Question

You are caring for a client with chronic lung disease who is being maintained with mechanical ventilation. You have just gotten this client's laboratory results, and the client's pH is 7.24. Which is the most appropriate nursing diagnosis for this client?

A) Impaired Gas Exchange
B) Ineffective Breathing Pattern
C) Risk for Aspiration
D) Altered Tissue Perfusion

Answer 1

The most appropriate nursing diagnosis for a client with chronic lung disease, maintained with mechanical ventilation, and presenting with a pH of 7.24, is 'Impaired Gas Exchange'.

Step-by-step explanation:

You are caring for a client with chronic lung disease who is being maintained with mechanical ventilation. You have just gotten this client's laboratory results, and the client's pH is 7.24. Given the acidity indicated by the pH value, this suggests respiratory acidosis. Among the nursing diagnoses presented, Impaired Gas Exchange is the most appropriate for a client with a pH of 7.24. When compliance of the lung decreases, or when resistance increases leading to obstruction of the airways, breathing becomes more difficult.

These changes can be indicative of restrictive or obstructive diseases, and both affect gas exchange due to the mismatch of ventilation and perfusion (V/Q mismatch). This is what's likely happening with a patient receiving mechanical ventilation who presents a low pH, indicating a respiratory acidosis. Therefore, since this client's primary issue revolves around gas exchange, 'Impaired Gas Exchange' would be the most accurate nursing diagnosis.