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.
Here are five (5) nursing care plans and nursing diagnosis (NDx) for near-drowning:
- Impaired Gas Exchange
- Ineffective Cerebral Tissue Perfusion
- Deficient/Excess Fluid Volume
- Risk for Infection
- Risk for Decreased Cardiac Output
Deficient/ Excess Fluid Volume
Nursing Diagnosis
May be related to
- Deficit
- Saltwater aspiration
- Fluid shift from intravascular to interstitial space
- Excess
- Freshwater aspiration
- Fluid shift from interstitial to intravascular space
Possibly evidenced by
- Deficit
- Dark colored urine
- Decreased urine output less than 30 ml per hour
- Decreased blood pressure
- Hemoconcentration
- Increase heart rate
- Excess
- Decreased hemoglobin and hematocrit levels
- Distention of jugular vein
- Increased blood pressure
- Increased central venous pressure (CVP)
- Weight gain over a short period
Desired Outcomes
- Client will maintain adequate fluid volume, as evidenced by urine output greater than 30 ml per hour, normotensive blood pressure, and heart rate less than 100 beats per minute.
Nursing Interventions | Rationale |
---|---|
Assess for any changes in weight. | Body weight is a more sensitive indicator of fluid volume status than intake and output. 2.2 pounds of weight gain is equivalent to 1 liter of fluid. |
Assess client’s intake and output; Monitor urine specific gravity. | Although total fluid intake may be sufficient, shifting of fluid out of the intravascular and into the extravascular spaces may lead to dehydration and decrease output. Specific gravity measurement provides information on the degree of fluid concentration or dilution. |
Assess for crackles and shortness of breath. | These signs are caused by fluid accumulation in the lungs. However, the presence of crackles on auscultation or pulmonary congestion on x-ray film may not indicate fluid overload if the client has a saltwater aspiration, which pulls water from the circulation into the alveoli. |
Note for any changes in heart rate and blood pressure. | Freshwater aspiration entering the circulation will expand the blood volume and increase HR and BP |
Assess for distended neck veins. | Clients with expanded volume will exhibit elevated CVP and distended neck veins. |
Monitor client’s laboratory values, as ordered: | |
| This assessment determines the level of hemodilution or concentration. |
| Dehydration is a hyperosmolar state in which serum sodium levels rise. Serum sodium levels decline with hemodilution. |
| Hypokalemia may result from the increase in urinary output. |
| Acidosis and alkalosis require correction. Specific change guide the treatment approach. |
Monitor the client’s central venous pressure. | This direct measurement serves as an optimal guide for therapy. Severe hypovolemia will cause decreasing CVP, indicating the need for volume expanders. Fluid excess increases CVP. |
Assist the physician with the insertion of a central venous line and arterial line as ordered. | These measures allow for more effective fluid administration and facilitate hemodynamic monitoring. |
Administer IV fluids as ordered. | Fluids are given to maintain hydration status in clients with a fluid deficit. |
Administer fluid volume expanders as ordered. | Volume expanders are the intravenous fluid solutions that are used to increase or retain the volume of fluid in the circulating blood. It can also correct fluid imbalances. |
Administer sodium bicarbonate as ordered. | Metabolic acidosis is corrected by the administration of sodium bicarbonate. |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- 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, 2021-2023Â (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.
See Also
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