❣️ Impaired gas exchange is the highest-priority nursing diagnosis because the client has an oxygen saturation of 88% on room air, which indicates significant hypoxemia.

❣️ The client also has labored breathing, tachypnea at 24/min, diminished breath sounds, and shortness of breath, all of which support impaired oxygen transfer at the alveolar-capillary level.

❣️ The presence of a left upper-lobe lung mass and mild obstructive pulmonary changes can further interfere with ventilation and effective oxygenation.

❣️ According to the airway, breathing, circulation (ABC) priority framework, problems affecting breathing and oxygenation take precedence over pain, nutrition, and potential infection.

❣️ Prompt interventions may include positioning, supplemental oxygen as prescribed, respiratory reassessment, and monitoring for worsening hypoxemia or respiratory distress.

Ambulation

✳️ Progressive ambulation can improve ventilation, promote lung expansion, and help mobilize respiratory secretions in a client experiencing pulmonary symptoms.

✳️ Regular activity also helps reduce deconditioning and fatigue, which can become significant problems in clients with cancer and chronic respiratory impairment.

✳️ Ambulation should be introduced according to the client's tolerance because the current SpO₂ of 88% and labored breathing indicate that oxygenation must be monitored closely during activity.

✳️ Appropriate activity can improve functional capacity and support more effective breathing when combined with rest periods and other pulmonary rehabilitation strategies.

✳️ Ambulation is therefore an appropriate non-pharmacological intervention once the client's oxygenation and respiratory status are sufficiently stabilized.

Albuterol

✳️ Albuterol is a short-acting beta₂-adrenergic agonist that relaxes bronchial smooth muscle and produces rapid bronchodilation.

✳️ The client's PFTs show a mild obstructive pattern, making bronchodilator therapy potentially useful for reducing reversible airway narrowing and improving airflow.

✳️ Improved airway caliber can decrease dyspnea, wheezing, chest tightness, and work of breathing when bronchospasm or obstructive airway disease contributes to symptoms.

✳️ The nurse should assess respiratory rate, breath sounds, oxygen saturation, and response to treatment while monitoring for adverse effects such as tachycardia or tremor.

✳️ Albuterol can therefore be anticipated as a pharmacological strategy for symptomatic airflow limitation associated with the client's obstructive pulmonary findings.

Breathing exercises

✳️ Breathing exercises, including diaphragmatic breathing and pursed-lip breathing when appropriate, can help clients control dyspnea and improve ventilation efficiency.

✳️ These techniques encourage more deliberate respirations and can reduce the sensation of air hunger and excessive work of breathing.

✳️ Deep-breathing exercises also promote alveolar expansion and can assist with mobilization of secretions when combined with effective coughing.

✳️ Teaching breathing techniques gives the client a non-pharmacological method to manage episodes of shortness of breath and anxiety associated with respiratory distress.

✳️ Breathing exercises are therefore appropriate supportive therapy for this client's dyspnea, labored respirations, and reduced pulmonary function.

1. Assess airway/breathing

🧿 The nurse should first assess airway patency, respiratory effort, breath sounds, respiratory rate, and oxygenation because breathing problems can become immediately life-threatening.

🧿 The client already demonstrates shortness of breath, labored respirations, diminished breath sounds, tachypnea, and an SpO₂ of 88% on room air, confirming significant respiratory compromise.

🧿 Assessment establishes the client's baseline status and helps determine the severity of the impaired gas exchange before interventions are initiated.

🧿 The **ABC framework—airway, breathing, circulation—**places respiratory assessment ahead of medications, teaching, and other supportive interventions.

🧿 Rapid assessment therefore allows the nurse to identify deterioration and select the safest immediate intervention for the client's oxygenation needs.

2. Apply oxygen

🧿 After respiratory assessment, supplemental oxygen should be applied because the client's SpO₂ of 88% indicates clinically significant hypoxemia.

🧿 Oxygen therapy increases the concentration of oxygen available for diffusion across the alveolar-capillary membrane and helps improve tissue oxygen delivery.

🧿 The nurse should administer oxygen using the prescribed device and titrate therapy according to the client's clinical response and ordered saturation target.

🧿 Oxygen saturation, respiratory rate, work of breathing, mental status, and skin color should be reassessed to determine whether the intervention is effective.

🧿 Correcting hypoxemia takes priority before less urgent interventions because inadequate oxygenation can rapidly compromise the brain, heart, and other vital organs.

3. Administer medications

🧿 Once immediate oxygenation support is established, the nurse should administer prescribed medications aimed at improving the client's respiratory symptoms and airflow.

🧿 A bronchodilator such as albuterol may be prescribed because the pulmonary function tests demonstrate a mild obstructive pattern.

🧿 Bronchodilation relaxes bronchial smooth muscle, decreases airway resistance, and can reduce dyspnea and work of breathing when reversible bronchospasm is contributing to symptoms.

🧿 The nurse should monitor for therapeutic response and adverse effects such as tachycardia, tremor, or palpitations after administration.

🧿 Pharmacologic therapy follows immediate assessment and oxygen support because medications require time to exert their effects and do not replace urgent stabilization of hypoxemia.

4. Initiate breathing exercises

🧿 After the client's immediate respiratory status has been supported, breathing exercises can help improve ventilation and provide additional control over dyspnea.

🧿 Techniques such as diaphragmatic breathing and pursed-lip breathing can decrease respiratory effort and promote more effective air movement and exhalation.

🧿 Deep breathing may also encourage alveolar expansion and help mobilize respiratory secretions when paired with effective coughing.

🧿 The client should be taught these techniques when sufficiently stable to participate without worsening fatigue or respiratory distress.

🧿 Breathing exercises are therefore an important supportive intervention but come after assessment, oxygen therapy, and necessary medications.

5. Educate client and family

🧿 Client and family education is important but should occur after the client's immediate physiologic needs have been stabilized.

🧿 Teaching may include information about lung cancer, prescribed medications, oxygen therapy, breathing techniques, nutrition, warning signs, and the treatment plan.

🧿 Education is most effective when the client is comfortable, adequately oxygenated, and able to concentrate, rather than struggling to breathe.

🧿 Family involvement can strengthen adherence, emotional support, symptom monitoring, and preparation for future treatments or procedures.

🧿 Education therefore appropriately occurs last in this sequence because life-threatening breathing and oxygenation problems take priority over learning needs.

Accessory muscle use

❣️ A reduction or absence of accessory muscle use indicates that the client is breathing with less effort and experiencing decreased respiratory distress.

❣️ Accessory muscles are recruited when normal respiratory muscles cannot adequately meet the body's ventilatory demands, making their use an important indicator of increased work of breathing.

❣️ This client initially demonstrates labored breathing, so decreased accessory muscle involvement would provide observable evidence that respiratory function is improving.

❣️ The nurse should assess the neck, shoulders, and intercostal muscles for retractions or excessive movement while comparing findings with the client's previous respiratory assessment.

❣️ Decreased accessory muscle use therefore represents a meaningful clinical indicator of improved ventilation and reduced work of breathing.

Respiratory rate

❣️ Respiratory rate is an objective and measurable indicator that can be trended to evaluate changes in respiratory status.

❣️ The client's initial respiratory rate of 24/min indicates tachypnea, which is consistent with dyspnea and increased work of breathing.

❣️ Improvement would be demonstrated by the respiratory rate moving toward the expected adult range while respirations become regular and less labored.

❣️ A decreasing respiratory rate should be interpreted together with oxygen saturation, breath sounds, mental status, and work of breathing to ensure the client is genuinely improving.

❣️ Respiratory rate therefore provides an important measurable criterion for determining whether interventions are improving the client's ventilatory status.

SpO₂

❣️ SpO₂ provides an objective measurement of arterial oxygen saturation and is one of the most useful indicators for evaluating respiratory improvement.

❣️ The client's initial oxygen saturation of 88% on room air indicates significant hypoxemia and requires prompt intervention and continued monitoring.

❣️ An increase in oxygen saturation toward the prescribed target would demonstrate improved oxygenation and gas exchange.

❣️ Pulse oximetry allows the nurse to assess the client's response to interventions such as oxygen administration, positioning, bronchodilator therapy, and breathing techniques.

❣️ A sustained improvement in SpO₂ therefore provides strong measurable evidence that the client's respiratory status is improving.

Perform venipuncture for blood draws to monitor coagulation studies.

♦️ An appropriately trained LPN can perform venipuncture and collect blood specimens when this skill is permitted by applicable scope-of-practice and facility policies.

♦️ Clients receiving anticoagulation require laboratory monitoring appropriate to the prescribed drug, such as aPTT, anti-Xa, PT, or INR when indicated.

♦️ Specimen collection is a technical task that does not require the RN to independently formulate a nursing diagnosis or care plan.

♦️ The RN remains responsible for evaluating clinically significant laboratory findings and determining whether the client's overall plan of care requires modification.

♦️ Venipuncture can therefore be delegated to a qualified LPN while the RN retains responsibility for interpretation and clinical decision-making.

Administer anticoagulant injections and monitor for signs of bleeding.

♦️ Medication administration, including prescribed subcutaneous anticoagulant injections, is generally within the scope of practice of a qualified LPN.

♦️ The LPN can observe for routine findings such as bruising, injection-site bleeding, hematuria, or other signs of anticoagulant complications.

♦️ Any abnormal findings should be promptly communicated to the RN for additional assessment and clinical decision-making.

♦️ The RN retains responsibility for evaluation of complex or unstable findings and for modification of the nursing plan.

♦️ Administration of ordered anticoagulants with routine observation is therefore appropriate for delegation to the licensed practical nurse.

Assist the client with ambulation and report any complaints of sudden chest pain or dyspnea.

♦️ A nursing assistant can provide ambulation assistance when the client's condition is sufficiently stable and activity has been approved.

♦️ Ambulation is a routine task that does not require independent nursing judgment when clear instructions and safety parameters are provided.

♦️ The nursing assistant should be instructed to immediately report sudden dyspnea, chest pain, dizziness, or weakness rather than interpreting those findings independently.

♦️ The RN must assess any new cardiopulmonary symptoms because they can indicate worsening pulmonary embolism or another acute complication.

♦️ This delegation appropriately uses the NA for routine mobility while ensuring that abnormal symptoms are rapidly reported to licensed nursing staff.

Monitor the client's oxygen saturation and respiratory status every 2 hours.

♦️ An experienced LPN can collect focused respiratory data such as oxygen saturation, respiratory rate, breathing pattern, and breath sounds as part of ongoing monitoring.

♦️ Pulse oximetry is an objective measurement that can be obtained and reported by appropriately trained nursing personnel.

♦️ The LPN should immediately report worsening hypoxemia, increased respiratory effort, new chest pain, or other significant changes to the RN.

♦️ The RN remains responsible for comprehensive assessment and evaluation when the client becomes unstable or develops new findings.

♦️ Routine respiratory monitoring can therefore be delegated to the LPN while the RN maintains accountability for interpreting changes and directing care.