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Medical Diagnosis: Bronchial Asthma Problem: Impaired Gas Exchange RT Ventilation Perfusion Imbalance Assessment Subjective: (none) Objective:

wheezing upon inspiration and expiration dyspnea coughing, sputum is yellow and sticky tachypnea, prolonged expiration tachycardia chest tightness suprasternal retraction restlessness anxiety cyanosis Altered loc Nursing Diagnosis Impaired gas exchange RT ventilation perfusion imbalance AEB dyspnea, tachypnea, and tachycardia Scientific Explanation Bronchial asthma is a condition wherein the airways diameter is highly reduced. This is due to severe bronchospasm, mucosal edema and mucus plug formation. There is a rise in airway resistance which leads to decreased amount of air that enters upon inspiration as well as expiration. Thus, ventilation is impaired. In bronchial asthma, perfusion is not directly affected. However, the balance between ventilation and perfusion (V/Q ratio) is lost because despite the adequate perfusion (capillary circulation), not much gas is available to diffuse from the alveoli to the capillaries. Planning Choose: Patient will improve gas exchange AEB absence of respiratory distress Patient will demonstrate improved ventilation and adequate oxygenation of tissues by ABGs within clients normal limits and absence of symptoms of respiratory distress. Patient will verbalize understand of causative factors and appropriate interventions (deep breathing, cough exercises, etc) Interventions 1. Establish rapport. 2. assess pt.s condition 3. VS monitor and record 4. Auscultate breath sounds and assess airway pattern 5. Elevate head of the bed and change position of the pt. every 2 hours. 6. Encourage deep breathing and coughing exercises. 7. Demonstrate diaphragmatic and pursed-lip breathing. 8. Encourage increase in fluid intake 9. Encourage opportunities for rest and limit physical activities. 10. Reinforce low salt, low fat diet Rationale 1. To gain pt.s trust. 2. To obtain baseline data 3. Serve to track important changes 4. to check for the presence of adventitious breath sounds 5. To minimize difficulty in breathing 6. To maximize effort for expectoration. 7. To decrease air trapping and for efficient breathing. 8. To prevent fatigue. Evaluation Patient will improve gas exchange AEB absence of respiratory distress Patient will demonstrate improved ventilation and adequate oxygenation of tissues by ABGs within clients normal limits and absence of symptoms of respiratory distress. Patient will verbalize understand of causative factors and appropriate interventions (deep breathing, cough exercises, etc)

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Conversely, the gases in the capillaries do diffuse to the alveoli but since expiration is impaired, such gases fail to be ventilated out. Thus, gas exchange is impaired.

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