NC vs. Mask

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    Hey Guys. I got a quick question. I work HH and the Grandmother, who is in billing at a respiratory office, and is VERY VERY VERY OVERBEARING, stated to me this morning that she did not want a mask on her quad, averbal, g-button, severe head trauma granddaughter because an RT told her with masks, they do not breath right (something about to much CO2, she could not remember exactly why.).

    I have always gone by the rule 1-4 lpm, nc, higher than 4, mask. To me a nc on 7 liters would blow away any nasal floor she has. I tried to contact RN, and of course did not get a call back yet. (and of course observe Dr. orders)
    This is just a case of a nurse obtaining any knowledge that can be passed on from experience. Thank you.

    Just to give you an idea of how overbearing she is, my pt is an 18 year old, fully deveolped woman, and the grandmother orders pedi masks for svn tx, even after my re-teaching her (almost 3 times now) that a pedi mask does not fit her face properly and she doesn't get the full benefit.) And there are several more incidents. I understand I must insure the family is comfortable, but this is trying on my nerves. The other day she insisted that Pt needed to be oral suctioned. I got everything ready (less than 10 sec), and there was NOTHING in pt oral cavity. Showed it to g-ma and she stated "well it took you so long to get the equipment, i guess she just swallowed it." I have been with pt for over 8 mos, and have never had to suction pt.)
    Last edit by texas_lvn on Apr 14, '06

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  2. 0
    Does your agency have any printed materials about oxygen therapy? If you were to bring her some sort of references about the types of masks and their fit, it might help for things to sink in.
  3. 0
    Thanks, That is an idea.
  4. 0
    Rebreathing CO2 occurs then the liter flow is inadequate to meet respiratory demands when using a mask.
    Hard and fast rules:

    n/c 1-6 l/m .... more when using a pendant cannula (high flow device)
    simple o2 mask > 5 l/m
    partial rebreather 10 l/m and above entrains some room air
    nonrebreather NEVER below 10 l/m does NOT entrain room air
    venturi masks (venti-masks) o2 flow is determined by the Fio2 % you want
    it is imprinted on the side of the venturi

    Hope this helps!
  5. 0
    Thanks for the input!
  6. 0
    texas nurse, We all have to deal with family members who get on our nerves. Keep in mind that this, "18 year old fully developed woman" is a child to grandma and Will always be a child to grandma. This must be terrible for this grandma to see her granddaughter with a severe head injury. Put yourself in grandma's place, with no medical background, caring for your grandaughter with a severe head injury; hearing one thing from an rt and another from an lvn.She probably heard from doctors and an rn too,and probably a case manager at some point too. I know you feel like this but don't show it if you can try to be like this:angel2: and mabe you will get the response you are looking for, for your pt's sake, at least some of the time.
    Runnigcirclesaround
  7. 0
    Texas nurse, Can the grandma be taught to oral suction? I understand that you have never had to do it, Mabe it makes her feel better, The grandma I mean.
    runnungcirclesaround
  8. 0
    RCA,
    Thanks for your input. I have worked there for over a year now, and just realized basically what you have said. Sometimes it is emotionally tormenting, but I have come to learn that what she does is not against me, but I think she has a deep seeded OCD. Pt had to go to the hospital and was admitted yesterday. The first thing she starts doing is rearranging the room! So I think I have a grasp on her, now. Yes, GM does know how to suction, but I think she is scared to do it. Which, I understand. Thanks again!
  9. 0
    Glad I could help, I had the same problem with a husband last night who's wife almost died over 2 years ago, but in his mind she still is about to die, but she isn't, now he is enableing her not to get better. He has ocd too. ocd about he has to keep her from dying and really what he does is keep her from getting better. It is emotionally tomenting, and for a year for you I bet you feel like screaming sometimes. Runningcirclesaround


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