Concept Map Assignment #2 Concept Gas Exchange

Please follow the grading rubric

create a concept map with references

concept : gas exchange

Age: 68 years

Sex: Male

Height/Weight: 510 (178 cm), 185 lb (84 kg)

Allergies: NKDA

Code Status: Full code

68-year-old male with a 20-year history of Chronic Obstructive Pulmonary Disease (COPD), diagnosed 10 years ago. He has a 45-pack-year smoking history, having smoked 11.5 packs per day since his early 20s; he quit smoking 3 years ago after a hospitalization for a COPD exacerbation.

His medical history includes:

• COPD (chronic bronchitispredominant)
• Hypertension
• Hyperlipidemia

He worked as a construction foreman for over 35 years, with frequent exposure to dust and chemical fumes. He reports chronic productive cough, especially in the mornings, and baseline dyspnea on exertion. At home, he uses 2 L/min oxygen via nasal cannula at night and PRN with activity.

He presents to the emergency department with worsening shortness of breath, increased sputum production, and fatigue over the past 3 days. He reports the sputum is thicker and yellow-green. He states, I cant catch my breath even just walking to the bathroom.

Assessment Findings

Vital Signs

• Temperature: 99.1F (37.3C)
• Heart Rate: 104 bpm
• Blood Pressure: 148/86 mmHg
• Respiratory Rate: 26 breaths/min
• SpO2:
• 86% on room air
• 90% on 2 L/min O2 via nasal cannula

Physical Assessment

• Patient appears anxious, sitting in tripod position
• Use of accessory muscles noted
• Barrel chest present
• Lung sounds:
• Diminished breath sounds bilaterally
• Expiratory wheezes in upper lobes
• Coarse crackles in lower lobes
• Cough: Frequent, productive with thick yellow sputum
• Skin: Warm, slightly diaphoretic; mild cyanosis around lips
• Mental status: Alert and oriented 4 but reports headache and fatigue

Diagnostic Data

Arterial Blood Gas (on 2 L O2)

• pH: 7.32
• PaCO2: 58 mmHg
• PaO2: 62 mmHg
• HCO3: 30 mEq/L
• SaO2: 90%

Indicates respiratory acidosis with metabolic compensation, consistent with chronic CO2 retention and impaired gas exchange.

Complete Blood Count (CBC)

• WBC: 13.8 103/L
• Hemoglobin: 17.9 g/dL
• Hematocrit: 54%

Elevated Hgb/Hct consistent with secondary polycythemia due to chronic hypoxia.

Chest X-Ray Findings

• Hyperinflated lungs
• Flattened diaphragms
• Increased bronchial markings
• No acute infiltrates

Nursing Diagnosis

Impaired Gas Exchange related to alveolar-capillary membrane changes and airflow obstruction secondary to COPD, as evidenced by hypoxemia, hypercapnia, dyspnea, abnormal ABGs, and decreased oxygen saturation.

Key Nursing Concerns

• Inadequate oxygenation
• CO2 retention
• Risk for respiratory failure
• Anxiety related to dyspnea
• Risk for infection

Common Nursing Interventions (Brief Overview)

• Monitor SpO2 and ABGs closely
• Maintain low-flow oxygen as ordered (avoid over-oxygenation)
• Position in high-Fowlers or tripod
• Encourage pursed-lip breathing
• Administer bronchodilators, corticosteroids, and antibiotics as prescribed
• Promote effective coughing and secretion clearance
• Assess for changes in mental status (early sign of CO2 retention)