{"id":1190,"date":"2015-04-14T16:34:15","date_gmt":"2015-04-14T20:34:15","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/5-5-management-of-hypoxemia\/"},"modified":"2019-09-30T13:41:13","modified_gmt":"2019-09-30T17:41:13","slug":"5-6-management-of-hypoxia","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/5-6-management-of-hypoxia\/","title":{"raw":"5.6 Management of Hypoxia","rendered":"5.6 Management of Hypoxia"},"content":{"raw":"Hypoxemia or hypoxia is a medical emergency and should be treated promptly. Failure to initiate oxygen therapy can result in serious harm to the patient. The essence of oxygen therapy is to provide oxygen according to target saturation rate, and to monitor the saturation rate to keep it within target range. The target range (SpO2<\/sub>) for a normal adult is 92% to 98%. For patients with COPD, the target SpO2<\/sub> range is 88% to 92% (Alberta Health Services, 2015; Kane et al., 2013; Perry et al., 2018).\r\n\r\nAlthough all medications require a prescription, oxygen therapy may be initiated without a physician's order in emergency situations. Hypoxia is considered an emergency situation. Most hospitals have a protocol in place allowing health care providers to apply oxygen in emergency situations. The health care provider administering oxygen is responsible for monitoring the patient response and keeping the oxygen saturation levels within the target range. The most common reasons for initiating oxygen therapy include acute hypoxemia related to pneumonia, shock, asthma, heart failure, pulmonary embolus, myocardial infarction resulting in hypoxemia, post operative states, pneumonthorax, and abnormalities in the quality and quantity of hemoglobin. There are no contradictions to oxygen therapy if indications for therapy are present (Kane et al., 2013).\r\n\r\nHypoxic patients must be assessed for the causes and underlying reasons for their hypoxia. Hypoxia must be managed not only with supplemental oxygen but in conjunction with the interventions outlined in Table 5.4.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
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Table 5.4 Interventions to Treat and Prevent Hypoxia<\/h3>\r\n<\/td>\r\n<\/tr>\r\n

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Interventions<\/h4>\r\n<\/td>\r\n

\r\n

Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

Raise the head of the bed<\/td>\r\nRaising the head of the bed promotes effective breathing and diaphragmatic descent, maximizes inhalation, and decreases the work of breathing.\u00a0Positioning enhances airway patency in all patients. A Fowler's or semi-Fowler's position promotes a patient's chest expansion with the least amount of effort. Patients with COPD who are short of breath may gain relief by sitting with their back against a chair and rolling their head and shoulders forward or leaning over a bedside table while in bed.\r\n\r\n[caption id=\"attachment_5470\" align=\"aligncenter\" width=\"300\"]\"High<\/a> High Fowler's position[\/caption]<\/td>\r\n<\/tr>\r\n
Deep breathing and coughing techniques<\/td>\r\nDeep breathing and coughing techniques help patients effectively clear their airway while maintaining their oxygen levels. Teach patients \u201ccontrolled coughing\u201d by having them take a deep breath in and cough deeply with the mouth slightly open. If they have difficulty coughing, teach the huffing technique. This involves taking a medium breath and then making a sound like \u201cha\u201d to push the air out fast with the mouth slightly open. This is done three or four times, and then they are instructed to cough. If secretions are thick and tenacious, the patient may be dehydrated and require additional fluids (if medical condition does not contraindicate additional fluids).<\/td>\r\n<\/tr>\r\n
Oxygen therapy and equipment<\/td>\r\nIf patient is already on supplemental oxygen, ensure equipment is turned on and set at the required flow rate and is connected to an oxygen supply source. If a portable tank is being used, check the oxygen level in the tank. Ensure the connecting oxygen tubing is not kinked, which could obstruct the flow of oxygen. Feel for the flow of oxygen from the exit ports on the oxygen equipment. In hospitals where medical air and oxygen are used, ensure patient is connected to the oxygen flow port.\r\n\r\n[caption id=\"attachment_6669\" align=\"aligncenter\" width=\"300\"]\"Applying<\/a> Applying nasal prongs[\/caption]<\/td>\r\n<\/tr>\r\n
Assess need for bronchodilators<\/td>\r\nFigure 5.6 Baby with rescue inhaler and spacerPharmacological management is essential for patients\r\n\r\nwith respiratory disease. Medications such as bronchodilators effectively relax smooth muscles and open airways in certain disease processes such as COPD. Glucocorticoids relieve inflammation and also assist in opening air passages. Mucolytics and adequate hydration decrease the thickness of pulmonary secretions so that they can be expectorated more easily.\r\n\r\n \r\n\r\n \r\n\r\n[caption id=\"attachment_3035\" align=\"alignright\" width=\"185\"]\"\" Figure 5.5 Baby with spacer and rescue inhaler[\/caption]\r\n\r\n[caption id=\"attachment_5055\" align=\"alignleft\" width=\"199\"]\"Assess<\/a> Assess need for bronchodilation[\/caption]<\/td>\r\n<\/tr>\r\n
Oral suctioning<\/td>\r\nSome patients may have a weakened cough that inhibits their ability to clear secretions from the mouth and throat. Patients with muscle disorders or who have experienced a cerebral vascular accident (CVA) are at risk for aspiration related to ineffective cough reflex, which could lead to hypoxia. Provide oral suction if patient is unable to clear secretions, foreign debris, or mucous from the mouth and pharynx. See Checklist 43<\/a>\u00a0for further directions.\r\n\r\n[caption id=\"attachment_3943\" align=\"aligncenter\" width=\"300\"]\"Oral<\/a> Oral suctioning may be necessary[\/caption]<\/td>\r\n<\/tr>\r\n
Pain relief<\/td>\r\nProvide adequate pain relief. Pain is known to increase the metabolic demands on the body, which in turn increases the need for more oxygen supply.<\/td>\r\n<\/tr>\r\n
Devices to enhance secretion clearance<\/td>\r\nMany devices assist with secretion clearance, such as vests that inflate with large volumes of air and vibrate the chest wall, and handheld devices that help provide positive expiratory pressure to prevent airway collapse in exhalation.\u00a0Usefulness of these therapies is decided based on the individual patient's situation and the preference of both the patient and care provider.<\/td>\r\n<\/tr>\r\n
Frequent rests in between activities<\/td>\r\nPatients experiencing hypoxia often feel short of breath (SOB) and fatigue easily. Allow patient to rest frequently, and space out interventions to decrease oxygen demand in patients whose reserves are likely limited. Has the patient just returned from a walk down the hall or to the bathroom?\r\n\r\nAssess for underlying causes of the hypoxia. Is the potential problem respiratory or cardiovascular? What underlying respiratory or cardiovascular conditions exist? Complete respiratory and cardiovascular assessments may reveal potential abnormalities in these systems.<\/td>\r\n<\/tr>\r\n
Obstructive sleep apnea<\/td>\r\nPatients with obstructive sleep apnea (OSA) may be unable to maintain a patent airway. In OSA, nasopharyngeal abnormalities that cause narrowing of the upper airway produce repetitive airway obstruction during sleep, with the potential for periods of apnea and hypoxemia. Pressure can be delivered during the inspiratory and expiratory phases of the respiratory cycle by using a mask to maintain airway patency during sleep. The process requires consideration of each individual's needs in order to to obtain compliance.<\/td>\r\n<\/tr>\r\n
Anxiety and depression<\/td>\r\nThe most common co-morbidities of COPD are anxiety and depression. Anxiety is related to chronic shortness of breath and an inability to breathe effectively. Anxiety and depression are chronically undertreated and may be relieved with breathing retraining, counselling, relaxation techniques, or anti-anxiety medications if appropriate.<\/td>\r\n<\/tr>\r\n
Data source: Cigna & Turner-Cigna, 2005; Kane et al., 2013;\u00a0Maurer et al., 2008;\u00a0Perry et al., 2007;\u00a0Perry et al., 2018;\u00a0Shackell & Gillespie, 2009<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

Applying and Titrating Oxygen Therapy<\/h2>\r\nWhen providing oxygen therapy, remember the following (Kane et al., 2013; BCCNP, 2018):\r\n