Oxygen Therapy

[Deli]

I just have a general question about giving someone oxygen I was never really given a guide on this so I was wondering for example if I had a patient whose spo2 is 90 if this value is not normal for a patient would I start off with NP or would I start off with a simple mask or a non-rebreather.

So in other words my question is, at what range of Spo2 would I use each oxygen therapy device for (Nasal prongs, simple mask, non-rebreather)?

[Hannahbanana, BSN, MSN]

There is a gadget that measures exhaled CO2, which would equal alveolar CO2 whic would equal capillary CO2 . Already been done, LOL. Urinary pH is rough. Best predictor is history absent ABG. 

[amoLucia]

Hannah - you got a name for that gadget? I guess there's pulmonary function type testing equip that might be the prototype, but I'd be really interested in something since I last did inquiry.

[NRSKarenRN, BSN, RN]

Decoding the oxyhemoglobin dissociation curve

Quote

 

...When the pulse oximeter’s low alarm goes off, don’t assume you need to start giving oxygen or increase the oxygen flow. Assess the patient, not the machine: Is the patient in respiratory distress? Check the oxygen supply: Is the oxygen tubing kinked? Is the oximeter applied properly? Does the patient have a disease or condition that increases oxygen demand, such as fever, acidosis, or infection? If so, decreasing Spo2 values may indicate the need to contact the physician for further orders, in addition to increasing the oxygen flow.

If the pulse oximetry value is within a normal range, don’t assume the patient is adequately oxygenated. Instead, assess respiratory status, especially if the patient’s receiving supplemental oxygen. Is the patient breathing adequately? Because of compensatory mechanisms, good Spo2 values may give false reassurance despite deterioration in the patient’ respiratory status. For example, patients in near respiratory failure may be hyperventilating, resulting in respiratory alkalosis. This causes the OHDC to shift to the left, with more hemoglobin hanging on to oxygen instead of releasing it at the tissue level where it’s needed....

 

What does your patient LOOK like in choosing oxygen device + liter flow --add in HGB level if known along with underlying disease process :  Signs of inadequate oxygenation include tachypnea, accessory muscle work, dyspnea, cyanosis, tachycardia and hypertension along with Spo2 < 88 at rest.

Usually start low flow device and change to mask or high flow device depending on patient response and physician order. 

RT Magazine:  Oxygen Administration: What Is the Best Choice?

Nursing 2003:  How do I choose a supplemental oxygen delivery device?

5.5 Oxygen Therapy Systems

 

[amoLucia]

Hannah - you piqued my interest. I tried some googling re capnographic breath measuring. There was some info that I started to read but I became m overwhelmed. That happens when I get tired.

Usually it's just nighttime tiredness. But mental fatigue is one of my S&S when it's time for me to rest with my Trilogy machine. Like I said, I get fuzzy and find it hard to concentrate. Also I start to get really cranky & short tempered. Like a little kid.

Like when I was trying to tell that dipstick nurse I was having problems, but "she was the nurse". I demanded an RT and as soon as that guy came, he got me a machine and within an hour I was better.

I'm trying to  think this out, but how would anemia (chronic or sudden loss) shift the curve. Less HGB for oxygen to bind AND hypercapnia. Tried thinking it out last nite but ... I'm still thinking about it this afternoon.

 

[NRSKarenRN, BSN, RN]

On 3/24/2021 at 2:16 PM, amoLucia said:

I'm trying to  think this out, but how would anemia (chronic or sudden loss) shift the curve. Less HGB for oxygen to bind AND hypercapnia. Tried thinking it out last nite but ... I'm still thinking about it this afternoon.

Anemia compensation - OpenAnesthesia

Quote

When anemia develops over a long period of time, the oxyhemoglobin dissociation curve is shifted to the right, whereby hemoglobin has a decreased affinity for the oxygen molecule and releases oxygen to the tissues at higher partial pressures.

Image from Primary Care Notebook  right shift of the oxygen-haemoglobin dissociation curve

[Hannahbanana, BSN, MSN]

Short-term, for an acute bleed including untransfused surgical blood loss, not much. In any case of anemia, the nurse has to look at oxygen carrying CAPACITY as well as %saturation and PaO2. 

How’s that work?

Somebody c a hematocrit of 22 may have 100% sat and a PaO2 of 82 at rest on room air, both normal. Great, huh?
But he is delivering just half the oxygen to his body that he could be doing if his hematocrit was 44, that is, if he had twice as many RBCs. 
This means that when he gets up to walk he now uses up that oxygen quickly, having no reserves at all. He will become SOB from hypoxia while blowing off CO2, thus becoming alkalotic, thus decreasing the RBCs from releasing their oxygen. 
Isn’t physiology fun? 

[Hannahbanana, BSN, MSN]

On 3/15/2021 at 9:15 PM, LovingLife123 said:

FYI, in the real world you have a standing order to apply oxygen is the spO/2 is less than a certain percent.  It’s with every single admission.  Nursing school is ridiculous.  It’s a standing order with literally ever single admission.

Oh, no, it’s not. And if is all the time, I suggest seriously that you take it up with the medical staff (Anes, critical care, medicine, surgery) to review that. For the reasons in this thread. 

[LovingLife123]

4 hours ago, Hannahbanana said:

Oh, no, it’s not. And if is all the time, I suggest seriously that you take it up with the medical staff (Anes, critical care, medicine, surgery) to review that. For the reasons in this thread. 

Umm yes it is.  It’s a standard order in an admission order set.  For most patients it’s keep sat above 92%.  Sometimes, I see a 90%.  It goes right in with insert IV order set, vital signs order set, all your standard admission orders.  

[Hannahbanana, BSN, MSN]

Perhaps in your facility. I can assure you that it’s not like that everywhere. Good luck.