Oxygen administration

  1. 1 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?
  2. Visit  rlsilkett profile page

    About rlsilkett

    Joined Feb '08; Posts: 2; Likes: 1.

    14 Comments so far...

  3. Visit  EricJRN profile page
    0
    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.
  4. Visit  cardiacRN2006 profile page
    0
    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...)
  5. Visit  NRSKarenRN profile page
    1
    great respiratory evidenced based clinical practice guidelines http://www.rcjournal.com/online_reso.../cpg_index.asp

    includes:
    oxygen therapy for adults in the acute care facility
    oxygen therapy in the home or alternate site
    Silverdragon102 likes this.
  6. Visit  pavanneh profile page
    1
    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.
    MirandaN likes this.
  7. Visit  Trans-am profile page
    0
    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
  8. Visit  PageRespiratory! profile page
    0
    Quote from 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)
  9. Visit  jmgrn65 profile page
    0
    Quote from 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.
  10. Visit  PageRespiratory! profile page
    0
    Quote from 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.
  11. Visit  rachelgeorgina profile page
    0
    ^^ 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
  12. Visit  PageRespiratory! profile page
    0
    Quote from rachelgeorgina
    ^^ 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
    >
    Just because someone has obstructive lung disease, DOES NOT mean they are "more that likely" to be chronically hypercapnic, although some COPD'rs are "CO2 retainers". Furthermore, a chronically hypercapnic Pt DOES NOT rely on the mythical "hypoxic drive" to breathe. On rare occasions a Pt's pCO2 may increase when recieving high concentration supplemental oxygen by other mechanisms than hypoventilation. The "hypoxic drive" theory is hogwash, please read the link I posted earlier.
  13. Visit  pavanneh profile page
    0
    Sorry have not been back in awhile. While research may say it is a myth, the reality is seeing a patient who has lived on an anerobe drive for several years at 3 lpm NC, increased to 6 LPM-by a well meaning nurse. Get somnolent and respiratory rate drop to 8 from 20 and SaO2 drop from 91% to 73% until we returned his O2 to 2-3 lpm. So, it doesn't matter to me what the research says, it is more important what happens to a patient who is not in distress and does not NEED the oxygen. There is a difference.
  14. Visit  pavanneh profile page
    0
    Hmmm I replied to the other post, but will again. It is not hogwash. Have personally seen it happen. You are correct though, not all COPD patient's rely on a hypoxic drive. You need to asses blood gases and patient's response to O2 to determine their level of need for O2. Again correct, you don't deny a patient O2 if they NEED it. Not all COPD patient's need higher flows of O2. It may have more to do with their disease process and ability to diffuse O2/CO2. Raising their O2 does not necessarily resolve the issue of their shortness of breath and low SaO2, but can increase the problem. PATIENT ASSESSMENT OF NEED,

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