Objectives The learner Will: Define hypoxia r/t the need for oxygen therapy. Demonstrate proper technique when applying oxygen therapy in the patient care setting. Discuss the nursing interventions and rationale for oxygen r/t hypoxia. Use a case study to promote an understanding of proper oxygen titration per hospital policy and Physician order. As a group discuss questions qualifying the understanding of lectured material.
Need for Oxygen Therapy Defined Hypoxia-An insufficient amount of oxygen contained in the cells, to meet the metabolic needs of the body. Nursing must address the oxygen needs of each patient, with each assessment, as needed per individual patient diagnosis (COPD, CHF). Subjective signs of hypoxia- Sudden mental status changes, dyspnea , increased anxiety, chest pain r/t possible pulmonary embolism (PE), cardiac event MI. Objective signs hypoxia-SA02 < 90%, Tachycardia HR > 100BPM, decreased quality of respirations, Cyanosis (bluish color of skin, lips, and nail beds).
Nursing Rationale r/t Hypoxia and Patient Care The purpose of this teaching session is to maintain a patent airway and prevent obstructions. To promote respiratory function with the optimal gas exchange of oxygen (02) and carbon dioxide (CO2), in and out of the lungs. To prevent pneumonia that may result from the accumulation of respiratory secretions.
Nursing Treatments promoting Lung Expansion Proper positioning-Semi fowlers contributes to full lung expansion. Breathing exercises- Cough and deep breathing, incentive spirometry (IS). Oxygenation therapy-Nasal cannula, Venti Masks, Non rebreathers.
Nurses role in Oxygen Therapy r/t Care of the Patient Nurse’s role in the prevention and treatment of patients who need oxygen therapy: Recognize clinical symptoms Recognize associated risk factors Use medications appropriately as ordered Patient education Teach smoking cessation Nutritional and fluid guidelines per disease process Recommend and immunize for flu and pneumonia
Oxygen delivery r/t FI02 FIo2 is the percentage of inspired oxygen in a gaseous mixture or room air (RA). Oxygen delivery systems are divided into categories. low flow (NC, Non-rebreather)and high flow systems (Venti-Mask) An example of a low flow oxygen delivery system is the nasal cannula (NC). FI02 on room air is 21%. FI02 on 2-6L of o2 is 24-45%.
Oxygen Therapy Initiation r/t Hospital Policy Oxygen therapy is initiated when patients oxygen level (SA02) falls below 92%, normal SA02 is (95-100%). Oxygen is administered in cylinders and wall units in the hospital settings. The NC is applied to each nostril, extends around the face and is anchored at the ears. The other end of the oxygen tubing connects to the wall unit or cylinder, with a dosage meter. Check to make sure oxygen is flowing freely through the tubing, making sure there are no leaks and recheck patient’s SA02 . Oxygen therapy via NC does not interfere with the patients ability to eat, talk or ambulate. Use humidification with sterile water when using 4-6 liters of oxygen, preventing mucous membranes from drying out.
Nursing Interventions r/t Oxygen Therapy Determine the need for oxygen therapy by verifying the written order from the Physician, and hospital policy. Perform respiratory assessments on each patient to determine level of 02 therapy and titration protocol, documenting appropriately. Explain to the patient the need for oxygen titration per Physician order and hospital protocol. Encourage the use of incentive spirometry each hour, to avoid hospital acquired pneumonia.
Case Study r/t Titration of Oxygen Therapy Patient is a 25 yo woman who had an appendectomy and is one day post-op, without post-op complications. VS BP 138/80, P 90 regular, RR 14 regular, SA02 100% 2LNC, afebrile. The patient has NKDA and has been healthy up until now. The patient tells the Physician she is afraid to take deep breaths and is in a lot of pain. The patient has been instructed by her Physician to use incentive spirometry. In managing the care around this patient the nurse reads the Physicians order to titrate 02 to off with SA02 > or = to 92% and give Hydrocodone 5/500 oral every 4-6 hours prn for pain. How will the nurse help this patient?
Nursing Implementation r/t Titration of Oxygen Therapy Instructions are given to patient regarding incentive spirometry, with encouragement. Patient is given a full nursing assessment, using respiratory assessment skills of inspection, auscultation, percussion, palpation, with VS. Patient was assessed after 02 was weaned to off, SA02 was 98% on RA, RR 18 non-labored. Patient was provided pain medicine to promote full lung expansion. Pain was assessed at 8-10 prior to pain medicine, reassessment of pain post medication was 3-10. Patient performed incentive spirometry hourly as instructed. Patient’s VS after nursing interventions and patient teaching were BP 118/56, pulse 68 and regular, RR 18, SA02 100% RA, afebrile.
Nursing Evaluation r/t Oxygen Titration The patient remained pain free with regular pain assessments and pain management. The patient used incentive spirometry hourly on her own, post patient education. The patient’s SA02 remained 98-100% on RA. The patient ambulated around the unit and discharge planning is scheduled for the next morning.
Questions? Why is it important to wean and titrate patient’s off oxygen therapy? This patient did not have COPD, but what if she had? Why is it important to use incentive spirometry? Why in the case study was the patient non compliant about using the incentive spirometer? What effect did pain management have on the patient’s perception to teaching? Give examples of patient compliance from the case study?
References American Lung Association-homepage http://www.lungusa.org Simmons, P. & Simmons, M. (2004). The administration of oxygen to patients with COPD. Medsurg Nursing, 13(2). Wilkins, Stoller & Kacmarek (2009). Egan’sfundamentals of respiratory care (9th ed) St. Louis, Missouri: Mosby.