Nursing Diagnosis: Risk for Impaired Gas Exchange related to changes in alveolar capillary membrane due to a buildup of fluid in the lung cavity
Purpose:
After nursing actions on the client, with the expected outcomes:
Looks adequate ventilation and oxygenation of the tissues in which normal limits, and free from symptoms of respiratory distress.
Participate in treatment.
Interventions:
Purpose:
After nursing actions on the client, with the expected outcomes:
Looks adequate ventilation and oxygenation of the tissues in which normal limits, and free from symptoms of respiratory distress.
Participate in treatment.
Interventions:
- Auscultation breath sounds, note the wheezing.
- Teach the client to cough effectively and breathe deeply.
- Adjust the position of sleeping with the head elevated 200-300, semi-Fowler, put a pillow on the elbow.
- Give medications as indicated.
- Provide oxygen as needed.
- Indicate the presence of congestive lung / collection secretion.
- Clearing the airway and facilitate the exchange of oxygen.
- Reducing the need for oxygen and improve lung development to the fullest.
- Increasing the concentration of oxygen alveoli, which may reduce tissue hypoxemia.
- Bronchodilator, increase oxygen intake by widening the airway and commercialize a diuretic effect on the reduction of pulmonary failure.