RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Medical & Surgical Nursing
Easy
In Carbon monoxide poisoning, what change would you expect in the skin color of the patient?
Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Explanation
- Carbon monoxide (CO) has an affinity for hemoglobin that is approximately 200 times greater than that of oxygen.
- When inhaled, CO binds to hemoglobin to form carboxyhemoglobin (COHb).
- Carboxyhemoglobin has a bright, cherry-red color, which imparts a characteristic pink or reddish hue to the skin and mucous membranes.
- This sign, while classic, may not be present in all patients and is often a late finding.
Why Other Options Were Wrong
- Option A: Bluish discoloration (cyanosis) is caused by an increased amount of deoxygenated hemoglobin, not carboxyhemoglobin. It indicates hypoxia from other causes.
- Option B: Yellowish discoloration (jaundice) is caused by elevated bilirubin levels in the blood, which is related to liver dysfunction or hemolysis, not CO poisoning.
- Option D: Purplish discoloration can be due to various causes like bruising (ecchymosis), bleeding disorders (purpura), or very severe, advanced cyanosis, but it is not the specific sign of CO poisoning.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pathophysiology and clinical signs of carbon monoxide poisoning in acute care settings.
- A key nursing responsibility is recognizing that the absence of cherry-pink skin does not rule out CO poisoning. Clinical suspicion should be high based on the patient's history (e.g., exposure to faulty heaters, fires, car exhaust).
- It is a critical patient safety issue to understand that standard pulse oximeters are unreliable in CO poisoning. They cannot differentiate between oxyhemoglobin and carboxyhemoglobin, often showing a falsely reassuring high oxygen saturation. A CO-oximeter is required.
- What if the patient presents with a headache and nausea after being in an enclosed space with a running generator, but their skin color is normal and pulse oximeter reads 98%? The nurse should still suspect CO poisoning, immediately administer 100% oxygen, and advocate for a blood gas analysis with co-oximetry.
How to Approach the Question
- First, identify the key terms in the question: 'Carbon monoxide poisoning' and 'skin color change'.
- Recall the specific pathophysiology of CO poisoning. Remember that CO binds to hemoglobin with extremely high affinity.
- Think about the name of the compound formed: carboxyhemoglobin. Associate this compound with its specific color.
- Evaluate the options based on this knowledge. 'Cherry pink' or 'cherry red' is the classic description for the color of carboxyhemoglobin.
- Eliminate the other options by recalling their causes: bluish for cyanosis (low oxygen), yellowish for jaundice (bilirubin), and purplish for bleeding or severe hypoxia.
Concept Tested & Keywords
- Concept Tested: Pathophysiology and clinical signs of carbon monoxide poisoning
- Stem keywords: Carbon monoxide poisoning, skin color
- Lead-in keywords: what change
Question ID
QUJKY81IDCy8h_4FsgZ293
Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 53-55
E6 Medicine Harrison 22e Part 1 p. 319-321
E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 416-418
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