Oxygen administration

Feb 18, 2008 07:29 PM

by rlsilkett

I am a nursing student and I have an evidence based research project to do. We were instructed to pick a topic/question about nursing interventions. I am having trouble finding the information I need so any help would be great!
I know doctors prescribe how much oxygen to administer to patients and it is generally a standard protocol for each unit. But I've noticed that for instance a pt. has a SpO2 of 88% and the nurse puts the patient on 2L of O2 per nasal canula. My question is: As a nursing judgement, how do you know how much o2 to administer based on the stats?

**EricJRN** · Feb 19, 2008, 12:16 PM

Re: Oxygen administration

You've already hit on the issue. On many units, liter flow for oxygen admininstration is not a nursing judgment, but rather a physician order or a unit protocol.

*cardiacRN2006* · Feb 19, 2008, 12:21 PM

Re: Oxygen administration

Usually, pts have an order that says, "02 @2L, titrate/keep sats >92%".

But, I'm not going to wait for an order if my pts sats drop. I'll call the Dr when I can, or have someone else call if I don't have an order, but I'll just place the O2 right away.

You wanted to know how much to put on, or how we know how much to put on? The answer is, however much the pt needs. If his sats drop to 85%, and you put him on 2L, and they are still in the 80's, then you trurn the O2 up.

(Of course, your actions are based on the pts history, reason for admission,etc, etc...)

**NRSKarenRN** · Feb 25, 2008, 07:39 AM

Re: Oxygen administration

Great Respiratory evidenced based clinical practice guidelines http://www.rcjournal.com/online_resources/cpgs/cpg_index.asp

includes:
Oxygen Therapy for Adults in the Acute Care Facility
Oxygen Therapy in the Home or Alternate Site

pavanneh · Mar 15, 2008, 08:57 PM

Re: Oxygen administration

I am currently a respiratory therapist. A sat of 88% at 2 LPM would require that you increase the Liter flow by at least 1 liter and titrate up if needed. However, as someone posted earlier how much depends on the patient's condition, Chronic and current. A Chronic Obstructive Pulmonary Disease patient that lives on a hypoxic drive-meaning they can't tolerate high levels of oxygen in their blood or they don't breathe, can't tolerate O2 saturations above 92% very often. I have a lady right now that lives at 90% and she is on 5 LPM. Always, Always...assess the patient and give them what THEY need. The websites that you were given are good resources as is the NBRC website and AARC website-both Respiratory websites.

Trans-am · May 17, 2009, 09:04 PM

Re: Oxygen administration

If their sats are low i consider it a nursing judgment to go ahead and start out at 1-2l and go from there depending on their needs. I would call the md after establishing a good o2 sat first

PageRespiratory! · May 29, 2009, 06:54 PM

Re: Oxygen administration

Originally Posted by pavanneh

I am currently a respiratory therapist. A sat of 88% at 2 LPM would require that you increase the Liter flow by at least 1 liter and titrate up if needed. However, as someone posted earlier how much depends on the patient's condition, Chronic and current. A Chronic Obstructive Pulmonary Disease patient that lives on a hypoxic drive-meaning they can't tolerate high levels of oxygen in their blood or they don't breathe, can't tolerate O2 saturations above 92% very often. I have a lady right now that lives at 90% and she is on 5 LPM. Always, Always...assess the patient and give them what THEY need. The websites that you were given are good resources as is the NBRC website and AARC website-both Respiratory websites.

>
Bottom line: Don't deny the hypoxic Pt. O2. As for this "hypoxic drive" nonsense, it's just that. Please stop perpetuating the myth.
http://home.pacbell.net/whitnack/The...ive_Theory.htm

(I got this link from a nurse here on AN......thanks whoever it was)

*jmgrn65* · May 29, 2009, 07:43 PM

Re: Oxygen administration

Originally Posted by PageRespiratory!

>
Bottom line: Don't deny the hypoxic Pt. O2. As for this "hypoxic drive" nonsense, it's just that. Please stop perpetuating the myth.
http://home.pacbell.net/whitnack/The...ive_Theory.htm

(I got this link from a nurse here on AN......thanks whoever it was)

Um it isn't nonsense if you give too much o2 to a COPD patient their Co2 will increase and then if untreated they will need to be intubated or die. I have seen many a COPD patient have sats of 88% and the MD doesn't want it titrated for that reason. just as the op said treat the patient not the numbers.

PageRespiratory! · May 29, 2009, 08:22 PM

Re: Oxygen administration

Originally Posted by jmgrn65

Um it isn't nonsense if you give too much o2 to a COPD patient their Co2 will increase and then if untreated they will need to be intubated or die. I have seen many a COPD patient have sats of 88% and the MD doesn't want it titrated for that reason. just as the op said treat the patient not the numbers.

>
I said the "hypoxic drive" theory is nonsense..........and it is. A COPDer may or may not be chronically hypercapnic, but those that are MAY have an increase in pCO2 when recieving high concentration supplemental oxygen, by other mechanisms than "hypoxic drive". This happens on a rare occasion and does not happen acutely. I suggest reading the link I posted. As far as "not treating the numbers", considering a pulse oximeter in a noninvasive moniter with at least a +- 2% margin of error, I rarely use it for more than a quick and dirty assesment tool.

rachelgeorgina · Jun 07, 2009, 07:25 AM

Re: Oxygen administration

^^ have you not heard the term 'CO2 retainer' that basically incorporates all this? i.e. exercise caution with O2 therapy in the pt with COPD as more than likely, they are a CO2 retainer and to much O2 kills their drive to breath

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Oxygen administration

Oxygen administration

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