Impaired gas exchange subjective data

Running head: CONCEPT MAP 1

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Concept Map

Learner’s Name

Capella University

Biopsychosocial Concepts for Advanced Nursing Practice I

Concept Map

April, 2019

CONCEPT MAP 2

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Concept Map

Patient Info

Name: Jane Doe | Gender: Female | Age: 72 Vitals: Temp: 37 °C (98.6 °F), BP: 162/94, Pulse: 92, Respiratory rate: 26 and shallow Chief complaint: Shortness of breath (SOB) and difficulty breathing Medical history: Hypertension, hyperlipidemia, and chronic obstructive pulmonary disease (COPD)

Nursing Diagnosis Impaired gas exchange related to destruction of the alveoli, narrowing of bronchioles, and trapping of air resulting in loss of lung elasticity Subjective data: Difficulty breathing and SOB Objective data: Crackles and wheezing heard upon auscultation, dyspnea, tachypnea, nasal flaring, use of accessory muscles, late signs of cyanosis (Linton, 2015), and oxygen saturation is 90% on room air

Nursing Diagnosis Activity intolerance related to hypoxia (imbalance between oxygen supply and demand)

Subjective data: “I find it difficult to breathe. I can’t catch my breath when I walk a few feet.” — Jane Doe

Objective data: Late signs of cyanosis, crackles and wheezing heard upon auscultation, and use of accessory muscles (Linton, 2015)

Nursing Diagnosis Ineffective airway clearance related to bronchoconstriction, increased mucus production Subjective data: The patient states she has been sleeping in a recliner chair for the past three nights because of difficulty breathing

Objective data: Wheezing heard upon auscultation, dyspnea, tachypnea, and use of accessory muscles (Linton, 2015)

Nursing Interventions

Independent intervention (II): Monitor the patient’s arterial blood gases, oxygen saturation, vital signs, and color and assess for manifestations such as restlessness, anxiety, lethargy, and confusion Rationale: This process will help detect potential hypoxemia or hypercapnia (LeMone et al., 2015)

Collaborative intervention (CI): Supervise oxygen (O2) at 2 L/min through nasal cannula as ordered. Instruct the patient and kin not to increase the O2 level Rationale: Oxygen therapy is used to treat hypoxia and is prescribed for chronic and acute breathing problems (Rees, 2017). However, a sudden increase in the O2 level can lead to respiratory failure (Linton, 2015)

II: Position the patient in an upright or high Fowler’s position (Linton, 2015) Rationale: This posture promotes lung ventilation (LeMone et al., 2015)

II: Instruct and teach the patient to perform the pursed-lip breathing technique Rationale: This technique slows the respiratory rate and reduces air trapping and fatigue (LeMone et al., 2015)

Expected Outcomes Arterial blood gases and vital signs will be consistent with patient norms, indicating improvement in gas exchange (Linton, 2015)

The pursed-lip breathing technique will reduce dyspnea (Linton, 2015)

Nursing Interventions II: Demonstrate pursed-lip and diaphragmatic breathing and encourage the patient to practice them periodically Rationale: These techniques reduce air trapping and fatigue and help maintain open airways (LeMone et al., 2015)

II: Position the patient in an upright or high Fowler’s position Rationale: This posture promotes lung ventilation (LeMone et al., 2015)

CI: Encourage deep breathing and the use of an incentive spirometer Rationale: Using an incentive spirometer prevents complications such as pneumonia and atelectasis (LeMone et al., 2015)

CI: Collaborate with a respiratory therapist to teach the patient how to cough effectively Rationale: This technique helps open distal alveoli and remove secretions (LeMone et al., 2015)

II: Provide emotional support to the patient Rationale: This intervention will be therapeutic, make the patient feel comfortable, and help her cope with the diagnosis (Kazanowski, 2017; LeMone et al., 2015)

Expected Outcomes The patient will have open airways. Signs of clear and open airways are normal depth and rate of respiration, normal breathing sounds, and effective coughing of secretions (Linton, 2015)

Nursing Interventions II: Teach and encourage the use of the pursed-lip breathing technique while performing activities Rationale: This technique can lower breathlessness and improve respiratory function (Ackley, Ladwig, Makic, 2016)

II: Advise the patient to take rest periods before and after activities Rationale: Resting reduces fatigue and lowers the demand for oxygen (LeMone et al., 2015)

CI: Recommend a pulmonary rehabilitation program Rationale: Pulmonary rehabilitation can lower exertional dyspnea and perceived intensity of breathlessness (Ackley et al., 2016)

CI: Collaborate with a respiratory therapist for cough control and improved breathing Rationale: This will help improve or maintain oxygenation in the patient (Boon, 2018)

CI: Supervise oxygen (O2) at 2 L/min through nasal cannula as ordered. Instruct the patient and kin not to increase the O2 level Rationale: Oxygen therapy is used to treat hypoxia and is prescribed for chronic and acute breathing problems (Rees, 2017). However, a sudden increase in the O2 level can lead to respiratory failure (Linton, 2015)

Expected Outcomes

The vital signs of the patient will show normal fluctuation during physical activity, which is a measure of activity tolerance (LeMone et al., 2015)

CONCEPT MAP 3

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Introduction

This paper presents an evidence-based concept map that illustrates a nursing care plan to achieve high-quality outcomes for a

patient experiencing SOB and difficulty breathing. The concept map contains urgent diagnoses, possible nursing interventions, and

opportunities for interprofessional collaboration as well as rationales and possible high-quality outcomes. The narrative justifies the

value and relevance of the evidence used in the concept map and provides additional evidence, conflicting data, and the scope of

interprofessional collaborations in achieving high-quality outcomes.

Additional Evidence

Jane Doe is a 72-year-old female experiencing SOB and difficulty breathing. The suspected diagnoses are based on the

patient’s medical history and physical examination. The evidence used in the concept map is a combination of subjective (patient-

reported distress) and objective (symptoms or characteristics related to a condition observed in the patient) data obtained after an

investigation. Doe also suffered from emphysema in the past. Fatigue, SOB, edema, and wheezing are common symptoms of COPD.

The diagnoses in the concept map are related to various conditions related to COPD such as emphysema and chronic bronchitis. This

evidence suggests that the client’s current distress could be related to COPD. However, symptoms such as wheezing, edema, SOB,

and fatigue can also be observed in a person suffering from congestive heart failure (LeMone et al., 2015). Even though COPD and

congestive heart failure have several risk factors and symptoms in common, the causes and treatments are different.

Interprofessional Strategies

An interprofessional collaboration between health care professionals, patients, and their caregivers is required for high-quality

outcomes. Successful collaborations require positive reinforcement and mutual feedback in an objective and non-discriminatory