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Discussion

Respiratory Tx inquiry

What are your opinions on non-rebreather masks, acute respiratory distress, & comfort measure patients? I had a patient last night that was transferred to my unit. She initially presented to the ICU (days ago) w/ temp elevation, elevated WBC count, & was unresponsiveness, (which was accompanied by acid-base imbalance). She stayed in the ICU for three days, on the forth day she was transferred to my med-surg unit. This pt was on a bi-pap in ICU & then started on 100% non-rebreather mask before being trasferred to my med-surg floor (pt was unresponsive when she was transferred). Also, they made her a comfort measures pt prior to transferring her to my med surg unit. Isn't there some relationship between acid-base imbalances & non-rebreather masks, perhaps a contraindication? Let me know what you think, I value your input. I know there are risks w/ non-rebreathers like drying mucous membranes & possibly developing atelectasis, but let me know what all of you think. Thanks:specs:

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Relieving air-hunger and providing oxygen is a comfort measure, and that trumps any contraindications or risks you may have to consider with other patients.

a nonrebreather mask deliverys 95 - 100% oxygen; there is a one-way valve and the mask prevents the room air and the client's exhaled air from entering the reservoir bag, and so only oxygen in the bag is inspired. And to prevent carbon dioxide buildup, the nonrebreather bag must not totally deflate during inspiration. If it does, then correct this problem by increasing the litre flow of oxygen.

I have to agree, my rule is: never deny oxygen. To prevent excessive dry mouth you could provide frequent mouthcare, use artificial saliva (even though it's kind of gross). I don't really worry about atelectasis in CMO pts. Keep them comfy with O2, pain meds, and your presence.

pH imbalances, would not be a consideration right now.

i'm 'assuming' your pt is getting lots of morphine, if she's comfort care.

nrb's, theoretically, are supposed to prevent co2 from being reinspired.

if her resps are increased, i suppose she'd be at risk for alkalosis...

but again, would imagine the mso4 would take care of that.

just focus on making her as comfortable as possible.

it's time to let go of conceptually 'fixing' things, and let her body slip away.

it would be your job to ensure she is as comfortable as possible.

morphine is her friend.

leslie

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I just wanted to thank all of you that responded to my inquiry, your responses were very helpful. :specs:

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