Gas Exchange
Michelle Schultz
Definition
• The process by which oxygen is transported to
cells and carbon dioxide is transported from
cells. (Giddens,p.161)
• Requires interaction among the neurologic,
respiratory, and cardiovascular systems.
Impaired Gas Exchange
• Impaired gas exchange represents a variety of
physiologic process.
• Three board categories that describe these
– Ventilation
– Transport
– Perfusion
Ventilation
• Process of inhaling oxygen into the lungs and
exhaling carbon dioxide from the lungs
• Impaired by the unavailability of oxygen as
well as by any disorder affecting the
nasopharynx and lungs.
• Pt had multiple rib fractures cause
hemothorax
Hemothroax
• Hemothorax is a collection of blood in the
space between the chest wall and the lung
(the pleural cavity)
• Admitting Diagnoses:
– Following a fall that caused him to hit head and
fractured his ribs
– Puncture caused hemothorax
Labs, Radiology, Medical Interventions
• Labs:
–
–
–
–
–
Hgb: 7.0 – low due to the blood loss from the chest tube
Hematocrit: 21.1 – low due to the blood loss from the chest tube
PT:16.5- high due to patients heparin drip
INR:1.5- high due to patients heparin dirp
APTT:34.8-WNL heparin is effective
• Radiology: x-ray of the lungs results: 9-14-14 showed hemothorax
at the base of the right lung and fractures of the 8th and 9th right
rib. Most recent chest was inserted on 9-23-14 and x-rays showed
tubes in the lungs between 6th and 7th intercostal space and the
lateral right side.
• Medical interventions : antiplatelet aggregations , Chest tube
Nursing Intervention
• Body Positioning and its effect on
oxygenation-a literature review
– Appropriate positioning of the critically ill can
dramatically improve gas exchange
• The ‘good lung down’ theory may be
contraindicated in certain lung pathologies
such as pulmonary abscess, pulmonary
hemorrhage and interstitial emphysema.
(Marklew,2006)
References
• Marklew A. Body positioning and its effect on
oxygenation -- a literature review. Nursing In
Critical Care. 2006 Jan-Feb 2006;11(1):16-22.
• Giddens, J.(2013). Concepts for nursing
practice. (p.161) St. Louis, MO:
Mosby/Elsevier.
NCLEX Question
Patients with suspicious masses in the lung as seen on
chest x-ray could have which of the following diagnostic
studies to provide information on soft tissue masses?
A.
B.
C.
D.
Gastrograffin swallow test
Pulmonary function tests (PFTs)
Wedge resection of the identified area of the lung
CAT scan and magnetic resonance imaging (MRI)
D. CAT scan and magnetic resonance imaging (MRI)
Rationale: The chest x-ray usually is the first
examination that the physician will order.
Suspicious masses seen on the chest x-ray could
signal the need for CAT scan and an MRI to provide
additional information about soft tissue masses.
The gastrograffin swallow test would be used to
diagnose an esophageal rupture, while a wedge
resection would be treatment for a lung mass.
NCLEX
The nurse is teaching a group of older clients about the
functions of the respiratory tract as part of health promotion.
Which statement made by patients would indicate a need for
further teaching?
A. ”The respiratory system helps maintain heat balance
in our bodies.“
B. "Our lungs keep the balance of acids and bases in
our bodies."
C. "Parts of our respiratory system help us produce
speech and better communication."
D. "The lungs keep our blood pressure in normal range,
so we can breathe better."
D. "The lungs keep our blood pressure in normal
range, so we can breathe better."
Rationale: The respiratory system performs
several secondary functions, including
maintenance of acid-base balance, production
of speech, and maintenance of body water and
heat balance. The heart and cardiovascular
system are responsible for the blood pressure.
NCLEX
All of the following nursing diagnoses are important
for a client with chronic pulmonary emphysema
(COPD). Which would receive priority when
planning nursing interventions?
A.
B.
C.
D.
Impaired gas exchange
Activity intolerance
Self-care deficit
Ineffective airway clearance
A. Impaired Gas Exchange
Rationale: Physical assessment of older
persons with COPD might find ineffective airway
clearance, but the classic physiology alteration is
the destruction of the alveoli with resulting
complications. Therefore, impaired gas exchange
always is present.
NCLEX
Chest percussion has been ordered for a client on bedrest
with respiratory infections and increased secretions. The
nurse should use which of the following hand positions to
administer chest percussion?
A.
B.
C.
D.
Cupped-hand position
Fisted-hand position
Flexed-hand position
Flat-hand position
A. Cupped-hand position
Rationale: Cupped-hand position enhances
vibration, which helps to loosen secretions, clear
airway, and improve gas exchange. The flat,
fisted, and flexed hand positions can cause pain
and harm the patient.
NCLEX
Which of the following is a normal finding when assessing
the respiratory system of an elderly client?
A.
A decreased anteroposterior diameter and
increased alveolar surface
B.Bronchovesicular breath sounds throughout the lungs
C.
Decreased mobility of the thorax and increased
chest wall stiffness
D.
Increased thoracic expansion and relaxation of
elastin tissues
C.
Decreased mobility of the thorax and
increased chest wall stiffness
Rationale: The normal aging process is
accompanied by physiologic changes to the
respiratory system such as stiffening of elastin and
collagen tissues, increased alveolar diameter,
decreased alveolar surface, and increased chest
wall stiffness. Bronchovesicular breath sounds are
heard over major bronchi where fewer alveoli are
located.