Oxygenation Basics

Identify factors that affect oxygenation

Oxygenation Assessment

The nurse must assess several different things to determine factors affecting oxygenation.  As you learned in 507 it's essential to know the patient's history, medications, current living conditions, and allergies.  In your health history you also looked at the patient's lifestyle including exercise, general feeling of health, diet, and age.  

Select all the health history pieces that should be assessed to determine the factors affecting the patient's oxygenation.

  • environment
  • age
  • cognitive abilities
  • exercise tolerance
  • alcohol intake
  • recent stressors

Oxygen administration

Oxygen delivery devices

There are many oxygen delivery devices.  Your job is to know the safety aspects of each device, the liter per minute limits, and the indications for use.  There are other pieces to oxygen delivery including flow rate adjustment, humidification, safety precautions, and documentation.  Based on the introduction by faculty in the classroom and skill lab practice, what do you know about oxygenation?  Test your knowledge in the next section.

Here is a quick review of the devices and their recommended liters per minute:

nasal cannula - 1-6 lpm

simple face mask - 6-10 lpm

venturi mask - 8-15 lpm, depending on the percentage setting

non-rebreather mask - 15 lpm

trach mask - up to 15 lpm and humidified, usually with a percentage set by a respiratory therapist

Oxygen is a medication that requires an order

  • True
  • False

Match up the device with its correct limit based on liters per minute (lpm)

  • nasal cannula
    1-6 lpm
  • simple face mask
    6-10 lpm
  • tracheostomy mask
    up to 15 lpm and humidified
  • venturi mask
    8-15 lpm depending on percentage setting

Describe oxygen safety monitoring

Oxygen safety

The following safety measures are essential for patients receiving oxygen.

•Signs: “No smoking. Oxygen in use.”

• Remove matches, lighters and cigarettes.

• Remove and store electrical equipment to avoid sparks. Ground electrical equipment.

• Avoid materials that generate static electricity

• Avoid use of volatile, flammable materials, such as alcohol.

•Know location & use of fire extinguishers & alarms.

What is the single biggest safety issue for a patient wearing oxygen?

  • kinked tubing
  • flowmeter malfunction
  • fire

Develop a plan of care using the nursing process after identifying oxygenation issues

Nursing Diagnoses

In class you have discussed nursing diagnoses that are appropriate for oxygenation issues.  Try your hand at choosing the correct diagnosis for the presenting problem.  Remember your anatomy when choosing.

The patient presents with fever and cough that is determined to be pneumonia. What is the best nursing diagnosis?

  • Ineffective airway clearance
  • Impaired gas exchange
  • Ineffective breathing pattern
  • Impaired spontaneous ventilation

The patient presents in cardiac arrest following a myocardial infarction. What is the best nursing diagnosis?

  • Ineffective airway clearance
  • Impaired gas exchange
  • Ineffective breathing pattern
  • Impaired spontaneous ventilation

The patient presents a rattling in the back of the throat, weak cough, and oxygen saturation of 85%. What is the best nursing diagnosis?

  • Ineffective airway clearance
  • Impaired gas exchange
  • Ineffective breathing pattern
  • Impaired spontaneous ventilation

The patient presents with a respiratory rate of 46 and retractions at the sternal notch. What is the best nursing diagnosis?

  • Ineffective airway clearance
  • Impaired gas exchange
  • Ineffective breathing pattern
  • Impaired spontaneous ventilation

Nursing interventions

There are two types of interventions done by nurses.  Dependent and independent interventions may be tough to distinguish.  There are many examples of interventions a nurse can do without a physician's order.  Below a few of them are listed:

•Airway maintenance

•Positioning

•Deep breathing & coughing

•Pursed-lip breathing

•Abdominal/diaphragmatic breathing

•Hydration

•Teaching of health habits

Many interventions are done in collaboration with physicians and require the order of a licensed independent practitioner.  Some examples of this are:

•Incentive spirometry

•Percussion/postural drainage

•Suctioning

•Oxygen therapy

•Medications

•Monitor pulse oximetry

Keep all these interventions in mind when creating a plan of care for the patient with oxygenation issues.