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
Risk for Infection
- Risk for Infection
May be related to
- Contaminated water aspiration
- Gastric contents aspiration
- Increased secretions
Possibly evidenced by
- [not applicable]
- Client will be free of infection, as evidenced by normal vital signs and absence of purulent drainage from wounds, incisions, and tubes.
|Assess client’s temperature.||Fever provides data about the client’s response to invading organisms and is a sign of infection.|
|Assess for any signs of respiratory difficulties.||Early assessment promotes immediate intervention.|
|Monitor the client’s sputum including the amount, color, and odor.||Yellow or yellow-green sputum is indicative of respiratory infection.|
|Monitor client’s white blood cell count and culture studies.||WBC elevation indicates the body’s effort to combat pathogens and is a sign of infection. Blood should be cultured from all clients who have aspirated water. Laboratory cultures determine the pathogen present and guide the selection of antimicrobial therapy.|
|Monitor chest x-ray results as ordered.||Aspiration of contaminated water during near-drowning puts the client at risk for pneumonia.|
|Encourage the use of an incentive spirometer when the client is neurologically stable.||Incentive spirometers improve lung expansion and reduce alveolar collapse.|
|Maintain the client in an upright position.||An upright position promotes optimal lung expansion and improved air exchange and reduces the risk for the stasis of secretions.|
|Maintain body temperature with cooling or warming blankets as indicated.||Continued hypothermia increases the risk for sepsis.|
|Suction secretions as needed only. Provide a sputum sample for culture and sensitivity test.||Suctioning as needed reduces the stasis of secretions in the lungs and bronchial tree. Culture and sensitivity testing help determine the appropriate selection of antibiotics.|
|Reposition the client, and perform chest physical therapy as needed.||These maneuvers promote drainage (postural drainage) of the affected areas of lung tissue.|
|Administer antibiotics as ordered.||Antimicrobial agents either are toxic to the pathogen or retard the pathogen’s growth.|
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