a patient has O2 sat= 100% and we dont think they're hypoxic.. but then the tissues have 5g/100ml=tissue hypoxia.. so what? why is this important?'
my professor gave us an example btw three patients. all the pts have O2 sat of 100%.. the only difference is the Hgb.
pt 1 has Hgb of 5g/100ml
pt2 2 Hgb of 10g/100ml.
pt 3 has 15g/100ml she wanted to show how a patient with Hgb of 15 has more blood cells to be saturated with O2. a patient may have O2 sat=100%, but the patient w/ 5g/100ml does not have enough blood cells compared with the pt with 15g/100ml. so there's just a lot of oxygen in the body that is not being carried by red blood cells.
what happens to that excess oxygen not being picked up by RBCs? what will the patient look like if have only 5g/100ml of Hgb? they will be cyanotic?
what is the priority intervention for a person with cyanosis?
[quote....... so there's just a lot of oxygen in the body that is not being carried by red blood cells.
what happens to that excess oxygen not being picked up by RBCs? what will the patient look like if have only 5g/100ml of Hgb? they will be cyanotic?
what is the priority intervention for a person with cyanosis?
how would you put this in a scenario?
Nope- there isn't a lot of oxygen in the body of the patient with the hgb of 5 at all. Think of it this way - You have a mini cooper, a ford f150 pickup, and a 18wheeler semi trailer. you can fill each of them 100% full with topsoil from the garden center. You won't be able to plant much of a garden from the mini's trunk, the ford's load will make a nice flower box, and from the semi trailer you can grow enough to feed the neighborhood. But each one was "100%" saturated with topsoil when it left the garden center. Hemoglobin is the oxygen carring truck for the body. Even if you saturate 100% if you don't have enough little trucks full of oxygen going out you will be starving the tissues in the end. Odds are you are not going to see cyanosis- the arteries and capillaries are still being fed bright red blood, it is just mighty purple by the time it gets back to the lungs. You will see palor, and very poor activity tollerence, weakness, and dyspnea on exertion, tachycardia and in extream cases confusion. We spend a lot of time trying to convince our intensiveists and respiratory therapists that a post surgical patient with a O2 sat of 94% is not OK, even though the textbooks say 94% is an acceptable saturation. If they are anemic then they need 96% or greater- and even then it may not be enough. Only 2-5% of oxygen CAN be carried in the serum without being bound to hemoglobin. You can usualy discount this amount since unless the patients 100% saturated the serum oxygen is quickly picked up into the blood cells.
Think of it this way - You have a mini cooper, a ford f150 pickup, and a 18wheeler semi trailer. you can fill each of them 100% full with topsoil from the garden center. You won't be able to plant much of a garden from the mini's trunk, the ford's load will make a nice flower box, and from the semi trailer you can grow enough to feed the neighborhood. But each one was "100%" saturated with topsoil when it left the garden center.
There's a more direct way to help a patient that has a very low H&H. It does involve giving a substance by IV though. Can you think of it?
A blood transfusion. I have a lot of Jehovahs Witnesses at my hospital. How would you handle the situation with a patient who refuses blood transfusions.
Specializes in Acute Care Cardiac, Education, Prof Practice.
I always thought of it as this:
You can have a blood cell carrying as much oxygen as it can (saturation) but if you don't have enough blood cells all together then you aren't in total carrying enough oxygen to support your body.
Tait
Yeah I see someone already hit this :) But I will leave it up as another version.
As most of you nurses know......This situation is quite common in our sickle cell population, only they also present in extreme pain. Also depending on how bad the crisis is you may not just give blood. If they "live" with a hg of 6-7 and they are now 5 it is more of a sickle problem....
Just another reason the fully look at your pts history....
Specializes in SICU, EMS, Home Health, School Nursing.
I have lived this, my hgb was 6.3, 02 on RA was 96% and 100% 2/L. I was very short of breath because of course there is not enough RBC's to carry the O2. So of course I was extremely SOB and had a hard time convincing a new nurse that I needed O2. She kept telling me, your 02 sat is 96% you do not need 02. Well yeah I did. I am not receiving enough O2 because my Hgb is 6.3, so I explained if there are not enough RBC's to carry the O2, I need the O2. Sats are going to be normal, they do not measure the RBC's. Understand?? Maybe that is not what you are looking for?
This is a perfect example of why you should always treat the patient and not the monitor.
One thing to always keep in mind about oxygen saturation on the monitor... Like the post I quoted mentioned, a pulse ox does not measure the RBCs or even the percentage of oxygen a person needs vs what they are receiving. What it measures is the "saturation" of the cells, in other words, it measures the amount of blood cells that are actually saturated with oxygen or even some cases with carbon monoxide. For example you have a patient with a Hgb of 5 and all of the cells are saturated with oxygen, their pulse ox will read 100%, but since they have less than half of the oxygen carrying cells they need, their vital organs will not be receiving an adequate supply of oxygen. A pulse ox can give you a very misleading reading, so make sure you always treat your patient and not the monitor.
The person with a Hgb of 5 will most likely not be cyanotic. The majority of the time, they will be very pale and complain of feeling tired. Any oxygen that is not picked up by the RBCs is removed during exhalation. Your priority interventions for any patients should always be ABC. Always make sure they are breathing adequately first and foremost. If their breathing isn't adequate, who cares what their Hgb is. Then check out their circulation. Try to figure out why their Hgb is so low, correct the problem and replace the blood that has been lost.
Oxygen is exchanged at the alveolar level in the lungs- if there is no hgb to pick it up, it does enter the bloodstream as far as I understand.
Sorry I mistyped there. It should read..."it does not enter the bloodstream". for some reason I couldn't edit my previous post.
I think this is a great thread. Thank you CoreO for your great post. I, too was operating under an incorrect definition of cyanosis. Just goes to show that you can know something but not really know it.
a patient has O2 sat= 100% and we dont think they're hypoxic.. but then the tissues have 5g/100ml=tissue hypoxia.. so what? why is this important?'
my professor gave us an example btw three patients. all the pts have O2 sat of 100%.. the only difference is the Hgb.
pt 1 has Hgb of 5g/100ml
pt2 2 Hgb of 10g/100ml.
pt 3 has 15g/100ml she wanted to show how a patient with Hgb of 15 has more blood cells to be saturated with O2. a patient may have O2 sat=100%, but the patient w/ 5g/100ml does not have enough blood cells compared with the pt with 15g/100ml. so there's just a lot of oxygen in the body that is not being carried by red blood cells.
what happens to that excess oxygen not being picked up by RBCs? what will the patient look like if have only 5g/100ml of Hgb? they will be cyanotic?
what is the priority intervention for a person with cyanosis?
how would you put this in a scenario?
The patient would look dead, or almost dead, that's what they would look like.
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EricJRN, MSN, RN
1 Article; 6,683 Posts
There's a more direct way to help a patient that has a very low H&H. It does involve giving a substance by IV though. Can you think of it?