Excess or inadequate oxygenation and/or carbon dioxide elimination

• Ineffective airway clearance
• Ineffective breathing pattern
• Pain

• Alveolar-capillary membrane changes
• Asthma
• General anesthesia
• Heart diseases
• Ventilation-perfusion imbalance

• Age
• Gender
• Smoking history
• Neurologic status, including level of consciousness, orientation, and mental status
• Respiratory status, including respiratory rate and depth, symmetry of chest expansion, use of accessory muscles, cough, sputum, palpation for fremitus, percussion of lung fields, auscultation of breath sounds, arterial blood gas (ABG) levels, and pulmonary function studies
• Cardiovascular status, including skin color and temperature, heart rate and rhythm, blood pressure, and complete blood count
• Activity status, including such functional capabilities as range of motion and muscle strength, activities of daily living (ADLs), and occupation

• Abnormal arterial pH
• Abnormal skin color
• Altered respiratory depth
• Altered respiratory rhythm
• Bradypnea
• Confusion
• Decreased carbon dioxide level
• Diaphoresis
• Drowsiness
• Headache upon awakening
• Hypercapnia
• Hypoxemia
• Hypoxia
• Irritable mood
• Nasal flaring
• Psychomotor agitation
• Tachycardia
• Tachypnea
• Visual disturbance

• Patient will maintain respiratory rate within five breaths of predetermined baseline.
• Patient will sustain sufficient fluid intake to prevent dehydration: ___ mL/24 hours.
• Patient will exercise and perform ADLs without experiencing dyspnea or excessive fatigue.
• Patient will maintain adequate ventilation and have clear breath sounds on auscultation.
• Patient or family members will state understanding of causes for impaired gas exchange and behaviors to prevent it.
• Patient will have normal breath sounds.
• Patient's ABG levels will return to baselines: ___ pH; ____ partial pressure of arterial oxygen (Pao₂); ____ partial pressure of arterial carbon dioxide (Paco₂).
• Patient will perform relaxation techniques every 4 hours.
• Patient will use correct bronchial hygiene.

Suggested NOC Outcomes

• Establish baseline values for respiratory assessment to distinguish age-related changes that may mimic disease states from disease. Older adults take shorter breaths. This decreases maximum breathing capacity, vital capacity, residual volume, and functional capacity.
• Assess and record pulmonary status every 4 hours or more frequently if patient's condition is unstable. Poor pulmonary status may result in hypoxemia.
• Monitor vital signs and heart rhythm at least every 4 hours to detect tachycardia and tachypnea, which could indicate hypoxemia.
• Place patient in position that best facilitates chest expansion to enhance gas exchange.
• Change patient's position at least every 2 hours to mobilize secretions and allow aeration of all lung fields.
• Perform bronchial hygiene, as ordered, including coughing, percussion, postural drainage, and suctioning. These measures promote drainage and keep airways clear.
• Give medications, as ordered, to improve oxygenation. Monitor and record efficacy and adverse reactions to guide treatment.
• Administer and monitor oxygen therapy, as ordered, to enhance oxygenation and detect signs of decompensation. Older patients have a high incidence of chronic cardiac and chronic pulmonary disorders. Detecting early changes in condition allows for early intervention.
• Record intake and output to monitor patient's fluid status.
• Report signs of dehydration or fluid overload immediately. Dehydration may hinder tissue perfusion and secretion mobilization; fluid overload may cause pulmonary edema.
• Assist patient with ADLs to decrease tissue oxygen demand.
• Encourage patient to alternate periods of rest and activity. Activity increases tissue oxygen demand; rest enhances tissue oxygen perfusion.
• Monitor ABG levels and notify physician immediately if Pao₂ or arterial oxygen saturation drops or Paco₂ rises. Administer endotracheal intubation and mechanical ventilation if needed. This helps increase ventilation and gas exchange.
• Have patient turn, cough, and deep breathe every 4 hours to prevent atelectasis or fluid buildup in lungs and to enhance blood oxygen level.
• Teach patient relaxation techniques to reduce tissue oxygen demand.
• Have patient perform relaxation techniques every 4 hours to establish routine and reduce oxygen demand.

Suggested NIC Interventions

• Patient's respiratory rate remains within established limits.
• Patient doesn't experience dyspnea.
• Patient's fluid intake remains sufficient to prevent dehydration.
• Patient performs ADLs without exhibiting dyspnea or other signs of abnormal ABG levels.
• Patient has normal breath sounds.
• Patient's pH, Pao₂, and Paco₂ return to and remain within established limits.
• Patient performs relaxation techniques every 4 hours.
• Patient uses correct bronchial hygiene.

• Patient's complaints of dyspnea, headache, and restlessness
• Patient's expression of well-being
• Observations of physical findings
• Effectiveness of medications
• Teaching provided and patient's response
• Patient response to interventions
• Other treatments performed by nurse
• Evaluations for expected outcomes

• Gilpin, R. (2017). Understanding the gas exchange process. EMS World, 46(4), 50-56.
• Johnson, N. J., Luks, A. M., & Glenny, R. W. (2017). Gas exchange in the prone posture. Respiratory Care, 62(8), 1097-1110.
• Marinus, N., Bervoets, L., Massa, G., Verboven, K., Stevens, A., Takken, T., & Hansen, D. (2017). Altered gas-exchange at peak exercise in obese adolescents: Implications for verification of effort during cardiopulmonary exercise testing. Journal of Sports Medicine and Physical Fitness, 57(12), 1687-1694.
• Oribabor, C., Gulkarov, I., Khusid, F., Fischer, E., Esan, A., Rizzuto, N., … Kenney, B. (2018). The use of high-frequency percussive ventilation after cardiac surgery significantly improves gas exchange without impairment of hemodynamics. Canadian Journal of Respiratory Therapy, 54(3), 58-61.