B2 · Poor oxygen exchange in the lungs
Actual Breathing and circulation
Definition
The lungs are not moving enough oxygen into the blood or carbon dioxide out, which may show as low oxygen readings, drowsiness, or confusion.- Pneumonia
- fluid in the lungs
- lung scarring
- shallow breathing after surgery
- Low oxygen readings
- fast breathing
- restlessness or confusion
- blue lips
- abnormal blood gas results
📋 Scenario
A woman with pneumonia has an oxygen saturation of 88% and is restless at night.
Subjective (S): "I feel like I'm not getting enough air, and I'm so tired."
Objective (O): Oxygen saturation 88% on room air; respiratory rate 26/min; restless at night; crackling sounds in the right lung; temperature 38.4 C.
Assessment tools for this scenario: CP-BREATH Breathing & Circulation Check CP-INFECT Infection Check
Validated scales to consider: NEWS2, SpO₂, ECG, qSOFA / sepsis screen
**CarePath diagnosis:** Poor oxygen exchange in the lungs related to pneumonia, as evidenced by low oxygen readings and fast breathing.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Raise the head of the bed. | Raising the head lets the diaphragm move down and the lungs expand, so more air reaches the air sacs where oxygen passes into the blood. |
| Give oxygen as ordered. | Extra oxygen raises the blood oxygen level when infected lungs cannot move enough oxygen across on their own. |
| Check oxygen and breathing often. | Frequent checks catch falling oxygen or rising breathing rate early. Restlessness can be an early sign that the brain is short of oxygen. |
| Encourage deep breathing and coughing. | Deep breathing opens collapsed air sacs and coughing clears mucus, so more of the lung can take part in gas exchange. |
| Report falling oxygen. | Prompt reporting lets the doctor change oxygen or treatment before the patient becomes exhausted or seriously short of oxygen. |
**Expected outcomes**
- Within 24 hours: oxygen saturation at or above 94% (or the doctor's target), breathing rate 12-20/ min, calm and oriented.
- By discharge: clear breath sounds.
**Linking the data to the diagnosis**
The patient has pneumonia, with oxygen saturation 88% on room air, breathing rate 26/min, crackling sounds in the right lung, temperature 38.4 C and restlessness at night. She says she is not getting enough air and feels very tired. This is an actual problem because the low oxygen is already measured, not just possible. Struggling to breathe comfortably could be confused with it, but the key finding here is the failure to move oxygen into the blood, not the feeling of effort. The plan aims for saturation at or above 94% (or the doctor's target), a normal breathing rate and calm orientation within 24 hours, and clear breath sounds by discharge.
CarePath diagnosis
Poor oxygen exchange in the lungs related to pneumonia, as evidenced by low oxygen readings and fast breathing.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Raise the head of the bed. | Raising the head lets the diaphragm move down and the lungs expand, so more air reaches the air sacs where oxygen passes into the blood. |
| 2. Give oxygen as ordered. | Extra oxygen raises the blood oxygen level when infected lungs cannot move enough oxygen across on their own. |
| 3. Check oxygen and breathing often. | Frequent checks catch falling oxygen or rising breathing rate early. Restlessness can be an early sign that the brain is short of oxygen. |
| 4. Encourage deep breathing and coughing. | Deep breathing opens collapsed air sacs and coughing clears mucus, so more of the lung can take part in gas exchange. |
| 5. Report falling oxygen. | Prompt reporting lets the doctor change oxygen or treatment before the patient becomes exhausted or seriously short of oxygen. |
Expected outcomes
- Within 24 hours: oxygen saturation at or above 94% (or the doctor's target), breathing rate 12-20/ min, calm and oriented.
- By discharge: clear breath sounds.
Linking the data to the diagnosis
The patient has pneumonia, with oxygen saturation 88% on room air, breathing rate 26/min, crackling sounds in the right lung, temperature 38.4 C and restlessness at night. She says she is not getting enough air and feels very tired. This is an actual problem because the low oxygen is already measured, not just possible. Struggling to breathe comfortably could be confused with it, but the key finding here is the failure to move oxygen into the blood, not the feeling of effort. The plan aims for saturation at or above 94% (or the doctor's target), a normal breathing rate and calm orientation within 24 hours, and clear breath sounds by discharge.