exchange.

Acute Respiratory Distress Syndrome (ARDS): ARDS is a severe lung condition that can occur as a result of various factors, including severe infections, injuries, or inhalation of harmful substances. It causes inflammation and fluid buildup in the lungs, leading to impaired gas exchange.

Anemia: Anemia is a condition characterized by a low level of red blood cells or hemoglobin, resulting in decreased oxygen-carrying capacity. Insufficient oxygen supply to the tissues can affect gas exchange.

Structural Abnormalities: Structural abnormalities in the lungs, such as lung fibrosis, lung tumors, or chest trauma, can hinder the normal functioning of the respiratory system and impair gas exchange.

Impaired Gas Exchange causes
Causes of Impaired Gas Exchange

Sign and Symptoms of Impaired Gas Exchange

Expected Outcomes

  1. Improved Oxygenation:
    • The patient will achieve and maintain oxygen saturation within the target range.
    • Signs and symptoms of hypoxia, such as cyanosis and shortness of breath, will be resolved.
    • The patient will report improved overall well-being and reduced fatigue.
  2. Optimal Carbon Dioxide Elimination:
    • Arterial carbon dioxide levels will decrease and remain within the desired range.
    • Symptoms associated with hypercapnia, such as confusion and lethargy, will improve or resolve.
    • The patient’s breathing pattern will normalize, with a decrease in respiratory rate.
  3. Alleviated Respiratory Distress:
    • The patient will experience a decreased sensation of dyspnea.
    • Use of accessory muscles for breathing will be reduced or eliminated.
    • The patient will demonstrate effective coughing and clearance of respiratory secretions.
  4. Maintained Ventilation and Perfusion Matching:
    • Ventilation and perfusion ratios will improve, leading to enhanced gas exchange in the lungs.
    • Arterial blood gas values will approach normal levels.
    • Breath sounds will become clearer upon auscultation.
  5. Prevention of Complications:
    • The patient will remain free from respiratory infections, such as pneumonia or bronchitis.
    • Atelectasis will be prevented or promptly treated.
    • The risk of respiratory failure or exacerbation of underlying lung conditions will be minimized.
  6. Enhanced Activity Tolerance:
    • The patient will demonstrate increased endurance during physical activities.
    • Oxygen saturation levels will remain stable or only mildly decrease during exertion.
    • The patient will be able to perform daily activities without significant respiratory limitations.
  7. Optimized Oxygen Delivery to Tissues:
    • Tissue oxygenation will improve, leading to enhanced organ and cellular function.
    • Vital signs will stabilize, and the patient will exhibit improved mental status.
  8. Patient Education and Self-Management:
    • The patient and their family will have a better understanding of their condition and treatment plan.
    • The patient will be able to self-monitor respiratory status and recognize signs of worsening gas exchange.
    • The patient will actively participate in their care, adhere to prescribed medications and treatments, and seek appropriate medical assistance when needed.

Nursing Assessment and Rationales

  1. Respiratory Assessment:
    • Assess the patient’s respiratory rate, depth, and effort. Increased respiratory rate (tachypnea), shallow breathing, and the use of accessory muscles indicate respiratory distress.
    • Rationale: Abnormal breathing patterns can provide early indications of impaired gas exchange and help determine the severity of the condition.
  2. Auscultation of Breath Sounds:
    • Listen to breath sounds using a stethoscope. Note the presence of abnormal sounds, such as crackles, wheezes, or decreased breath sounds.
    • Rationale: Abnormal breath sounds can indicate underlying lung pathology or fluid accumulation, which can contribute to impaired gas exchange.
  3. Oxygen Saturation Monitoring:
    • Measure the patient’s oxygen saturation levels using a pulse oximeter.
    • Rationale: Monitoring oxygen saturation provides objective data on the adequacy of oxygenation and helps determine the effectiveness of interventions.
  4. Assessment of Color and Capillary Refill:
    • Observe the patient’s skin color, lips, and nail beds. Assess capillary refill time.
    • Rationale: Cyanosis (bluish discoloration) indicates decreased oxygen levels. Delayed capillary refill may suggest poor peripheral perfusion and compromised gas exchange.
  5. Vital Signs Assessment:
    • Monitor the patient’s heart rate, blood pressure, and temperature.
    • Rationale: Vital signs can provide valuable information about the patient’s overall condition, response to impaired gas exchange, and potential complications.
  6. Mental Status Assessment:
    • Evaluate the patient’s level of consciousness, orientation, and cognitive function.
    • Rationale: Impaired gas exchange can affect cerebral oxygenation, leading to changes in mental status. Assessing mental status helps identify hypoxia-related neurological changes.
  7. Symptom Assessment:
    • Assess the patient’s subjective symptoms, such as shortness of breath, chest pain, fatigue, and cough.
    • Rationale: Understanding the patient’s symptoms provides insight into the severity and impact of impaired gas exchange on their daily activities and quality of life.
  8. Review of Diagnostic Tests:
    • Review arterial blood gas (ABG) results, chest X-rays, or other diagnostic tests related to respiratory function.
    • Rationale: Diagnostic tests provide objective data regarding the patient’s gas exchange status, lung pathology, or underlying causes of impaired gas exchange.

Nursing Interventions and Rationales

  1. Administer Oxygen Therapy:
    • Provide supplemental oxygen as prescribed, ensuring the appropriate delivery method (nasal cannula, mask, etc.) and flow rate.
    • Rationale: Supplemental oxygen increases the oxygen concentration in inhaled air, improving oxygenation and alleviating hypoxia.
  2. Positioning and Airway Clearance:
    • Help the patient assume positions that facilitate optimal lung expansion, such as semi-Fowler’s position or sitting upright.
    • Encourage deep breathing exercises, coughing, and use of incentive spirometry.
    • Rationale: Proper positioning and airway clearance techniques help optimize lung ventilation, promote effective coughing, and prevent or manage complications like atelectasis.
  3. Promote Respiratory Hygiene:
    • Educate the patient and caregivers about proper respiratory hygiene, including covering the mouth and nose when coughing or sneezing and practicing hand hygiene.
    • Rationale: Respiratory hygiene measures help prevent the spread of respiratory infections, which can further compromise gas exchange.
  4. Administer Medications as Prescribed:
    • Administer bronchodilators, anti-inflammatory agents, mucolytics, or other respiratory medications as ordered.
    • Rationale: Medications help reduce airway inflammation, dilate bronchioles, promote airway clearance, and improve overall respiratory function.
  5. Monitor Fluid Balance:
    • Assess and maintain adequate hydration status.
    • Monitor intake and output closely.
    • Rationale: Maintaining proper fluid balance helps optimize respiratory function, prevent thickened secretions, and promote effective gas exchange.
  6. Collaborate with the Interdisciplinary Team:
    • Communicate with physicians, respiratory therapists, and other healthcare professionals involved in the patient’s care.
    • Share assessment findings, progress, and concerns, and collaborate on the development and adjustment of the care plan.
    • Rationale: Collaboration facilitates a holistic approach to care, ensuring coordinated interventions and timely adjustment of the treatment plan to improve gas exchange.
  7. Educate the Patient and Family:
    • Provide education on the patient’s specific condition, treatment plan, medications, and techniques for managing respiratory symptoms.
    • Teach the importance of smoking cessation, avoidance of respiratory irritants, and compliance with prescribed therapies.
    • Rationale: Patient and family education empowers them to actively participate in their care, manage symptoms effectively, and promote long-term respiratory health.
  8. Monitor and Evaluate Response to Interventions:
    • Regularly assess the patient’s vital signs, oxygen saturation, respiratory status, and symptom progression or improvement.
    • Document the effectiveness of interventions and report any concerns or changes promptly.
    • Rationale: Monitoring and evaluation help determine the efficacy of interventions, guide further interventions, and ensure the patient’s progress toward improved gas exchange.
Impaired Gas Exchange Nursing Care Plan
Impaired Gas Exchange Nursing Care Plan

Similar NANDA Nursing Diagnoses for Impaired Gas Exchange

  1. Ineffective Airway Clearance:
    • Related Factors: Excessive mucus production, airway obstruction, decreased cough reflex, weakened respiratory muscles.
    • Defining Characteristics: Abnormal breath sounds, presence of adventitious lung sounds (e.g., wheezes, crackles), ineffective cough, difficulty expectorating secretions.
  2. Impaired Spontaneous Ventilation:
    • Related Factors: Respiratory muscle weakness, neurological impairment, high cervical spinal cord injury, neuromuscular diseases.
    • Defining Characteristics: Decreased tidal volume, decreased respiratory rate, shallow breathing, use of accessory muscles, hypoxemia.
  3. Ineffective Breathing Pattern:
    • Related Factors: Respiratory muscle weakness, pain, anxiety, medications affecting respiratory drive.
    • Defining Characteristics: Irregular respiratory rate and depth, paradoxical breathing, tachypnea, bradypnea, dyspnea, decreased oxygen saturation.
  4. Risk for Infection:
    • Related Factors: Impaired immune response, invasive procedures, compromised respiratory defense mechanisms.
    • Defining Characteristics: Presence of risk factors, altered white blood cell count, abnormal sputum culture, presence of fever or chills.
  5. Impaired Gas Exchange:
    • Related Factors: Ventilation-perfusion imbalance, impaired alveolar-capillary membrane, altered oxygen-carrying capacity of blood.
    • Defining Characteristics: Hypoxemia, hypercapnia, cyanosis, altered mental status, increased work of breathing.
  6. Activity Intolerance:
    • Related Factors: Decreased oxygen supply, impaired gas exchange, decreased muscle strength, reduced cardiac output.
    • Defining Characteristics: Fatigue, exertional dyspnea, decreased tolerance for physical activity, decreased oxygen saturation with activity.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. 

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. 

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. 

Best Nursing Books and Resources

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The Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care

This is an excellent reference for nurses and nursing students. While it is a great resource for writing nursing care plans and nursing diagnoses, it also helps guide the nurse to match the nursing diagnosis to the patient assessment and diagnosis.

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NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023

All introductory chapters in this updated version of a ground-breaking text have been completely rewritten to give nurses the knowledge they require to appreciate assessment, its relationship to diagnosis and clinical reasoning, and the goal and use of taxonomic organization at the bedside.

Nursing Care Plans: Nursing Diagnosis and Intervention

It contains more than 200 care plans that adhere to the newest evidence-based recommendations.

Additionally, it distinguishes between nursing and collaborative approaches and highlights QSEN competencies.


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Anna Curran. RN, BSN, PHN

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.

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