NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00030 |
|---|---|
| Label | Impaired gas exchange |
| Spanish label | Deterioro del intercambio de gases |
| Domain | 3. Elimination and exchange |
| Class | 4. Respiratory function |
| Type | Problem-focused |
| Status | Current |
What it means
Oxygen doesn't move well from the alveoli into the blood, or CO₂ doesn't move well from the blood into the alveoli. The result is low blood oxygen, CO₂ retention or both, even when the patient's respiratory rate and effort look acceptable.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Pneumonia, pulmonary edema or ARDS.
- COPD and asthma exacerbations.
- Pulmonary embolism.
- Postoperative atelectasis.
- Heart failure with pulmonary congestion.
- A patient who needs supplemental oxygen to maintain the target saturation.
What to assess
- Oxygen saturation at rest and with exertion.
- Arterial blood gas if ordered: PaO2, PaCO2, pH and bicarbonate.
- Skin and mucous membrane color, cyanosis.
- Mental status: restlessness, confusion or drowsiness may signal hypoxia or CO₂ retention.
- Heart rate, respiratory rate and work of breathing.
- Breath sounds and the oxygen being delivered: device, flow rate or FiO2, and whether it is positioned correctly.
- History of COPD or CO₂ retention, which changes the saturation target.
- Activity tolerance: how much saturation drops with movement or eating.
Defining characteristics
Assessment findings that support the diagnosis. They go in the "as evidenced by" part of the statement.
- SpO2 below the patient's target, for example under 90% on room air.
- Low PaO2 on arterial blood gas.
- Elevated PaCO2, with or without acidotic pH.
- Cyanosis of the lips, nail beds or mucous membranes.
- Restlessness, confusion or drowsiness with no other cause.
- Morning headache, typical of CO₂ retention.
- Tachycardia.
- Dyspnea and nasal flaring.
- Saturation that drops with minimal exertion, such as sitting up or eating.
- Pale, cool or diaphoretic skin.
Related factors
The causes nursing can act on. They go in the "related to" part of the statement.
- Prolonged supine positioning.
- Shallow breathing due to chest or abdominal pain.
- Retained secretions filling the airway.
- Activity beyond the patient's tolerance that increases oxygen demand.
- Incorrect use of the oxygen device: nasal cannula out of the nose, poorly fitted mask, flow rate changed.
- Current smoking.
- Insufficient knowledge about using inhalers or home oxygen.
At-risk populations
- Older adults with chronic lung disease.
- Current smokers or people with a long smoking history.
- Patients recovering from thoracic or upper abdominal surgery.
- Bedbound patients or people with significant obesity.
- Preterm newborns.
- ICU patients or patients on mechanical ventilation.
Associated conditions
- Pneumonia, including COVID-19 pneumonia.
- COPD and asthma exacerbations.
- Pulmonary edema and heart failure.
- Acute respiratory distress syndrome (ARDS).
- Pulmonary embolism.
- Pulmonary fibrosis and other interstitial lung diseases.
How to write it (PES)
Impaired gas exchange related to shallow breathing from pleuritic pain and prolonged supine positioning as evidenced by SpO2 of 86% on room air, drowsiness and PaCO₂ of 55 mmHg on ABG.
Impaired gas exchange (00030).
What worsens gas exchange that nursing can modify: positioning, shallow breathing, secretions, exertion. Ventilation-perfusion mismatch or alveolar-capillary membrane damage are treated as associated conditions.
Objective data: saturation, ABG values and the clinical signs of hypoxia or hypercapnia.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Patient maintains an oxygen saturation of 92% or higher (or 88-92% with COPD and CO₂ retention).
- Patient is awake and oriented within 12 hours.
- Follow-up ABG shows improvement compared with the baseline.
- By day 2, patient tolerates sitting in the chair for 30 minutes without saturation falling below target.
- Before discharge, patient explains and correctly uses the oxygen device.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Give oxygen as prescribed with the ordered device and flow rate, and document saturation. | Corrects hypoxemia; in COPD, stay within the target to avoid raising CO₂. |
| Use semi-Fowler's or Fowler's position and reposition regularly. | Improves ventilation-perfusion matching. |
| Monitor mental status every shift. | Behavior changes appear early in hypoxia and hypercapnia. |
| Encourage coughing and deep breathing or incentive spirometry. | Reopens collapsed alveoli. |
| Manage chest or abdominal pain with the prescribed analgesia. | With less pain, the patient breathes more deeply and ventilates the bases better. |
| Cluster activities to allow rest periods. | Reduces oxygen consumption. |
| Check every shift that the oxygen device is positioned correctly and set to the prescribed flow. | A nasal cannula that has slipped out of the nose explains many desaturations. |
| Collect ABG samples as ordered and report abnormal results. | Allows support to be adjusted in time. |
| Notify the provider if saturation drops below target or drowsiness increases. | The patient may need a change in ventilatory support. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 0402Respiratory Status: Gas Exchange
- 0916Acute Confusion Level
- 0403Respiratory Status: Ventilation
NIC interventions
- 3140Airway Management
- 3350Respiratory Monitoring
- 3320Oxygen Therapy
- 3300Mechanical Ventilation Management: Invasive
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: COPD exacerbation with pneumonia
Patient. Joaquín, 67, has COPD and a 40-year smoking history. He comes in with three days of worsening shortness of breath and is diagnosed with right lower lobe pneumonia. He spends most of the day lying on his back because his side hurts when he breathes.
Assessment
- SpO2 85% on room air.
- ABG: pH 7.33, PaO2 52 mmHg, PaCO2 58 mmHg.
- RR 28 breaths/min, HR 108 bpm.
- Drowsy but responds to voice.
- Circumoral cyanosis.
- Right-sided pain of 6/10 on deep inspiration.
- Crackles in the right base.
Nursing diagnosis
Impaired gas exchange related to shallow breathing from pleuritic pain and prolonged supine positioning as evidenced by SpO2 of 85% on room air, PaO2 of 52 mmHg, PaCO2 of 58 mmHg, drowsiness and circumoral cyanosis.
Goal
Joaquín maintains an SpO2 of 88-92% on prescribed oxygen within the first hour and is alert at 12 hours.
Interventions
- Oxygen by Venturi mask at the prescribed FiO2 with continuous SpO2 monitoring.
- Fowler's position and turning to side-lying every 2 hours.
- Prescribed analgesia and deep breaths every hour while awake.
- Mental status checks every hour for the first 6 hours.
- Follow-up ABG as ordered; notify the provider if PaCO2 rises.
Evaluation
At 1 hour he maintains an SpO2 of 90%. At 12 hours he is alert and the ABG shows pH 7.36 and PaCO2 51 mmHg. The diagnosis stays active because he still needs oxygen; it is reassessed daily.
How it differs from similar diagnoses
- Ineffective breathing pattern (00032): Ineffective breathing pattern: the problem is how the patient breathes (rate, depth), not exchange at the alveolus.
- Ineffective airway clearance (00031): Ineffective airway clearance: the problem is secretions blocking airflow.
- Impaired spontaneous ventilation (00033): Impaired spontaneous ventilation: the patient cannot sustain breathing on their own.
Common mistakes
- Using it without objective oxygenation data: it rests on saturation, ABGs or clear signs of hypoxia.
- Writing "related to pneumonia" instead of something nursing can modify.
- Turning up the oxygen without a saturation target in patients with COPD.
- Trusting pulse oximetry in a patient with poor peripheral perfusion or nail polish: the reading may be inaccurate.
Assessment scales
Used in these conditions
Other diagnoses in the Respiratory function class
Domain 3, Elimination and exchange. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for impaired gas exchange?
00030, in Domain 3 (Elimination and exchange), Class 4 (Respiratory function). It is still current in the 2024-2026 edition.
Can impaired gas exchange and ineffective breathing pattern be used together?
Yes. One describes breathing mechanics and the other gas exchange; a patient with pneumonia can have both.
Do I need an ABG to use impaired gas exchange?
Not always: low saturation and clinical signs of hypoxia can support it, but an ABG confirms it.
Why is the SpO2 goal lower for COPD patients?
Some patients with COPD retain CO₂. If they get more oxygen than they need, CO₂ can rise and cause drowsiness. That's why the usual target is 88-92%, unless ordered otherwise.
When do I resolve this diagnosis?
When the patient maintains the target saturation on room air or on their usual home oxygen, and is alert.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Impaired gas exchange (00030) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1, source 2. Reviewed November 2, 2026.