Which of the following clients are likely experiencing a shift to the right in the dissociation curve? Select all that apply
A) A client with respiratory influenza with a temperature of 102.6°F
B) A COPD client with pneumonia with blood gas pH level of 7.31
C) A renal failure client with admitting hemoglobin level of 8.0 mg/dL
D) A client having a panic attack with respiratory rate of 36 and marked decreased PCO2 levels
E) A client who fell in an icy pond with admitting core body temperature of 94.1°F
Ans: A, B, C
Feedback:
A shift to the right indicates that the affinity of hemoglobin for oxygen is decreased and the PO2 that is available to the tissues at any given level of hemoglobin saturation is increased. It usually is caused by conditions that produce an increase in tissue metabolism, such as fever or acidosis, or by an increase in PCO2. High altitude and conditions such as pulmonary insufficiency, heart failure, and severe anemia also cause the oxygen dissociation curve to shift to the right. A shift to the left indicates that the affinity of hemoglobin for oxygen is increased and the PO2 that is available to the tissues at any given level of hemoglobin saturation is decreased. It occurs in situations associated with a decrease in tissue metabolism, such as alkalosis, decreased body temperature, and decreased PCO2 levels.
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