Gas Exchange

Gas Exchange and Nursing Actions

• Gas Exchange Process:

  • Oxygen is transported to cells.

  • Carbon dioxide is transported from cells.

• Nursing Actions:

  • Primary Level of Care: Promote healthy behaviors to optimize Gas Exchange.

  • Secondary Level of Care: Identify individuals at risk for impaired Gas Exchange and recognize when an individual is impaired.

  • Tertiary Level of Care: Respond with appropriate interventions.

Clinical Judgement and Nursing Actions

• Clinical Reasoning:

  • Baseline History.

  • Problem-Based History: Onset, location, duration, severity, description, factors that alleviate or aggravate, other symptoms, and actions taken by the patient.

• Vital Sign Collection and Interpretation:

  • Breathing should be quiet and effortless at a rate appropriate for age.

  • Oxygen saturation (SaO_2) is between 95% and 100%.

  • Skin, nail beds, and lips have appropriate colors for the patient’s race.

  • Thorax is symmetric with equal thoracic expansion bilaterally.

  • Spinous processes are in alignment; scapulae are bilaterally symmetric.

  • The anteroposterior (AP) diameter of the chest is approximately a 1:2 ratio of AP to lateral diameter.

  • Trachea is midline.

  • Breath sounds are clear bilaterally.

Understanding Altered Perfusion

• Signs and Symptoms:

  • Cough, shortness of breath, and chest pain with breathing.

  • When a symptom is reported, a symptom analysis is conducted.

  • Auscultation and Inspection are key assessment techniques.

• Understand Test Results:

  • Arterial Blood Gases (ABGs): pH, \text{SaO}2, \text{PaO}2, \text{PaCO}2, \text{HCO}3

  • Complete Blood Count (CBC)

  • White Blood Cell Count (WBC)

  • Sputum analysis

  • Skin test

Medications for Gas Exchange

• Upper Airway Medications:

  • Antihistamines

  • Decongestants

• Lower Airway Bronchodilators

• Cough Suppressants

• Antimicrobials

• Oxygen

Perfusion Continuum

• Optimal Gas Exchange

• Altered Gas Exchange

• No Gas Exchange

Conditions Affecting Gas Exchange

• Ventilation Issues: Narrow airways, poor diffusion in alveoli, inadequate tissue function.

  • Examples: Asthma, COPD, Premature birth

• Transport Issues: Availability of hemoglobin and the ability to transport oxygen

  • Examples: Anemia, blood loss, sickle cell

• Perfusion Issues: Decrease in Cardiac output and tissue perfusion.

Gas Exchange Changes

• Temporary

• Long Term

• Permanent

Normal Process of Gas Exchange

• Neurological System

• Respiratory System

• Cardiovascular System

Interruption of Gas Exchange - Common Causes

• Congenital

• Genetic

• Injury

• Inflammation

• Infection

• Lifestyle

Results of Impaired Gas Exchange

• Hypoxia

• Ischemia

• Infarct

• Anoxia

• Cellular Death

Age-Related Changes

• Infancy:

  • Development of Surfactant.

  • Small airways and nose breathers.

• Child to Adolescent:

  • Continued Development.

• Older Adults:

  • Stiffening and Thickening of Tissue.

  • Decrease in elasticity of arterial walls of alveoli.