Chapter 5: Oxygen Therapy
5.2 Oxygen
Critical Thinking Exercises: Questions, Answers, and Sources / References
- Explain how you might know if your patient is hypoxic or hypoxemic?
Answer: Hypoxia = arterial oxygen tension or partial pressure of oxygen PaO2 is below normal (<80 mmHg) and is measured by ABGs. Hypoxemia = reduction of oxygen supply to the tissues and is measured by pulse oximetry SpO2. A person can have hypoxemia but is compensating through increased HR / increasing oxygen supply.
Sources: Alberta Health Services. (2015). Oxygen therapy for acute adult inpatients. Learning module for Allied Health staff (category 1 and 2). http://www.albertahealthservices.ca/assets/info/hp/edu/if-hp-edu-ahc-oxygen-therapy-learning-module-cat-1and2.pdf.
Considine, J. (2007). Emergency assessment of oxygenation. https://acutecaretesting.org/en/articles/emergency-assessment-of-oxygenation.
Fournier, M. (2014). Caring for patients in respiratory failure. American Nurse Today, 9(11). https://www.americannursetoday.com/caring-patients-respiratory-failure/
- Why might the post surgical patient require supplemental oxygen?
Answer: Sedation from general anesthetics, sedatives, analgesics can cause ↓respiratory rate →inadequate ventilation = need for supplemental oxygen AND DB&C exercises
Source: Perry, A., Potter, P., Ostendorf, W. (2017). Clinical Skills and Techniques (9th ed.) Elsevier; Mosby.
Sample Quiz Questions
- Hilde. Age 59. History of smoking for 59 years is one day post op open cholecystectomy. Which of the following statements correctly reflect the nurse’s thinking when caring for her? Select all that apply.
- Hilde is at risk for atelectasis post op Answer: true. Post operatively patients are at risk for atelectasis due to pain and guarding which can result in diminished breaths eventually leading to atelectasis.
- Pain management along with ambulation and deep breathing and coughing should be encouraged approximately q2h. Answer: true. Pain management often improves the ability to deep breathe and cough and ambulate. Both of these will allow Hilde to take deep breaths, improve ventilation and reduce risk of atelectasis
- Lower than normal SpO2 is normal for Hilde. Answer: true. Hilde has smoked for 59 years. She may or may not have a diagnosis of lung disease. We know persons with COPD are expected to have below normal Spo2. The nurse should encourage DB&C, ambulation and consult the prescriber for oxygen orders and an acceptable SpO2 for Hilde. Generally for persons with COPD the SpO2 target range is 88-92% because of the lung changes associated with the disease.
Source: Abdo, W., Heunks, L. (2012). Oxygen induced hypercapnia in COPD: myths and facts. Critical Care, 16(5). doi: 10.1186/cc11475
- Use of Incentive inspirometry is an effective strategy to decrease risk of atelectasis and optimize oxygenation in the post op patient. True or False.
Answer: false. The evidence to support the use of routine use of incentive inspirometry to prevent post op respiratory complications is not strong. However ambulation, deep breathing and coughing are effective strategies and must be integrated along with effective pain management in order to reduce risk of respiratory related post op complications..
Sources:
Eltorai, A., Szabo et al. (2017 )Clinical Effectiveness of Incentive Spirometry for the Prevention of Postoperative Pulmonary Complications. Respiratory Care. DOI: 10.4187/respcare.05679
Strickland, S. L., Rubin, B. K., Drescher, G. S., Haas, C. F., O’Malley, C. A., Volsko, T. A., … Hess, D. R. (2013). AARC clinical practice guideline: Effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients. https://www.aarc.org/wp-content/uploads/2014/08/nonpharmacologic_2013.pdf.