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 Decreased Cardiac Output
- Risk for Decreased Cardiac Output
May be related to
- Decreased oxygenation
- Hypothermia-induced dysrhythmias
Possibly evidenced by
- [not applicable]
- Client will achieve an adequate cardiac output, as evidenced by strong peripheral pulses; normal vital signs; urine output greater than 30 ml per hour; warm. dry skin; and no further decrease in the level of consciousness.
|Monitor the skin temperature and color and peripheral pulses.||Peripheral vasoconstriction produces cool, pale, diaphoretic skin. Pulses may be weak with reduced output.|
|Monitor the client’s blood pressure.||Vasodilation occurs during rewarming and hypotension may happen unless the client is closely monitored with interventions as necessary. The direct intra-arterial monitoring of pressure should be anticipated for a continuing shock state.|
|Monitor client’s temperature.||Severe acute submersion hypothermia may be present. Myocardial contractility and vasomotor tone are decreased by hypothermia.|
|Assess for dysrhythmias.||Low perfusion state, acidosis, hypoxia, hypothermia, or electrolyte imbalance can result in cardiac dysrhythmia that can compromise stroke volume and cardiac output.|
|Monitor urine output.||Oliguria is a classic sign of inadequate renal perfusion from decreased cardiac output.|
|If hemodynamic monitoring is in place, assess the CVP, pulmonary artery diastolic pressure (PADP), pulmonary capillary wedge pressure, and cardiac output.||These direct measurements serve as optimal guides for therapy. CVP provides information on filling pressures of the right side of the heart; PADP and PCWP reflect left-sided fluid volume.|
|Monitor for the increased actions of medications as rewarming occurs.||Rewarming results in vasodilation and increased blood flow. These circulatory changes will alter the pharmacokinetic activity of medications.|
|Administer inotropic agents: digoxin, amrinone, dobutamine, or dopamine as ordered||If hypotension occurs, these agents improve myocardial contractility, which increases cardiac output.|
|Rewarm the client as appropriate (e.g., warm humidified oxygen, blankets, head wrap, or over-the-bed heaters, and IV fluids warmed to 98.6° TO 104° F, as appropriate).||Depending on the length of time of submersion, water temperature, and ambient air temperature, the core body temperature may be quite low so the client should be rewarmed slowly to avoid the rapid release of metabolites.|
|Administer plasma volume expanders, as ordered.||Volume expanders may be indicated to correct fluid imbalance and optimize cardiac output.|
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