patho and correction

Actual Nursing Diagnosis/Problem: Nursing Diagnosis/Problem: Impaired gas exchange related to abdominal distension related to pressure on the diaphragm secondary to small bowel obstruction with perforation

Predicted Patient Behavioral Outcome (Goal): : my patient will maintain an SpO2 level of 92% or higher while at rest, and a respiratory rate of 12-20 demonstrating effective gas exchange while in my care

Nursing Interventions: Administer oxygen therapy as ordered.

Scientific Rationale: Supplemental oxygen can improve oxygenation levels, compensating for impaired gas exchange due to abdominal distension and diaphragm pressure. An oxygen saturation of <90% (normal: 95% to 100%) or a partial pressure of oxygen of <80 (normal: 80 to 100) indicates significant oxygenation problems.

Actual patient response

evaluation: The patient managed to maintain an SpO2 level of 94% while at rest meeting the goal of 92% or higher indicating successful management of impaired gas exchange.

Nursing Intervention: Position the patient in a 30-45 degree angle

Scientific Rationale: Evidence confirms that positioning patient head in a semi-fowler which is around 30 to 45 is deal for feeding, lung expansion and decreasing cardiac and respiratory distress. High fowler position which involves elevating the patient head to 60 to 90 degree is ideal for breathing, eating and swallowing.

Actual patient response

evaluation: Patient reported improve feeding, lung expansion and reduce respiratory distress due to semi-foweler and high fowler positioning.

Nursing Intervention: Teach and encourage the patient to perform deep breathing and coughing exercises

Scientific Rationale: Evidence suggests that breathing and coughing exercise 3 to 5 time every 1 to 2 hours. Breath and coughing exercise were crucial for assisting breathing and clearing excess secretion. The reason why clearing excess secretion is crucial is because sputum build up in the lungs normally get infected and as result it increase risk of pneumonia. Therefore, the breathing exercises decrease the incidence and severity of pulmonary complication such as pneumonia, atelectasis and hypoxemia.

Actual patient response

evaluation: The breath and coughing exercises for 3-5 time in one to 2 hours improved the patient breathing and enable the patient clear excess secretion reduce respiratory infections.

Nursing Intervention: Promote Activity as Tolerated

Scientific Rationale: Externally resisted exercise provides greater muscle activity, improved circulation, lung expansion, and general respiratory function by preventing deconditioning and improving oxygenation.

Actual patient response

evaluation: Patient report improve muscle activity and improved circulation and lung expansion based on evaluation resulting to reduce respiratory distress

Nursing Intervention: Consult with a dietitian to assess nutritional needs and modify diet as necessary.

Scientific Rationale: Controlling patient's nutritional status in SBO cases is important as it improve hydration intake and to avoid malnourishment which can impede wound healing and energy levels, which in turn can impact recovery and respiratory function.

Actual patient response

evaluation: The patient nutritional needs were met and so the patient reported reduced bowel obstruction.

Nursing Intervention: Administer Medications as Ordered

Scientific Rationale: Medications, such as antibiotics or pain relievers, may be necessary to manage upper respiratory tract infection and these drugs must consider patient allergies, types of reaction and severity of reaction

Actual patient response

evaluation: There were no drug reaction, allergies and other complications associated with drugs administration.

Nursing Intervention: Educate Patient and Family

Scientific Rationale: Educating patients and families about the diagnosis, treatment, and recovery plan increases involvement in care, improves adherence to therapies, and facilitates understanding of how behaviors such as deep breathing affect recovery.

Actual patient response

evaluation: Improved patient and family regarding therapies, medication, further enhancing family and patient on how their behavior impacts their recovery.

Nursing intervention: Administer IV Fluids and Electrolytes.

Scientific Rationale: SBO with perforation can cause fluid and electrolyte imbalances due to vomiting, reduced intake, or fluid changes. Maintaining hydration and correcting imbalances promotes tissue oxygenation and cell activity.

Actual patient response

evaluation: Patient reported restoration of hydration and corrected imbalance which was evidenced by improved skin turgor and lab results which revealed normalized electrolyte levels.

Nursing intervention: Insert Nasogastric (NG) Tube

Scientific Rationale: An NG tube decompresses the stomach, alleviating pressure on the diaphragm and intestines, increasing lung volume, and preventing aspiration.

Actual patient response

evaluation: After insertion of NG tube, the patient experienced reduced abdominal distension hence reporting relief from pressure which was previously exerted on the diaphragm.

Nursing intervention: Collaborate with the surgical team and prepare the patient for potential surgery.

Scientific Rationale: Surgical intervention may be necessary to address the obstruction and perforation, which is crucial in determining the etiology of poor gas exchange.

Actual patient response

evaluation: Improved gas exchange as result of surgery

Nursing intervention: Regularly check complete blood count (CBC), electrolytes, WBC and possibly cultures if infection is suspected

Scientific Rationale: Monitoring these lab results aids in detecting infections, inflammation, and abnormalities that may affect oxygen supply and respiratory function.

Actual patient response

evaluation: It was possible to detect infection, and abnormalities and action taken to reduce complications resulting to improved overall patient care.

Nursing intervention: Assess respiratory rate, depth, and oxygen saturation frequently

Scientific Rationale: Continuous monitoring of respiratory parameters ensures early detection of worsening in gas exchange and allows for timely management.

Actual patient response

evaluation: The patient respiratory rates remained within the normal range of 14-18 breath per minutes suggesting effective gas exchange

Nursing intervention: Provide Pain Management

Scientific Rationale: Uncontrolled pain can raise respiratory rate and reduce efficient ventilation, affecting gas exchange. Pain management allows the patient to breathe deeply and participate in therapies more effectively.

Actual patient response

evaluation: The patient pain was reduced from scale rating of 8/10 to 3/10 after pain management intervention implemented.

Nursing intervention: Monitor Vital Signs Closely

Scientific Rationale: Frequent monitoring of vital signs aids in the early detection of complications such as shock, infection, or respiratory distress, all of which can impair gas exchange.

Actual patient response

evaluation: The patient vital signs remained stable with no signs of infection or peritonitis, blood pressure and heart rate also remained within normal limits.

Nursing intervention: Perform frequent abdominal assessments, checking for distention, tenderness, and signs of peritonitis

Scientific Rationale: Peritonitis or increasing distension may result in additional respiratory impairment. Regular examinations enable early detection and timely management to avoid future issues.

Actual patient response

evaluation: Regular examination led to early detection and timely management of issues identified reducing complications.

Overall Evaluation of Goal attainment and care effectiveness: The goal was for the patient to maintain a SpO2 level of 92% and higher at rest and a respiratory rate between 12-20 breaths per minute, demonstrating effective gas exchange during care. Based on the evaluation of the goal, in case the patient has maintained a SpO2 level of 92% or higher, these suggest that the goal was achieved. Oxygen level which is above this threshold suggests that the intervention effectively supported oxygen delivery and gas exchange. Also, in case the patient respiratory rate ranges with 12-20 breathe per minutes without any signs of labored breathing it suggest that the patient respiratory status is stable hence they are not in any respiratory distress and so the goal is achieved.

The sign of effective gas exchange include indicators such as normal skin color, absence of cyanosis, effective deep breathing and absence of confusion which indicate that the patient is oxygenating well and the goal of effective gas exchange is achieved. Evaluation of care effectiveness is gauged through evaluating oxygen therapy in ensuring adequate oxygenation of SpO2 levels remained stable. The effectiveness of semi-fower and high-fowler position, deep breathing and exercises and promoted activity tolerated is determined the intervention managed to enhance the patient lungs expansion, leading to absence of atelectasis and pneumonia. The NG Tube intervention is gauged if it reduced abdominal distension hence relieving pressure on the diaphragm facilitating better breathing mechanics.

The effectiveness of the pain management intervention is gauged if it helped to reduce discomfort that might have hindered deep respiration while patient tolerance comfort is gauged if the patient is able to participate in deep breathing exercise, tolerate activity and maintain comfort during course of care suggesting that the intervention were well-received and effective in promoting recovery. Lastly, the effective of training patient and the family is to ensure patient better understand the risk and benefit of intervention, there high compliance in medications recommended instructions. The overall outcome which is expected to be experience due to the intervention recommended is to reduce respiratory distress, infection and complication such as aspiration showcasing the effectiveness of intervention in improving overall wellbeing of the patient. Close monitoring of vital signs, lab values, and abdominal assessments provided the information necessary to detect and address any deviations from expected progress.

Describe the relationship between the nursing diagnosis/problem in this plan and the other two nursing diagnosis/problem you identified on the Clinical Worksheet

( nursing diagnosis is impaired gas exchange related to abdominal distension second to small bowel obstruction with perf and the other two identified above was constipation related decreased peristalsis and the other is anxiety related to prolonged hospital stay

Two nursing diagnoses or problems have been recognized based on the nursing diagnosis: acute pain associated with bowel obstruction and abdominal distention, as well as fluid and electrolyte imbalance linked to decreased absorption and omission as a result of small intestine blockage. Breathing will likely be affected since intense pain and reduced gas exchange are related. Particularly when resulting from an obstruction of the abdominal distension, severe discomfort can have a direct impact on the respiratory condition of the patient. Insufficient ventilation, compromised gas exchange, and reduced oxygen saturation might result from pain-induced shallow breathing or reluctance to take deep breaths. It becomes essential to treat pain if the patient is to engage in deep breathing exercises and continue to have enough gas exchange.

If the acute pain is not properly controlled, it will increase anxiety and respiratory rates, which will further compromise gas exchange by creating ineffective, fast, and shallow breathing. The pain and stomach blockages will have a confusing effect. Therefore, managing discomfort is crucial to maintaining good respiratory function and achieving gas exchange objectives. There will be some systemic effects from the connection between reduced gas exchange and fluid and electrolyte imbalance. Respiratory problems can be made worse by fluid and electrolyte imbalance, particularly when vomiting and reduced absorption from the bowel obstruction is involved. Dehydration and electrolyte abnormalities, such as low sodium and potassium, can impede the respiratory muscles' ability to contract, making breathing more difficult and further impairing gas exchange.

Respiratory patterns may also be impacted by electrolyte imbalances, which can result in metabolic acidosis or alkalosis. For instance, a patient experiencing metabolic acidosis may seek to compensate by hyperventilating, which might result in aberrant gas exchange and compromised oxygenation. Finally, failure to rectify the fluid and electrolyte imbalances may result in systemic organ malfunction, including the lungs, exacerbating the patient's respiratory state and raising the risk of complications. In order for the body to be able to sustain regular gas exchange, these imbalances must be corrected.