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Impaired Gas exchange Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane.
Visual disturbances, decreased carbon dioxide, dyspnea, abnormal arterial blood gases, hypoxia, irritability, somnolence, restlessness, hypercapnia, tachycardia, cyanosis, abnormal skin color, hypoxemia, hypercarbia, headache on awakening, abnormal rate rhythm depth of breathing, diaphoresis, abnormal arterial pH, abnormal nasal flaring.

Related to:
  1. decreased pulmonary perfusion associated with obstruction of pulmonary arterial blood flow by the embolus and vasoconstriction resulting from the local release of vasoactive substances (e.g. serotonin, endothelin, some prostaglandins);
  2. decreased bronchial airflow associated with bronchoconstriction resulting from:
    • the local release of substances such as serotonin and some prostaglandins
    • a compensatory response to an increase in the amount of dead space in the underperfused lung area (the compensatory bronchoconstriction also affects airways in perfused lung areas);
  3. loss of effective lung surface associated with atelectasis if it occurs.

Nursing Outcomes
  • Respiratory Status: Gas Exchange
  • Respiratory Status: Ventilation
  • Tissue Perfusion: Pulmonary
  • Vital Signs Status
  • Electrolyte and Acid-Base Balance

Client Outcomes
  • Demonstrates improved ventilation and adequate oxygenation as evidenced by blood gases within client's normal parameters
  • Maintains clear lung fields and remains free of signs of respiratory distress
  • Verbalizes understanding of oxygen and other therapeutic interventions