Nursing Interventions: Change Oxygen Delivery Method – COPD Nursing Care in ER

by Rhonda Lawes, PhD, RN

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      Slides Nursing Care COPD Patient.pdf
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      Reference List Medical Surgical Nursing and Pathophysiology Nursing.pdf
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    00:00 So back to those oxygen orders, right? We're gonna titrate this patient's oxygen.

    00:05 Now, we're already at 4 liters so we're at the end of the road for that first order.

    00:10 It tells us to change to a Venturi mask.

    00:13 So you're gonna titrate the oxygen on a Venturi mask, q, every 15 minutes, 6-15 liters per minute to maintain SPO2 or a sat of 90-93.

    00:25 For just a very short period of time we hit 90 but she came back down again so it just makes sense.

    00:31 We're gonna switch to the Venturi mask.

    00:33 We know that's a good option for COPD patients particularly those that have elevated CO2 which she does and we know she's still on the acidotic side so we're just gonna go ahead and do that.

    00:44 Remember, you're looking at the range and now we know we're still trying to keep it between 90-93 but what is a Venturi mask? Well, it's a mask that comes with all these adapters.

    00:57 Now, often times the adapters are all different colors.

    00:59 Blue, white, yellow, red, and green. It's a high flow device.

    01:04 So a Venturi mask is considered a high flow device and lets you precisely measure the amount of oxygen.

    01:11 Now it's the color that indicates how much oxygen is gonna be delivered.

    01:15 So if you put on the red attachment, the patient's gonna get 10-12 liters.

    01:20 If you put on the blue attachment, they're gonna get 2-4.

    01:24 Well, we're not gonna start with the same place we were, right? Because we're titrating things up because her saturation is still not where we want it to be but you use the different size ports or attachments to change the amount of FiO2, fraction of inspired oxygen, that the patient receives.

    01:42 Now, we can roughly go from about 24-60% of oxygen.

    01:46 Room air, 21%. So, but with using a Venturi mask, we can help the patient receive 24-60%.

    01:56 Now this is really helpful for patients with COPD especially if they can have -- need that extra precise measurement of O2 and we say that, we mean with the Venturi mask, we have a better chance of her getting that amount of oxygen because she's actually wearing a mask.

    02:14 So we're covering her nose and her mouth.

    02:15 If she's a mouth breather, no problem.

    02:18 We got that covered because the mask should cover both her nose and her mouth.

    02:23 So what color Venturi mask port would you choose for Mrs. Taylor and why? So look back at the reference slide and make a choice which color would you use.

    02:37 Right, we're gonna use the white one at 4-6 liters a minute because she was already at 4 and it didn't keep us within the range so we're gonna use the white one that'll bump us up a little bit to 28% of oxygen.

    02:52 So we're using the white port. Now, every kit comes with all the colors.

    02:57 You can keep changing it out. That's what you would do.

    02:59 Some really fancy Venturi mask have just one adaptor and you can kinda turn the dial and it will change the amount of oxygen.

    03:08 But this is fairly common to see the different colors with the Venturi mask.

    03:11 Now your job is to go back and develop an SBAR report for the health care provider.

    03:17 So pause the video. You know the questions that are involved in each one of these settings.

    03:23 I want you to walk through what the best update would be for the health care provider at this point.

    03:32 Alright. Now the big question. Discharge or admit? Remember when we talked about the priorities in ER.

    03:39 This is the decision they make with every patient.

    03:41 Are they safe to go home to be discharged home or do we need to admit them for more treatments and observation? So you gave a great SBAR report to the health care provider, the health care provider decides to admit Mrs. Taylor to the telemetry unit.

    03:57 Now why do you think Mrs. Taylor requires inpatient treatment versus outpatient treatment? Okay, that may seem like an odd question but that's when you should always ask yourself when you're getting ready to give report to another unit.

    04:11 You need to have clear in your mind why Mrs. Taylor needed to come to your unit and now why she needs to go to the next unit.

    04:19 So pause the video and come up with clinical, clear, concise, and objective reasons on why Mrs. Taylor needs to go to the telemetry unit.

    04:34 These are some things you may consider to communicate to the telemetry nurse.

    04:39 Now, you're gonna go through the patient system by system but the most likely reason that Mrs. Taylor needs to go to a telemetry unit, remember that's where your heart can be monitored, because her heart rate is pretty fast, she's still in sinus tach, and we're worried about her respiratory status.

    04:55 She's gonna need closer monitoring than a med-surg unit.

    04:59 So the reason that's she's going to telemetry, closer monitoring, we can watch her heart rhythm, and they can watch her respiratory status, keep a closer eye on pulse ox.

    05:09 So those are just some examples of why she's going to a telemetry unit versus outpatient or a med-surg unit.

    About the Lecture

    The lecture Nursing Interventions: Change Oxygen Delivery Method – COPD Nursing Care in ER by Rhonda Lawes, PhD, RN is from the course Respiratory Case Study: Nursing Care of COPD Patient.

    Included Quiz Questions

    1. Switch to a Venturi mask.
    2. Initiate bilevel positive airway pressure (BiPAP).
    3. Prepare for mechanical ventilation.
    4. Titrate the nasal cannula to 8 L/min.
    1. They allow for precise O2 management
    2. They provide heated oxygen to encourage bronchodilation
    3. The fraction of inspired oxygen (FiO2) can titrate up to 21%
    4. They are low flow oxygen devices
    1. The client also has cardiac abnormalities and needs closer observation
    2. Clients with COPD are always admitted to the telemetry unit
    3. The client also presents with a severe headache
    4. If a client needs oxygen administration, the client needs to be admitted to a telemetry unit

    Author of lecture Nursing Interventions: Change Oxygen Delivery Method – COPD Nursing Care in ER

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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