oxygenation

Question 1

Naloxone

Answer 1

• available in injectable and nasal spray (or “intranasal”) formulations.
• can reverse slowed breathing within 3 to 5 minutes. A second dose of naloxone may be needed if the first dose does not restore normal breathing
• effects of naloxone last for 20 to 90 minutes. After naloxone wears off, the opioid may still be present. The opioid can bind to its receptors in the brain and cause breathing to slow down again. That means the overdose may return, requiring another dose of naloxone

Question 2

Suspected Opioid Overdose In-Patient Acute Care

Answer 2

• decreased GCS
• decreased RR
• decreased HR
• decreased BP
• hypothermia
• hypoxia
• constricted pupils
• cyanotic lips and nail beds

Question 3

Suspected Opioid Overdose In-Patient Acute Care: Stage 1

Answer 3

• Patient is drowsy, Pasero scale 2
• RR greater than 10/ min
• Spo2 90% or greater on RA
• GCS 14-15

Question 4

Suspected Opioid Overdose In-Patient Acute Care: Stage 2

Answer 4

• Patient is nodding, Pasero scale 3
• RR less than 10/ min
• Spo2 81-90% or greater on RA
• GCS 10-13
• call code blue
• Apply and titrate oxygen
• Administer Naloxone 0.4mg IM – may repeat q3-5 min to a max of 5 doses or until RR is above 10

Question 5

Suspected Opioid Overdose In-Patient Acute Care: Stage 3

Answer 5

• Stage 3
• Patient is apneic (no RR or gasping) Pasero scale 4
• Spo2 80% or lower on RA
• GCS less than 10
• code blue
• initiate cardiac arrest management
• Administer Naloxone 0.4mg IM – may repeat q3-5 min to a max of 5 doses or until RR is above 10

Question 6

Clinical Signs & Symptoms of Hypoxia

Answer 6

• Apprehension, restlessness, inability to concentrate, decreased LOC, dizziness, behavioral changes
• Patient may be unable to lie down, appears fatigued and agitated
  – increased pulse, increased rate and depth of respiration
• Patient with a narcotic overdose, such as heroin, may display sings of hypoventilation
• Cyanosis
• Early stages of hypoxia BP is elevated—secondary to increased cardiac out put since pulse increases— UNLESS it is shock.
• Tachycardia, using accessory muscles to breathe

Question 7

Nursing Interventions Hypoxia

Answer 7

• Apply oxygen and titrate to keep Spo2 > 92%
• Position the patient in upright high fowlers
• Use pulse oximeter to measure oxygen saturation
• Administer medications like nebulizers, puffers, diuretics as ordered
• Encourage the patient to perform deep breathing & coughing exercises
• Increase fluid intake to loosen secretions if relevant EXCEPT with patients with CHF (they should be on fluid restrictions)
• incentive spirometer
• STAT blood work (ABG’s), chest Xray

Question 8

COPD and Oxygen

Answer 8

• Inappropriate administration of excessive O2 can result in hypoventilation because they have adapted to high carbon dioxide level, and their carbon dioxide sensitive chemoreceptors are not functioning.
• With excessive oxygen administration the stimulus to breath can be negated

Question 9

Low flow O2 delivery systems

Answer 9

• oxygen prongs, simple face mask, nonrebreathing mask –used for patients who need supplemental O2 but not precise concentration
• Refers to oxygen mixing with room air

Question 10

High Flow O2 delivery systems

Answer 10

• venturi mask (high flow simple face mask) or star wars mask
• Deliver O2 rates above the normal inspiratory flow rate and provided a fixed FiO2 (fraction of normal inspiratory oxygen) regardless of patient inspiratory flow and breathing pattern
• Used for patients who require larger flowrates of oxygen to maintain saturations
• face masks are generally temporary for transport or until RT can setup high flow systems when a patient fails to wean back to nasal prongs

Question 11

Nasal Prongs

Answer 11

O2 flow rate with NP 1-6L/min

Question 12

Simple face mask

Answer 12

• 5-8 L/min
• Side port openings located on either side of the mask allow room air to mix with delivered O2 and allow exhaled air to escape

Question 13

Non-rebreathing masks

Answer 13

used to deliver high concentrations of oxygen in emergency situations. These masks may be used for traumatic injuries, after smoke inhalation, and in cases of carbon monoxide poisoning

Question 14

venturi mask

Answer 14

4-12 L

Question 15

Describe how to teach the client pursed lip breathing

Answer 15

• Relax your neck and shoulder muscles
• Breath in slowly through your nose for two counts, keeping mouth closed
• Pucker or “purse” your lips as if you are going to whistle while counting to four
• Count to yourself: exhale, one, two, three, four

Question 16

Incentive Spirometry

Answer 16

• Encourages voluntary deep breathing by providing a visual feed back
• Prevents or treats atelectasis in post op patient (collapse of lung)
• Aim is to encourage patients to breath their normal inspiratory capacity
• Inhale slowly and deeply through the mouthpiece to raise the indicator.
• When you cannot inhale any longer, remove the mouthpiece and hold your breath for at least 5 seconds.
• Exhale normally.