STUDENTS - CNUR 103 Lecture - Feb 11 - Oxygen Therapy, Patient Safety, Restraints

Introduction

• Module 6: Patient Safety, Adverse Events, Oxygen Therapy, Use of Restraint.

• Delivered on Treaty 4 territory and Métis homeland.

• Instructors: Sarah Todd RPN, BScPN, MN (CNS); Adapted from Nori Manson-Brick, RN BScN, MN.

Learning Objectives

• Respiratory Function and Oxygenation.

• Oxygen Therapy.

• Promoting Airway Clearance and Bronchial Hygiene.

• Patient Safety including:

  • Assessing Patient Safety.

  • CNA Code of Ethics and Safety.

  • Cultural Safety.

  • Safe Use of Restraints (Least Restraint Approach).

Oxygen Therapy Overview

• Purpose: To prevent or treat hypoxemia.

• Signs & Symptoms of Hypoxia:

  • Decreased Level of Consciousness (LOC).

  • Confusion, drowsiness.

  • Altered concentration, dizziness.

  • Increased pulse and breathing rate.

  • O2 saturation < 90%.

  • Dyspnea (difficulty breathing).

  • Other physical signs: pallor, cyanosis, muscle fatigue.

Oxygen Administration Principles

• Oxygen as a Medication:

  • Use the 10 rights of medication administration.

  • Selection of devices depends on:

    • Required oxygen level.

    • Severity of hypoxia.

    • Patient’s health status and other factors.

Oxygen Delivery Devices

• Nasal Cannula: 1-6 L/min, 24%-44% O2.

  • Pros: Safe, simple, allows eating.

  • Cons: Cannot be used with nasal obstruction.

• Simple Mask: 5-10 L/min, contraindicated for CO2 retainers.

  • Risk of aspiration if <5L/min.

• Partial and Non-Rebreather Masks: 10-15 L/min, delivers 60-80% O2.

• Venturi Mask: Delivers specific amounts of O2.

Oxygen Safety Guidelines

• Oxygen should be treated as a medication; adjustments require provider consultation.

• Safety Practices:

  • Signage to indicate "Oxygen in Use".

  • Maintain distance from heat sources.

  • Proper handling and securing of oxygen tanks.

  • No smoking allowed where oxygen is present.

Promoting Airway Clearance

• Techniques include:

  • Client Positioning: optimal positions for gas exchange.

  • Deep Breathing and Coughing: helps mobilize secretions.

  • Incentive Spirometry: encourages deep breaths.

  • Pursed Lip Breathing: enhances oxygen exchange.

Nursing Diagnoses Related to Respiratory Issues

• Impaired gas exchange.

• Impaired ventilation.

• Anxiety related to dyspnea.

• Activity intolerance.

Patient Safety Importance

• Focus on reducing adverse events and improving quality care.

• Mandated by professional bodies (ICN, CNA).

Terminology in Patient Safety

• Near Miss: Caught before harm.

• Adverse Event: Harm not related to underlying condition.

• Critical Incident: Significant harm or loss of life.

Falls Risk Management

• Over one-third of seniors fall, leading to serious consequences.

  • Costs healthcare approximately $2 billion annually.

• Universal Fall Precautions:

  • Maintaining a safe environment and assisting with mobility.

Restraint Use

• Defined as any method that restricts movement or immobilizes a patient.

• Least Restraint Approach: Best practice in Canada, requires a physician's order, and should be a last resort.

• Alternatives to Restraints: Techniques to maintain safety without physical restraints.

Codes in Emergency Situations

• Code Blue: Cardiac arrest.

• Code Red: Fire.

• Code White: Violent patient.

• Code Yellow: Missing patient.

Conclusion

• Understanding and implementing these principles ensures patient and nurse safety, supports effective oxygen therapy, and promotes a culture of safety in healthcare.

Introduction

Module 6: Patient Safety, Adverse Events, Oxygen Therapy, Use of Restraint.Delivered on Treaty 4 territory and Métis homeland.Instructors: Sarah Todd RPN, BScPN, MN (CNS); Adapted from Nori Manson-Brick, RN BScN, MN.

Learning Objectives

• Respiratory Function and Oxygenation: Understanding the anatomy and physiology of the respiratory system, the importance of oxygenation for cellular metabolism, and the consequences of impaired respiratory function.

• Oxygen Therapy: Indications, contraindications, and different methods of administering oxygen therapy, including calculations of required oxygen levels.

• Promoting Airway Clearance and Bronchial Hygiene: Techniques to improve airway patency and facilitate effective gas exchange within the lungs.

• Patient Safety: Including comprehensive strategies for assessing patient safety based on the latest clinical practices and ethical guidelines.

  • CNA Code of Ethics and Safety: Emphasizes the importance of ethical principles in nursing practice that promote patient safety.

  • Cultural Safety: Understanding and respecting the cultural diversity of patients and how it relates to their care.

  • Safe Use of Restraints: Exploring the Least Restraint Approach that emphasizes alternatives to restraints in patient care.

Oxygen Therapy Overview

Purpose: To prevent or treat hypoxemia, which is a deficiency in oxygen reaching the tissues. Effective oxygen therapy is crucial in managing conditions such as COPD, pneumonia, and acute respiratory distress syndrome, among others.Signs & Symptoms of Hypoxia:

• Decreased Level of Consciousness (LOC), which may signify severe hypoxia.

• Neurological changes such as confusion, drowsiness, and agitation indicating compromised cerebral oxygenation.

• Physical signs including altered concentration, dizziness, increased pulse and rapid breathing, cyanosis (bluish discoloration of lips/fingers), and dyspnea (difficulty breathing).

• Other physical indicators include pallor and muscle fatigue typically associated with prolonged hypoxia.

Oxygen Administration Principles

Oxygen as a Medication:

• Nurses must adhere to the 10 rights of medication administration (patient, drug, dose, route, time, reason, documentation, response, education, and right to refuse).

• Selection of oxygen delivery devices depends on:

  • Required oxygen level (based on arterial blood gas results or pulse oximetry).

  • Severity of hypoxia.

  • Patient’s overall health status and existing comorbidities, which may influence their response to oxygen therapy.

Oxygen Delivery Devices

• Nasal Cannula: 1-6 L/min, providing 24%-44% O2.

  • Pros: Safe and easy to use; allows patients to eat and drink.

  • Cons: Ineffective in patients with nasal obstructions.

• Simple Mask: Provides 5-10 L/min of oxygen; not recommended for CO2 retainers (e.g. patients with COPD) as it may cause CO2 retention.

  • Risk of aspiration if delivered at <5 L/min.

• Partial and Non-Rebreather Masks: Administers 10-15 L/min, effectively providing 60-80% O2, particularly beneficial in emergencies.

• Venturi Mask: Delivers precise amounts of O2, allowing for accurate control over oxygen concentration.

Oxygen Safety Guidelines

• Oxygen should be treated as a medication; any adjustments in levels or delivery methods require provider consultation.

• Safety Practices:

  • Utilize signage that clearly states "Oxygen in Use" to alert those in the vicinity.

  • Maintain a safe distance from heat sources to prevent fires; oxygen promotes combustion.

  • Employ proper handling and securing of oxygen tanks to prevent accidents.

  • Strictly enforce a no smoking policy in areas where oxygen is in use.

Promoting Airway Clearance

Techniques include:

• Client Positioning: Positions such as Fowler’s or semi-Fowler’s may optimize gas exchange.

• Deep Breathing and Coughing: Techniques that facilitate mobilization of pulmonary secretions.

• Incentive Spirometry: Instrument that encourages patients to take deep, sustained breaths, enhancing lung expansion.

• Pursed Lip Breathing: A technique to control breathing and enhance oxygen exchange by prolonging expiration.

Nursing Diagnoses Related to Respiratory Issues

• Impaired gas exchange: Identifying alterations in oxygenation and potential interventions to address them.

• Impaired ventilation: Assessing breathing patterns and identifying influences on ventilation effectiveness.

• Anxiety related to dyspnea: Implementing strategies to manage anxiety linked to breathing difficulties.

• Activity intolerance: Evaluating limitations in physical activity due to respiratory distress.

Patient Safety Importance

• Focus on minimizing adverse events and enhancing the quality of care delivered to patients.

• Compliance with standards set by professional bodies, such as the International Council of Nurses (ICN) and the Canadian Nurses Association (CNA).

Terminology in Patient Safety

• Near Miss: An error that was caught before harm occurred to the patient.

• Adverse Event: Occurrences where harm is suffered that is unrelated to underlying conditions.

• Critical Incident: Events that lead to significant harm or loss of life, warranting thorough investigation and response.

Falls Risk Management

• Notably, over one-third of seniors fall each year, resulting in severe consequences such as fractures or head injuries.

• This aspect of care costs healthcare systems approximately $2 billion annually.

• Universal Fall Precautions:

  • Enforcing practices to maintain a safe environment and providing assistance with mobility where necessary.

Restraint Use

• Defined as any method that restricts movement or immobilizes a patient, raising ethical concerns around autonomy.

• Least Restraint Approach: Recognized as best practice in Canada, necessitating a physician's order, and should only be utilized when all other safety measures fail.

• Alternatives to Restraints: Comprehensive strategies that prioritize patient safety while respecting autonomy, including environmental modifications or increased staff vigilance.

Codes in Emergency Situations

• Code Blue: This indicates a cardiac arrest situation requiring immediate medical attention.

• Code Red: Signifies a fire emergency requiring evacuation procedures.

• Code White: Notifies staff about a violent or aggressive patient needing urgent intervention.

• Code Yellow: Indicates a missing patient, necessitating immediate action to locate and ensure their safety.

Conclusion

Understanding and implementing these principles not only ensures the safety of patients and healthcare providers but also supports effective oxygen therapy and fosters a culture of safety within healthcare settings.