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Discuss the various methods of oxygen therapy and the nurse’s role in administering oxygen therapy
Methods of Oxygen Therapy:
Nasal Cannula: Delivers low concentrations of oxygen.
Simple Face Mask: Provides moderate oxygen delivery.
Non-Rebreather Mask: Offers high concentrations of oxygen; designed for emergency use.
Mechanical Ventilation: Assists or controls breathing in patients with severe respiratory distress.
A Nurse’s Role:
Administer prescribed oxygen therapy correctly.
Monitor oxygen saturation using pulse oximetry.
Educate patients on the proper use of oxygen devices.
Ensure safety measures to prevent fire hazards associated with oxygen.
Identify and describe clinical outcomes of hyperventilation, hypoventilation and hypoxemia
Hyperventilation Outcomes:
Respiratory alkalosis due to decreased carbon dioxide levels, which can result in symptoms like lightheadedness, tingling in extremities, and palpitations.
Possible loss of consciousness if excessive and prolonged.
Hypoventilation Outcomes:
Respiratory acidosis due to accumulation of carbon dioxide, leading to symptoms like confusion, lethargy, and shortness of breath.
Risk of hypoxemia, which may cause further complications such as organ dysfunction.
Hypoxemia Outcomes:
Decreased oxygen supply to tissues, leading to symptoms like cyanosis (bluish coloration of skin), confusion, and increased heart rate.
Long-term hypoxemia can result in complications such as pulmonary hypertension or cor pulmonale (right-sided heart failure) if not addressed.
Identify nursing care interventions in primary care, acute care and restorative and continuing care settings that promote oxygenation
Primary Care:
Conduct regular assessments of respiratory function, including lung auscultation and oxygen saturation checks.
Educate patients on the importance of maintaining a smoke-free environment to enhance lung health.
Encourage regular physical activity tailored to the patient’s condition to improve lung function and oxygenation.
Provide vaccinations, such as influenza and pneumococcal vaccines, to prevent respiratory infections that can affect oxygenation.
Acute Care:
Monitor vital signs and oxygen saturation continuously to detect any deterioration in respiratory status.
Administer supplemental oxygen as prescribed, using the appropriate delivery system based on the patient's needs.
Implement position changes, such as elevating the head of the bed, to facilitate easier breathing and enhance lung expansion.
Employ incentive spirometry techniques to encourage deep breathing and promote lung re-expansion post-surgery or during illness.
Restorative and Continuing Care:
Develop individualized rehabilitation programs that include breathing exercises and physical therapy to enhance lung capacity.
Support patients in adhering to long-term oxygen therapy by providing education and follow-up assessments on equipment use and care.
Assist with transitions to home care by ensuring patients understand their oxygen therapy regimen and have access to necessary resources.
Collaborate with interdisciplinary teams (e.g., respiratory therapists, social workers) to ensure comprehensive care and support for patients with chronic respiratory issues.
Discuss delegation considerations in oxygen management
Assessing the Complexity of Tasks: Determine whether the task (e.g., adjusting oxygen levels, monitoring patients on oxygen therapy) requires a nurse's clinical judgment or can be delegated to unlicensed assistive personnel (UAP).
Patient's Condition: Evaluate the patient's health status. Stable patients may allow for more delegation, while high-risk patients may require closer nurse oversight.
Competency of the Delegatee: Ensure that the person to whom tasks are delegated is trained and competent to perform them, especially in monitoring vital signs or operating oxygen delivery devices.
Institutional Policies: Follow organizational guidelines which dictate what can be delegated in terms of oxygen therapy and other nursing responsibilities.
Communication: Maintain clear lines of communication with delegated personnel to effectively convey patient needs and expectations.
Monitoring and Accountability: Regularly monitor the performance of tasks delegated to ensure proper execution and assess outcomes. The nurse retains ultimate accountability for the patient’s care.
Identify unexpected outcomes and nursing interventions to manage
Unexpected Outcomes:
Increased work of breathing: Patients may exhibit laboured breathing or use accessory muscles, indicating respiratory distress.
Changes in mental status: Confusion, restlessness, or lethargy may occur due to inadequate oxygenation or hypercapnia.
Skin breakdown: Continuous use of oxygen delivery devices may lead to pressure ulcers or skin irritation at pressure points.
Equipment malfunctions: Oxygen devices may experience failures or obstructions that compromise oxygen delivery.
Hypoxia: Patients may show signs of oxygen deprivation despite the administration of oxygen, possibly due to underlying pulmonary issues or problems with delivery systems.
Nursing Interventions to Manage Outcomes:
Monitor respiratory status: Regularly assess lung sounds, respiratory rate, and effort to detect any deterioration early.
Adjust oxygen delivery: Modify flow rates or change delivery devices as indicated based on the patient’s response and condition.
Positioning: Elevate the head of the bed to enhance lung expansion and ease breathing. Consider positioning that optimally aids ventilation.
Skin care: Inspect areas in contact with oxygen devices and implement measures to prevent skin breakdown, such as padding or position changes.
Investigate equipment: Routinely check oxygen delivery systems for blockages, leaks, or functional issues and provide education on how to troubleshoot minor problems.
Communicate with the healthcare team: Report significant changes in patient condition to ensure prompt intervention and collaborative care.
What health teaching would you provide to a client and caregiver related to oxygen delivery, safety and management?
Oxygen Delivery:
Explain the purpose and function of the oxygen delivery device (e.g., nasal cannula, mask).
Instruct proper usage and positioning of the device for effective delivery.
Emphasize the importance of keeping the device clean and clear of obstructions.
Safety:
Educate on fire hazards associated with oxygen use; stress no smoking or flames nearby.
Advise on keeping oxygen equipment away from heat sources.
Review how to identify wear or malfunction in equipment and the need for reporting issues.
Management:
Teach monitoring of oxygen saturation with a pulse oximeter and when to seek help.
Provide dietary and lifestyle recommendations for better respiratory health (e.g., hydration, diet).
Encourage adherence to follow-up appointments for evaluation of respiratory function and oxygen needs.
