Concept:

Gas Exchange-
Transportation

Class 1/2
Karen Friedberg
 Goals for This Concept Presentation

1. Define and describe the concept of gas exchange

transportation (anemia).

2. Notice risk factors for anemia.

3. Recognize when an individual has compromised

gas exchange due to transportation (anemia).

4. Provide appropriate nursing and collaborative

interventions for optimizing
anemia.

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Elsevier Inc. All rights
reserved.
 Definition
 Gas exchange is the process by which
oxygen is transported to cells and carbon
dioxide is transported from cells.

 Transport refers to the availability of

hemoglobin and its ability to carry oxygen
from alveoli to cells for metabolism and
from cells to alveoli to be eliminated.
Scope
Review Red Blood Cell Production
 Reasons for Alteration in Gas
Exchange: Transport

Decreased number of RBC

 Blood loss
 Low production
 Cell destruction (hemolytic anemias)

Quality of RBC
 Anemias
 Consequence of Severe,
Unresolved
Impairment in Gas Exchange

Reduced oxygen in blood

(hypoxia)
Oxygen-Deprived
or Cell Death!
Tissues
Absence of oxygen in blood
(anoxia)

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Individual Risk Factors influencing
the number and quality of RBC

Modifiable Non-modifiable

Blood loss Heredity

Nutrition Age: Infants, children,

and older adults
Medications Gender

Environment Organ Dysfunction

Hydration Status
 Causes
Major cause of anemia
in a hospital is blood
loss (bleeding):
trauma, surgery
(√EBL), multiple blood
draws (ICU),
gastrointestinal,
uterine
 RECOGNIZE WHEN AN
INDIVIDUAL HAS
COMPROMISED GAS
EXCHANGE D/T
TRANSPORTATION ISSUES

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 Anemia
• Decreased RBC/Hemoglobin (Hb) content
that affects the O2 carrying capacity in the
body.

• Not a true disease

• Indicates an underlying disorder

• *Symptoms are similar regardless of

cause
 Types
Mild: Hb 10-12 gm/dL; asymptomatic.

Moderate: Hb 8-10 gm/dL; some fatigue,

dyspnea, and maybe palpitations. Possible pallor,
peripheral neuropathies, beefy tongue.
Why does this happen?

Severe: Hb 6.5-7.9 g/dL; pallor, tachycardia,

tachypnea, DOE, HA, anorexia, lethargy, and
angina.

Life threatening: Hb < 6.5 g/dL

Hmmmm…….
How do you assess
capillary refill in
older adults who
have thickened or
discolored fingers?

How do you assess

“skin changes”
associated with
anemia in people
of color?
 Common Diagnostic Tests
 Laboratory tests
– Complete blood count with indices
– Sickledex/Hemoglobin electrophoresis
– Blood typing and Rh factor
– Iron Studies
 Bone Marrow Aspirate and Biopsy
 Gene Analysis
 Endoscopy/colonoscopy for bleeding
episodes
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Bone Marrow Biopsy and Aspirate

 Patient Education
 Consent
 Prep
 Equipment
 Support
 Band-Aid (check
platelet count!)
 PROVIDE APPROPRIATE
NURSING AND
COLLABORATIVE
INTERVENTIONS TO
OPTIMIZE PERFUSION

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 Management Concept

How long it took a

person to develop
the problem, tells
you how severe
the symptoms are
and how fast the
treatment should
be.
 Clinical Management:
Primary Prevention
 Lifestyle choices: SAFETY
 Diet
 Preventing post operative
complications
 Correct medication
administration
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 Clinical Management:
Screening
 Patient education regarding
diagnostic testing

 Newborn screenings

 Genetic testing:

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 Subjective Assessments
 Past health history
 Medications
 Surgeries or other treatments
 Functional Health Patterns:
– Health Perception
– Nutritional/Metabolic Patterns
– Elimination Patterns (check for bleeding)
– Activity/Exercise
– Sleep/Rest (assess fatigue)
Subjective Assessments continued
 Cognitive/Perceptual Patterns
– Bone/joint; paresthesias
– Vision, hearing, taste or mental status
 Impact on function
 Role/relationship changes
 Sexuality/Reproductive Changes:
impotence, menstrual history, high risk
behaviors
 Coping/Value/Belief: Conflict with
transfusions or transplants
 Physical Exam

 Skin
 Cardiovascular
 Respiratory
 Gastrointestinal
 Neurological
 Clinical Management:
Collaborative Interventions

Treatment strategies depend on the

underlying condition and the age of
the patient.

Explain this statement.

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 Clinical Management:
Collaborative Interventions (Cont.)

 Pharmacotherapy
– Types of drugs
– Medication administration

 Nutrition therapy
 Activity
 Oxygen therapy
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 Interrelated Concepts
Collaborative Learning In your table
group, develop a list of the four most
important concepts interrelated to gas
exchange: transportation. Compare lists
with those of other learning groups. Defend
your answers.
Interrelated Concept Rationale

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 Exemplars

 Nutritional Anemias

 Sickle Cell Anemia


 Thalassemia

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Nutritional Anemias
Iron Deficiency

Folic Acid Deficiency

(including Celiac Disease)

Vitamin B12 Deficiency (diet)

Pernicious Anemia

Review of handout
 Nutritional Anemias: Recap
Which dietary food
groups best treat
these anemias?

 Iron Deficiency
 Folic Acid
 Vitamin B12
– Poor intake
– Pernicious (No
Intrinsic Factor)
 Hematology Scenario
A person had a gastric resection for peptic
ulcer disease 3 months ago in Colorado. She
now comes to the nursing clinic complaining
of SOB and fatigue with minimal exertion.
She is currently taking Protonix ® as her
only medication.

 What is the significance of the history of the gastric

resection?
 How might this contribute to this person’s lethargy?
 What is causing the SOB and fatigue?
 Describe what you would look for when doing your
physical exam.
 What labs would be appropriate to evaluate?
 What are your nursing outcomes?
 Teaching Plan
 Hemolytic Anemias

Problem: Red Blood Cell Destruction

Labs: Increased reticulocytes

Normal Indices

Management: Treat the cause and

symptoms
 Normal and Sickle Cells
 Autosomal
recessive: HbS
(40% of cells)
– Trait: 1 gene
– Disease: 2 genes

 Origin to combat
malaria (equator
countries)
 Sickle Cell Disease
 Chronic anemia over the lifespan

 Life expectancy: early middle age

 Issue with oxygenation leading to

ischemia

 Configuration of cells change in times of

stress, activity, cold, infection,
dehydration, and anesthesia
Voices of Sickle Cell
Disease
http://www.nytimes.com/interactiv
e/2011/03/02/health/healthguide/t
e_sicklecell.html
 1. Consumption 2. Cells now clump
of O2 causes the together creating
cell shape to sickle. further hypoxia.

3. Increased sickling
continues causing
blood vessel obstruction.
 Diagnosis
 Sickledex
 Mandatory screening at birth
 Rapid screen
 Does not differentiate trait from
disease

 Hemoglobin Electrophoresis
 Differentiates trait from disease
 Assesses abnormal vs. normal forms
of Hb
 Assess Immunoglobulins: IGM/IGA
 Additional Management
 Possible antibiotics to treat cause

 Vaccine for flu

 Oral PCN for dental work

 Multivitamin

 Transfusions not routine

 • Good Assessments
Nursing Care
• Address fears and
concerns re:
outcomes

• Access to healthcare

• Coping:
powerlessness,
anger, frustration

• Cultural differences

• Medic Alert Bracelet

 Thallesemia

• Inherited Disorder: Faulty Hb that easily

hemolyzes

• Cells do not function; no change in shape

• Screened at birth

• Mediterranean descent
Major vs. Minor
Major: 2 genes and symptomatic
Minor: 1 gene; asymptomatic

α chain defect: Asian

β chain defect: Cooley’s anemia (severe

form)
 Assessments
•Symptoms depend on the degree of
anemia

•Can lead to heart failure

•Hepatomegaly; splenomegaly

•Risk for fractured bones

 Diagnostics

CBC
•Hypochromic, microcytic RBC

•Target cells have a “bull’s eye”

appearance
 Treatment
• Repeated transfusion (up to 3X week!)
**Must watch for febrile/allergic reactions

• Now, a problem with Iron overload

(Hemasiderosis: bronze skin d/t body
trying to make more red blood cells).
**Must give chelating agents- painful
injections.

• ? BMT
 Nursing Care
• Assess cardiac function

• Risk for fractures:

safety

• Be alert for those

conditions that use up
O2

• Educate family

• Psychosocial support

• Developmental issues
 Audience Response Question

At an outpatient clinic, K.L.’s 78-year-old grandma is found to

have a Hgb of 8.7 g/dL (87 g/L) and a Hct of 35%. Based on the
most common cause of these findings in the older adult, the
nurse collects information regarding

a. a history of jaundice and black tarry stools.

b. a 3-day diet recall of the foods the patient has eaten.
c. any drugs that have depressed the function of the bone
marrow.
d. a history of any chronic diseases such as cancer or renal
disease.
Copyright © 2014 by Mosby, an
imprint of Elsevier Inc.
 Goal: To generate as many
Nursing Diagnosis for the
Round Robin topic of anemia.

Task: Starting in a group of

2, create one ND for any of
the anemias discussed.

After 10 seconds, time will

be called. Now find another
partner. Check what ND
your new partner has, and
generate a different ND for
the diagnosis of anemia.
You can add your partner’s
ND to your list if you do
not have it.

Time will be called again

and you must find another
partner and repeat the
process. Time frame: 5
minutes. The student with
the most ND wins!
 Goals for This Concept Presentation

1. Define and describe the concept of gas exchange

transportation (anemia).

2. Notice risk factors for anemia.

3. Recognize when an individual has compromised

gas exchange due to transportation (anemia).

4. Provide appropriate nursing and collaborative

interventions for optimizing
anemia.

Copyright © 2017,
Elsevier Inc. All rights
reserved.