Chapter 5: Oxygen Therapy
5.6 Management of Hypoxia
Critical Thinking Exercises: Questions, Answers, and Sources / References
- A patient is admitted with COPD and pneumonia and has an oxygen saturation of 88% on 1L/min of oxygen. Is this an appropriate oxygenation level for a patient with COPD? Why or why not?
Answer: yes it might be appropriate. For persons with COPD check prescribers orders for target range SpO2. Generally persons with COPD target ranges are approx. 88-92% because of the lung changes associated with the disease
Source: British Thoracic Society Emergency Oxygen Guideline Development Group. (2017). BTS guideline for oxygen use in adults in health care and emergency settings. Thorax, 72(1), i1-i90. https://www.brit-thoracic.org.uk/document-library/clinical-information/oxygen/2017-emergency-oxygen-guideline/bts-guideline-for-oxygen-use-in-adults-in-healthcare-and-emergency-settings/
- A patient with no underlying respiratory disease is hypoxic with an oxygen saturation level of 91% on room air. What are four additional interventions that may help improve oxygen saturation levels without applying oxygen therapy?
Answer: raise HOB, encourage slow deep breathing, identify and address any other causative factors, administer meds if appropriate (ie. bronchodilators)
Sources: Cigna, J. A., & Turner-Cigna, L. M. (2005). Rehabilitation for the home care patient with COPD. Home Healthcare Nurse, 23(9), 578-584.
Kane, B., Decalmer, S., & O’Driscoll, B. R. (2013). Emergency oxygen therapy: From guideline to implementation. Breathe, 9(4), 246-253. doi: 10.1183/20734735.025212l.
Maurer, J., Rebbapragada, V., Borson, S., Goldstein, R., Kunik, M., Yohannes, A., & Hanania, N. (2008). Understanding depression and COPD. Current understanding, unanswered questions and research needs. Chest, 134(4), 43s-56s. doi: 10.1378/chest.08-0342.
Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills & techniques (9th ed.). St. Louis: Elsevier-Mosby.
Shackell, E., & Gillespie, M. (2009). The oxygen supply and demand framework: A tool to support integrative learning. Journal of the Canadian Association of Critical Care Nurses, 20(4), 15-19. https://www.caccn.ca/pdfs/L2%20Oxygen%20Supply%20&%20Demand%20Framework%20(E%20Shackell,%20M%20Gillespie).pdf.
- Examine a decision support tool (DST) for the initial treatment of hypoxemia from your health authority. What is the maximum flow of oxygen allowed to be administered without an order according to that specific tool?
Answer: the student will have to find a DST on their own, preferably from the agency they are working in to determine policies and guidelines that impact the nurse’s ability to work within their independent scope of practice for diagnosing and treating hypoxia
Note: The Interior Health DST for diagnosing and treating hypoxia allows RNs to administer up to 10L/minute per mask without an order.
Source: BCCNP (2019). Diagnosing and treating hypoxia. https://www.bccnp.ca/Standards/RN_NP/resourcescasestudies/clientcare/scope/Pages/diagnosing_treating.aspx
- Hypoxia is measured as SpO2. True or false.
Answer: true. Hypoxia is the reduction of oxygen supply at the tissue level, which is not measured directly by a laboratory value (Metrovic, 2014), but by pulse oximetry (SpO2) ( (O’Driscoll et al., 2008). Note SaO2 and SpO2 are the same thing.
Sources: Meštrović, T. (2014). What is hypoxemia? http://www.news-medical.net/health/What-is-Hypoxemia.aspx.
O’Driscoll, B. R., Howard, L. S., & Davison, A. G. (2008). Guideline for emergency oxygen use in adult patients. Thorax, 63(6). https://thorax.bmj.com/content/63/Suppl_6/vi1.
- Hypoxemia is measured by PaO2. True or false.
Answer: true. Hypoxemia is a condition where arterial oxygen tension or partial pressure of oxygen (PaO2) is below normal (<80 mmHg). Hypoxemia is the inadequate supply of oxygen in the arterial blood. Hypoxemia is measured with a blood sample.
Sources:
Meštrović, T. (2014). What is hypoxemia? http://www.news-medical.net/health/What-is-Hypoxemia.aspx.
O’Driscoll, B. R., Howard, L. S., & Davison, A. G. (2008). Guideline for emergency oxygen use in adult patients. Thorax, 63(6). https://thorax.bmj.com/content/63/Suppl_6/vi1.
- Identify 4 possible causes of hypoxia.
Answer: carbon monoxide poisoning, smoke inhalation, bronchospasm, COPD, pneumonia, pulmonary edema
Source: British Thoracic Society Emergency Oxygen Guideline Development Group. (2017). BTS guideline for oxygen use in adults in health care and emergency settings. Thorax, 72(1), i1-i90. https://www.brit-thoracic.org.uk/document-library/clinical-information/oxygen/2017-emergency-oxygen-guideline/bts-guideline-for-oxygen-use-in-adults-in-healthcare-and-emergency-settings/
- Of the following list of patients, which is the priority?
| Patient Characteristics | Answer: | |
| a. | A patient with no other co morbidities SpO2 98% | incorrect. SpO2 of 98% is considered normal. |
| b. | A patient with asthma, coughing. Vitals stable | incorrect. Coughing is not necessarily a concern. Vital signs are stable. |
| c. | A patient with COPD, SpO2 94% | incorrect. Persons with COPD with an SpO2 between 88-92% is considered normal and is generally acceptable. |
| d. | A patient with no other comorbidities SpO2 92% | Correct. Even though SpO2 of 92% is technically normal a person with no other comorbidities should lead the nurse to suspect the beginnings of respiratory issues. Further causes of this SPO2 should be considered. |
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.
O’Driscoll, B. R., Howard, L. S., & Davison, A. G. (2008). Guideline for emergency oxygen use in adult patients. Thorax, 63(6). https://thorax.bmj.com/content/63/Suppl_6/vi1.
Kane, B., Decalmer, S., & O’Driscoll, B. R. (2013). Emergency oxygen therapy: From guideline to implementation. Breathe, 9(4), 246-253. doi: 10.1183/20734735.025212l.