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NCP
NCP
Problem: Hypoxia
Nursing Diagnosis: Impaired gas exchange related to altered oxygen carrying capacity of blood
Cause Analysis: Impaired gas exchange results from the destruction of the walls of overdistended alveoli. As the walls of alveoli are destroyed, the alveolar surface
area in direct contact with pulmonary capillary continually decreases, causing an increase in dead space and impaired oxygen diffusion, which leads to hypoxemia
( Medical-surgical Nursing by Smeltzer page 570).
“Hindi ko na After 3 days of nursing 1. Promoted bed rest/chair (recliner) 1 Available energy use for healing. After 3 days of nursing
naalagaan ang sarili interventions the pt will be rest during toxic state. Activity & an upright position are interventions, the goal wasn’t
ko dahil nanghihina na able: believed to decrease hepatic blood met. the pt will wasn’t able to
ang katawan ko,” as - to achieve measurable flow, w/c prevents optimal circulation achieve measurable increase in
verbalized by the increase in activity to the liver cells. activity tolerance & wasn’t to
patient. tolerance. reduce fatigue & weakness.
- to reduced fatigue & 2. Provided quiet environment; limit 2. Allows for extended periods of
weakness. visitors. uninterrupted rest.
3. Do necessary task quietly & at one 3. Promotes optimal respiratory fxn &
time as tolerated. minimizes pressure areas to reduce
risk of tissue breakdown.