impaired gas exchange subjective data

Evidence: 8/10 pain, The formatting isnt always important, and care plan formatting may vary among different nursing schools or medical jobs. This can prevent airway collapse, Pillows to support elevated position and support for arms, Supportive therapy to decrease chest and abdominal discomfort and pain if present, Assistance with positive airway pressure techniques-CPAP, BiPAP, PEP device, Assure breathing deeply will not dislodge tubes or cause wound opening, Diuretics, bronchodilators, antibiotics, steroids, pain medications, anticoagulants. assessment and MAKE A CHANGE IN THE St. Louis, MO: Elsevier. q2hrs. Administer appropriate reversal agents as ordered. Impaired gas exchange is a disruption of the oxygen and carbon dioxide exchange in the lung tissues. Pathophysiology Impaired gas exchange is the state in which there is an excess or deficit in oxygenation or in the elimination of carbon dioxide at the level of the alveolocapillary membrane. -The nurse will provide the patient with smoking cessation materials and how it relates to COPD educational material. If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. To enable to patient to receive more information and specialized care in enabling of improved gas exchange. position changes and turn Changes in breathing patterns can indicate changes in oxygenation status. (Symptoms) Reports of feeling short of breath Lastly, providing thorough patient education both verbally and in writing is essential for these individuals to help them understand their diagnosis and what measures they can take at home to prevent additional exacerbations. IMPAIRED GAS EXCHANGE/SHORTNESS OF BREATH Subjective Data: Allergies: _____ Chief complaint: _____ Onset:_____ q New Onset Chronicq q Recurrence Severity of attack: Scale: (1-10)_____ Precipitating Factors: q Cold air Exercise Chemicalsq Respiratory infectionq Emotional situationsAir pollutants q q q . Cross), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. 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Lung disease can lead to severe abnormalities in blood gas composition.Because of the differences in oxygen and carbon dioxide transport, impaired oxygen exchange is far more common than impaired carbon dioxide exchange. Nursing Care Plan: Guidelines for Individualizing Client Care Across the Lifespan [eBook edition]. Chronic obstructive pulmonary disease (COPD). 2. The nurse is evaluating the plan of care and notes that none of the goals have been met for the client with impaired gas exchange. To reduce the risk of drying out the lungs. It is important for nurses to understand the various symptoms a patient may present with when experiencing an acute exacerbation. Close monitoring of types of food and drinks is also important. Reduced congestion will improve gas exchange. Buy on Amazon. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. Peripheral cyanosis (bluish discoloration of the skin, ear lobes, or nail beds) may be evident with hypoxemia. Our website services, content, and products are for informational purposes only. Others can include: Tests can help to detect and diagnose impaired gas exchange in COPD. Cervical spine a. If you have COPD with impaired gas exchange you may need to be treated with supplemental oxygen as well as other COPD treatments. Impaired Gas Exchange r/t ventilation-perfusion imbalance (atelectasis & anemia) aeb Hemoglobin level was 9 g, SaO2was 90%, Outcomes: The outcome of the plan of care is that by discharge Mrs. Moore will be able to move at least 1500 mL on the spirometer, have clear breath sounds bilaterally, have a SaO2 greater than 95%, be afebrile, and be able Good lung down position helps the patient achieve maximum oxygenation and enhanced blood flow to the remaining lung. Hypoxemia can be caused by the collapse of alveoli. such as monitor, assess, observe or Which action by the nurse is the most appropriate? Oxygen therapy will increase the supply of oxygen presently demanded by the body, Assist patient with ADLs as needed; Provide physical therapy exercises; Implement cardiac rehabilitation program and activity plan, These interventions will assist the patient with completing activities and will help to build the patients strength and endurance back to baseline, Using 3 pillows to sleep at night (increase from usual 1 pillow), Decreased activity level due to shortness of breath, Tachypneic, respiratory rate of 30 breaths/minute. It can lead to an inadequate amount of blood pumping out of the heart. Low ABG level . Medical-surgical nursing: Concepts for interprofessional collaborative care. Impaired gas exchange related to fluid overload as evidenced by labored, tachypneic breathing, decreased oxygen saturation, crackles in lung fields, pitting edema, congestion on chest x-ray. rest and promote a calm, This air travels through airways that gradually get smaller until it reaches the alveoli. Other types of COPD treatments that may be recommended include: Your doctor will work with you to develop a treatment plan for your COPD and impaired gas exchange. Some hospitals may havethe information displayed in digital format, or use pre-made templates. Breath sounds can help determine or confirm the cause of impaired gas exchange. All rights reserved. Finally, on Friday, March 3, the IHS Markit Services PMI for February will be released. Join the nursing revolution. Hemodynamic Monitoring (Normal Values| Purpose|Hemodynamic Instability), Sample Nursing Care Plan for Preeclampsia |scenario|NCP with rationales, 19 NANDA Nursing Diagnosis for Fracture |Nursing Priorities & Management, 25 NANDA Nursing Diagnosis for Breast Cancer, 5 Stages of Bone Healing Process |Fracture classification |5 Ps, 9 NANDA nursing diagnosis for Cellulitis |Management |Patho |Pt education, 20 NANDA nursing diagnosis for Chronic Kidney Disease (CKD), Administer supplemental oxygen therapy with continuous oxygen saturation monitoring, Supplemental oxygen will increase alveolar oxygen concentration, Rest will reduce the bodys oxygen demands and consumption, Position patient into Semi-Fowlers position, Positioning will allow for maximal lung expansion and inflation, Administer medications as ordered (diuretics), Diuretics will pull off excess fluid within the body thereby reducing congestion, The fluid restriction will prevent additional fluid accumulation, I&O monitoring will allow for assessment of progress made with the administration of diuretics and fluid restriction, Oxygen therapy will increase the available oxygen in the body for the myocardium and correct hypoxia, Administer antihypertensive medication as ordered, Antihypertensive medications will reduce the patients elevated blood pressure thereby reducing the additional stress on the heart, Administer medications as ordered (diuretics, ACE, and ARBs), Diuretics will decrease excess fluid and stress on the cardiac muscle, I&O should be monitored closely to successfully and accurately record the progress of treatment, Maintain chair/bedrest in semi-Fowlers position. Impaired gas exchange: Accuracy of defining characteristics in children with acute respiratory infection. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Wow, I give up! problems. (2015). Encourage adequate . To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Complaints of shortness of breath on excretion and atypical chest pain, has felt bad since Monday, states she is coughing up greenish to brownish sputum that is thick, pt feels chilled. What are the causes of impaired gas exchange? We and our partners use cookies to Store and/or access information on a device. The patients lab work reveals an elevated BNP level of 954pg/mL and a chest x-ray shows pulmonary congestion. Assess respirations for rate and quality, as well as use of accessory muscles. Desired Outcome: Within 1 hours of nursing interventions, the patient will have improved ventilation and gas exchange as evidenced by oxygen saturation within normal range, and respiratory rate greater than 8. #shorts #anatomy. This can lead to a variety of symptoms, such as: Impaired gas exchange is also characterized by hypoxemia and hypercapnia. Interventions Follow guidelines as per facility for patients who are high risk for falls. SATISFY THE OUTCOME A. -Pt will verbalize 4 benefits of wearing a CPAP machine at home when she sleeps. Having certain other health conditions is also associated with a poorer COPD outlook. Subjective Data: Pt family member tells you that the patient has been sleeping constantly for 2 weeks. It also leads to hypoxemia and hypercapnia. She found a passion in the ER and has stayed in this department for 30 years. High concentrations of oxygen should typically be avoided for patients with COPD. High fever in pneumonia poses a risk for higher metabolic demands, alteration in cellular oxygenation, and higher oxygen consumption. ABGs were collected and the patients pCO2 74, pH 7.24, P02 55, HCO3 33.2. All Rights Reserved. Fluid is constantly being added and reabsorbed by capillaries and lymph vessels in the pleura. Join the nursing revolution. Weight Mass Student - Answers for gizmo wieght and mass description. Objective and subjective data collection Vitals: R-54, H-128, T-37.4 (axillary), BP-91/64, MAP-62, O 2-94% Other objective data: Wt 9.6 kg, Ht 76.5 cm, apical strong and regular, nail beds pink . Breath sounds 5. Thieme. The patient is a current smoker and has been since she was 19 years old. Patient reports feeling weak and fatigued. Depending on the severity of your symptoms, you may need supplemental oxygen all the time or only at certain times. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Injection Gone Wrong: Can You Spot The Mistakes? When you breathe out, the lungs deflate, pushing carbon dioxide up through your airways where it exits your body through your nose and mouth. THE NURSE TO REEVALUATE How is impaired gas exchange and COPD diagnosed? ncbi.nlm.nih.gov/pmc/articles/PMC4230177/, nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/, nhlbi.nih.gov/health-topics/how-lungs-work, ncbi.nlm.nih.gov/pmc/articles/PMC3107696/, onlinelibrary.wiley.com/doi/full/10.1111/resp.12619, ncbi.nlm.nih.gov/pmc/articles/PMC4547073/, bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-016-0331-0, COPD: How a 5-Question Screening Tool Can Help Diagnose Condition, 5 Ways to Keep Your Lungs Healthy and Strong, FEV1 and COPD: How to Interpret Your Results. Frequent repositioning promotes drainage and movement of lung secretions. Reduced gas exchange from pulmonary edema can progress to ARDS. -The nurse will notify respiratory therapy to obtain ABG at 1500 and report results to the pulmonary md.-The nurse will monitor patients vital signs every hours while on the bipap machine. Desired Outcome: The patient will demonstrate adequate oxygenation as evidenced by improved arterial blood gases (ABG) results. Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), The Methodology of the Social Sciences (Max Weber), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Psychology (David G. Myers; C. Nathan DeWall), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Give Me Liberty! Assessment B. NCLEX Review Care Plan for Ineffective Gas Exchange, Ineffective Airway Clearance, Pneumonia, COPD, Emphysema, & Common Cold The free nursing care plan example below includes the following conditions: Ineffective Gas Exchange, Ineffective Airway Clearance, Pneumonia, COPD, Emphysema, & Common Cold. Reposition the patient by elevating the head of the bed and encouraging him/her to sit on an upright position. The patient is excessively sleepy and falls asleep easily even with stimuli. Scope and Categories: Scope: Gas exchange is the process by which oxygenated air enters the respiratory tract, flows into the lungs, and is transported to the cells. 9. Monitor the color of skin and mucous membrane. The nurse notes dyspnea upon minimal excretion with position changes. Anna Curran. Lab values and vital signs can also point to potential impaired gas exchange. For post-pneumonectomy patients, position the patient with good lung down, which means positioning on the non-operative side. Injection Gone Wrong: Can You Spot The Mistakes? PATIENTS CONDITION AND USA CON: NURSING PLAN OF CARE Semi-Fowlers position will allow for optimal oxygen usage by the body. Monitor body temperature. Respiratory effectiveness can be affected by chronic conditions that affect the lungs like chronic obstructive pulmonary disorder. demonstrating, performing treatments, Whatnursing care plan bookdo you recommend helping you develop a nursing care plan? Post fall alert Impaired gas exchange r/t alveolar-capillary membrane changes AEB chest x-ray suggesting possible area of consolidation in the right lower lobe Acute Confusion r/t situational crisis AEB restlessness, irritability, and agitation. During this process, oxygen enters the bloodstream while carbon dioxide is removed. OUTCOME STATEMENTS Impaired Gas Exchange is a NANDA nursing diagnosis that is used for conditions where there is an alteration in the balance between the exchange of gases in the lungs. Lab and Diagnostic work shows: WBC 30,000 and chest x-ray preliminary results show possible bilateral lower lobe pneumonia. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. According to the National Heart, Lung, and Blood Institute, up to 75 percent of people with COPD currently smoke or used to smoke. an appropriate diagnostic statement from the information you gave would be impaired gas exchange r/t ventilation perfusion imbalance secondary to cf aeb hypoxia, hypercapnia, restlessness, and irritability. What are nursing care plans? Chronic obstructive pulmonary disease. Treatment for hypercapnia involves noninvasive ventilation therapy, often called BiPAP, which is the name of a brand of ventilation therapy machine. Patients who suffer from chronic respiratory disorders can benefit from pulmonary rehabilitation training. Lung expansion is also achieved in doing these nursing interventions. This will be a closely watched data point as it provides insight into the health of the US labor market. To improve the delivery of oxygen in the airways and to reduce shortness of breath and risk for airway collapse. Nursing Diagnosis: Impaired gas exchange related to ventilation perfusion imbalance secondary to hypovolemic shock as evidenced by cyanosis, heart rate 162 bpm, and oxygen saturation 76%. Comer, S. and Sagel, B. To create a baseline set of observations for the ARDS patient, and to monitor any changes in the vital signs as the patient receives medical treatment. See our full, Important Disclosure: Please keep in mind that these care plans are listed for, Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on Pinterest (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on Pocket (Opens in new window), Click to share on Telegram (Opens in new window), Click to share on Skype (Opens in new window), IV Drug Use Complications & Dangers: (Endocarditis, Infection, Infectious Diseases). DIAGNOSIS She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. A statistically significant reduction of itching score has already been reached on day 2 (0.84 1.26, p < 0.0001). This care plan is listed to give an example of how a Nurse (LPN or RN) may plan to treat a patient with those conditions. The patient has a history of obstruction sleep apnea. EVALUATION, Pathophysiological process Planning C. Implementation D. Diagnosis 4. Patient exhibited dyspnea on ambulation from stretcher to bed. What nursing care plan book do you recommend helping you develop a nursing care plan? A 63 year old female presents to the ER with complaints of shortness of breath on excretion and atypical chest pain. It is also imperative that the nurse assesses the individuals airway and breathing status immediately and prioritizes this above any other nursing intervention. -Pt will list 3 signs and symptoms of high PCO2 level and when to notify her doctor. Impaired gas exchange can result from any condition that compromises a patients airway, blood flow, or respiratory effectiveness. -Pt will verbalize 5 benefits of the pneumococcal vaccine within 48 hours. Client mentions that he is starting to experience shortness of breath and has a hard time taking a deep breath Client states he feels lightheaded while in bed and has a constant headache. 101.6, Skin feels hot on assessment, WBC 30,0000, chest x-ray shows possible bilaterally lower lobe pneumonia. Nursing Diagnosis: Impaired Gas Exchange related to pus and fluid-filled alveoli secondary to pneumonia as evidenced by shortness of breath, skin pallor, cyanosis, wheeze upon auscultation, phlegm, oxygen saturation of 80%, hypotension, tachycardia, restlessness, and reduced activity tolerance. Nursing Diagnosis: Impaired Gas Exchange related to alveolar edema due to elevated ventricular pressures secondary to CHF as evidenced by shortness of breath, SpO2 level of 85%, abnormal ABG results and crackles upon auscultation. An example of data being processed may be a unique identifier stored in a cookie. Educate the patient in how to perform therapeutic breathing and coughing techniques. Certain drugs, including opiates, can depress a patients respiratory rate and depth resulting in impaired gas exchange as well. (2014). Overall, treatment for COPD with impaired gas exchange focuses on reducing symptoms and slowing disease progression. Hypoxic patients can become anxious and irritable. breath sounds are To increase oxygen saturation 92% prior to transfer from ED and admission to hospital floor unit, To decrease excess fluid by 10 pounds by discharge to return patient to baseline dry weight. Heart failure is a chronic, progressive condition. Learn more about COPD, Theres no cure for COPD, but you can feel better and stay more active by changing your lifestyle. We strive for 100% accuracy, but nursing procedures and state laws are constantly changing. Diseases that affect the ability for blood to carry oxygen can also result in impaired gas exchange. Pascoal LM, et al. Encourage the patient to cough to expectorate phlegm. Etiology The most common cause for this condition is poor oxygen levels. Encourage frequent It also leads to hypoxemia and hypercapnia. This demonstrates to the nurse that the patient is not hemodynamically stable and the main goal is stabilizing the patients respiratory status. Using the nursing risk for impaired gas exchange care note can help alleviate clients symptoms of impaired gas exchange and prevent life-threatening complications. Use a continuous pulse oximeter to monitor oxygen saturation. Gas exchange is the process where carbon dioxide, a waste gas, is exchanged in the lungs for fresh oxygen. All vital signs -Pt will be free from any facial and mouth breakdown frombipap machine. airways or alveoli that have lost elasticity and cannot expand and deflate to their full capacity when you breathe in and out, alveoli walls that have been destroyed, leading to reduced surface area for gas exchange, long-term inflammation thats led to thickening of the airway walls, airways that have become clogged with thick mucus, pipe, cigar, or other kinds of tobacco smoke. Intro SA PAG Aaral NG WIKA (Ang Pagtatamo at Pagkatuto ng Wika), Pretest IN Grade 10 English jkhbnbuhgiuinmbbjhgybnbnbjhiugiuhkjn,mn,jjnkjuybnmbjhbjhghjhjvjhvvbvbjhjbmnbnbnnuuuuuuhhhghbnjkkkkuugggnbbbbbbbbfsdehnnmmjjklkjjkhyt ugbb, 446939196 396035520 Density Lab SE Key pdf, Fundamentals-of-nursing-lecture-Notes-PDF, ENG 123 1-6 Journal From Issue to Persuasion, Historia de la literatura (linea del tiempo), Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1. On assessment, patients skin feels hot to touch despite the patient stating she feels chilled. Anti-pyretic drugs aim to reduce the bodys temperature levels. This is THE OUTCOME OBJECTIVES). Auscultate the lungs and monitor for wheezing or other abnormal breath sounds. optimal chest Respiratory acidosis and hypoxemia are evidenced by increasing PaCO2 and decreasing PaO2. Pahal P, et al. Seventy-seven-year . In this post, well formulate a sample nursing care plan for a patient with Congestive Heart Failure (CHF) based on a hypothetical case scenario. This care plan is listed to give an example of how a Nurse (LPN or RN) may plan to treat a patient with those conditions. Impaired Gas Exchange related to decreased lung compliance and altered level of consciousness as evidence by dyspnea on exertion, decreased oxygen content, decreased oxygen saturation, and increased PCO2. The most important part of the care plan is the content, as that is the foundation on which you will base your care. (2015). Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[250,250],'nurseship_com-leader-4','ezslot_10',642,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-leader-4-0'); Once the patients breathing status is stabilized the next likely task will be to diuresis the patient. A 70 year old female presents from the ER to your PCU unit. Lung cancer patients who have undergone respiratory surgical procedures may show a difference in breath sounds upon auscultation: Post-pneumonectomy the operative side will show lack of air movement and consolidation, Post-lobectomy the remaining lobes will demonstrate normal airflow. ancillary services) INTERVENTIONS Pt family member tells you that the patient has been sleeping constantly for 2 weeks. COPD, and by extension the impaired gas exchange associated with it, is caused by long-term exposure to environmental irritants. St. Louis, MO: Elsevier. OUTCOMES patient will have Excess fluid will be removed and the patients weight will return to baseline. Continue with Recommended Cookies. oxygenation. C. Patient will have NANDA label (Doenges) This leads to excess or deficit of oxygen at the alveolar capillary membrane with impaired carbon dioxide elimination. pertinent only to the nursing will be clear to Oxygen therapy needs to be carefully monitored, as it can worsen hypercapnia in some situations. Fluid resuscitation will treat the underlying cause of the impaired gas exchange and improve oxygenation status. -The nurse will administer Ativan 0.5 mg PO every 6 hours to the patientas needed for anxiety when on the bipap machine. As a nurse, you will either follow doctors' orders for nursing interventions or develop them yourself using evidence-based practice guidelines. Monitor the chest drainage system of post-lobectomy or lung resection patient. Our website services and content are for informational purposes only. (Signs) Adventitious breath sounds (i.e., crackles, rhonchi, wheezes) 2. You note when the patient is asleep she has apneic episodes where her oxygen saturation will decrease to 82%. Oxygen and carbon dioxide are exchanged across the alveolar-capillary barrier in a passive manner, depending on both gases concentrations. NURSING DIAGNOSIS Compared to those with normal blood oxygen levels, those with hypoxemia had greater declines in 5-year quality of life. Copyright 2023 RegisteredNurseRN.com. oxygenation. The patients airway is protected and he is able to breathe on his own. Impaired Gas exchange. These include things like heart disease, pulmonary hypertension, and lung cancer. This will also help to determine if additional medications are warranted or dosage adjustments need to be made. To enable to patient to receive more information and specialized care in the removal of thick lung secretions and enabling of improved gas exchange. NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Assessment -The nurse will teach the patient 3 signs and symptoms that indicate PCO2 level may be high and when to contact her md. Three nursing diagnoses--ineffective breathing pattern (IBP), ineffective airway clearance (IAC), and impaired gas exchange (IGE)--were among the most frequently used, yet no reported clinical studies validated the defining characteristics of these diagnoses. Nursing Interventions and Rationale: Independent: AHN, GENERATE SOLUTIONS The consent submitted will only be used for data processing originating from this website. The consent submitted will only be used for data processing originating from this website. VS: HR 85, BP 130/82, Temp 98.6, RR irregular 19. Effective chest drainage helps the remaining lung segments to re-expand successfully. What are nursing care plans? Otherwise, scroll down to view this completed care plan. Oxygenation and ventilation may need to be supported mechanically. Physiological impairment in mild COPD. However, my patient had normal vital signs, no complaint of pain, and no lab test except a positive strep test. The following is how scoring is interpreted: Encourage the patient to cough to expectorate thick sputum. The main assessment findings the nurse should be aware of for this patient begin with his vital signs, all of which are listed are abnormal. When collecting primary subjective data, which is an appropriate source for the nurse to use? required for EACH The following diagnoses are usually made when caring for patients with pneumonia: Impaired gas exchange Ineffective airway clearance Ineffective breathing pattern Knowledge deficit/Deficient knowledge Activity intolerance Risk for infection Risk for nutritional imbalance: less than body requirements (relevant medical orders, comfort Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. s erm In 2 days, the patient will Patient verbalizes understanding of oxygen and other therapeutic interventions. Last medically reviewed on October 29, 2021. Desired Outcome: Within 1 hour of nursing interventions, the patient will demonstrate improved gas exchange as evidenced by oxygen saturation greater than 90%. We avoid using tertiary references. Pursed lip breathing and deep breathing exercises also prevents atelectasis or lung collapse. -Pt will be provided with a CPAP machine to take home that meets her expectations. Respiratory System Crackles in all lung fields Diminished Impaired gas exchange related to smoking as evidenced by dyspnea, crackles all lung fields, and oxygen . Patient expresses concern and fear about his condition. Nursing Diagnosis: Impaired gas exchange related to alveolar-capillary membrane changes secondary to COPD as evidenced by oxygen saturation 79%, heart rate 112 bpm, and patient reports of dyspnea. The patient is on 3L nasal cannula with oxygen saturation of 88%. These risks and uncertainties include, without limitation, the impact of public health crises, including pandemics (such as the coronavirus ("COVID-19") pandemic) and epidemics and any related company or governmental policies or actions, the risk that our and Cimarex's businesses will not be integrated successfully, the risk that the cost . Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply secondary to lung cancer as evidenced by shortness of breath, wheeze upon auscultation, hypercapnia, cyanosis of the lips, oxygen saturation of 80%, restlessness, and changes in mentation.

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