Near-drowning is defined as survival for at least 24 hours from suffocation by submersion. Aspiration of water causes plasma to be pulled into the lungs, resulting in hypoxemia, acidosis, and hypovolemia. Hypoxemia results from the decrease in pulmonary surfactant caused by the absorbed water that leads to damage of the pulmonary capillary membrane. Severe hypoxia can also result from asphyxia related to submersion without aspiration of fluid.
Factors associated with near-drowning include an inability to swim, accidents/injuries, alcohol use, underlying seizure disorder or cardiac dysrhythmia, hyperventilation, and hypothermia. A client who has nearly drowned may be unresponsive. Other symptoms may include cold or pale skin, abdominal swelling, vomiting, cough with pink, frothy sputum, shortness or lack of breath, lethargy, and chest pain.
Freshwater drownings are far more common than saltwater drownings. Fresh water usually results in surfactant loss, and hence, producing areas of atelectasis. Saltwater aspiration, on the other hand, results in pulmonary edema due to the osmotic effects of the salt within the lung.
Nursing Care Plans
Therapeutic goals for a client who has nearly drowned include providing adequate oxygenation, maintaining a patent airway, maintaining cerebral perfusion, continuous monitoring, providing rewarming methods, and absence of complications.
- Impaired Gas Exchange
- Ineffective Cerebral Tissue Perfusion
- Deficient/Excess Fluid Volume
- Risk for Infection
- Risk for Decreased Cardiac Output
Impaired Gas Exchange
- Impaired Gas Exchange
May be related to
- Aspiration (Freshwater or Saltwater)
- Pulmonary capillary membrane damage
- Pulmonary edema
- Pulmonary surfactant elimination
Possibly evidenced by
- Abnormal arterial blood gases
- Abnormal breathing rate, depth, and rhythm
- Bluish, pale appearance
- Frothy, pink-tinged sputum
- Client will maintain optimal gas exchange, as evidenced by arterial blood gases (ABGs) within client’s usual range, oxygen saturation of 90% or higher, alert, responsive mentation or no further decline in the level of consciousness, relaxed breathing, and baseline heart rate for the client.
|Assess the client’s level of consciousness.||Within three minutes of submersion, near-drowning clients are unconscious and are at risk for cerebral edema.|
|Assess the client’s respiratory rate, depth, and rhythm.||Changes in the respiratory rate and rhythm are early warning signs of impending respiratory difficulties. Impairment of gas exchange can result in both rapid, shallow breathing patterns and hypoventilation. Hypoxia is associated with increased breathing effort.|
|Auscultate lung for breath sounds such as crackles and wheezing.||Crackles are caused by fluid accumulation in the airways and by pulmonary edema. Wheezing is related to bronchospasm.|
|Monitor for signs of respiratory difficulties such as nasal flaring, stridor, retractions, and the use of accessory muscles.||The breathing pattern alters to increase chest excursion to facilitate effective breathing.|
|Assess for any signs of worsening pulmonary edema.||Pink, frothy sputum is a classic sign of pulmonary edema; this necessitates the need for mechanical ventilation.|
|Monitor oxygen saturation and ABGs as ordered.||Pulse oximetry is a useful tool to detect changes in oxygenation. Oxygen saturation should be at 90% or greater. Decreasing PaO2 and pulse oximetry readings and increasing PaCo2 are signs of respiratory failure.|
|Monitor chest-x-ray readings.||Chest X-ray reports on all submersion victims are done to assess for degree of aspiration and lung injury. Radiographic studies of lung water lag behind the clinical presentation by 24 hours.|
|Provide suctioning as per client’s need only.||Hypoxia and the Valsalva maneuver with suctioning may increase intracranial pressure (ICP).|
|Maintain the client’s airway and assist with ventilation as needed while protecting the cervical spine.||Maintaining patent airway is always the first priority. Cervical spine injuries should always be considered in victims of near-drowning especially after a dive.|
|Provide oxygenation as ordered.||If the client has spontaneous breathing, supplemental oxygenation is administered by mask.|
|Anticipate the need for intubation and mechanical ventilation.||The outcomes of pulmonary injury are a clinical picture of acute respiratory distress syndrome: pulmonary edema, atelectasis, hyaline membrane formation, and pulmonary capillary injury. Early intubation and mechanical ventilation are suggested to prevent full decompensation of the client. Mechanical ventilation provides supportive care to maintain adequate oxygenation and ventilation.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to respiratory system disorders:
- Asthma | 8 Care Plans
- Bronchiolitis | 5 Care Plans
- Bronchopulmonary Dysplasia (BPD) | 5 Care Plans
- Chronic Obstructive Pulmonary Disease (COPD) | 7 Care Plans
- Cystic Fibrosis | 5 Care Plans
- Hemothorax and Pneumothorax | 3 Care Plans
- Influenza (Flu) | 5 Care Plans
- Lung Cancer | 5 Care Plans
- Mechanical Ventilation | 6 Care Plans
- Near-Drowning | 5 Care Plans
- Pleural Effusion | 6 Care Plans
- Pneumonia | 11 Care Plans
- Pulmonary Embolism | 4 Care Plans
- Pulmonary Tuberculosis | 5 Care Plans
- Tracheostomy | 5 Care Plans