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/