Chapter 5. Oxygen Therapy Show
Hypoxemia or hypoxia is a medical emergency and should be treated promptly. Failure to initiate oxygen therapy can result in serious harm to the patient. The essence of oxygen therapy is to provide oxygen according to target saturation rate, and to monitor the saturation rate to keep it within target range. The target range (SaO2) for a normal adult is 92 – 98%. For patients with COPD, the target SaO2 range is 88 – 92% (Alberta Health Services, 2015; Kane, et al., 2013; Perry et al., 2014). Although all medications require a prescription, oxygen therapy may be initiated without a physician’s order in emergency situations. Hypoxia is considered an emergency situation. Most hospitals have a protocol in place allowing health care providers to apply oxygen in emergency situations. The health care provider administering oxygen is responsible for monitoring the patient response and keeping the oxygen saturation levels within the target range. The most common reasons for initiating oxygen therapy include acute hypoxemia related to pneumonia, shock, asthma, heart failure, pulmonary embolus, myocardial infarction resulting in hypoxemia, post operative states, pneumonthorax, and abnormalities in the quality and quantity of hemoglobin. There are no contradictions to oxygen therapy if indications for therapy are present (Kane et al., 2013). Hypoxic patients must be assessed for the causes and underlying reasons for their hypoxia. Hypoxia must be managed not only with supplemental oxygen but in conjunction with the interventions outlined in Table 5.3.
Applying and Titrating Oxygen TherapyWhen providing oxygen therapy, remember the following (Kane et al., 2013):
Oxygen is available in hospitals through bulk liquid oxygen systems that dispense oxygen as a gas through outlets in rooms. It can also be provided in cylinders (large or small) for easy transport for patient use while mobile or when moving around the hospital. An oxygen flow meter regulates the flow in litres per minute. Oxygen therapy may be short- or long-term depending on the SaO2 requirements of the patients and underlying diseases processes (Perry et al., 2014). Checklist 41 reviews the steps for applying and titrating oxygen therapy (see Figure 5.2). Checklist 41: Applying and Titrating Oxygen Therapy
Special considerations:
Which arterial blood gas ABG values confirms respiratory acidosis?Acid-base status:
The combination of the low pH and the high PCO2 tells us that the respiratory acidosis is the primary process. The metabolic alkalosis is the compensatory process.
When evaluating a client's arterial blood gases ABGS which value is consistent with metabolic alkalosis?A pH of less than 7.35 indicates acidosis and a pH greater than 7.45 indicates alkalosis.
Which set of arterial blood gas ABG results require further?Which set of arterial blood gas (ABG) results requires further investigation? Indicates respiratory alkalosis. The pH level is increased, and the HCO3- and PaCO2 levels are decreased. Normal values are pH 7.35 to 7.45; PaCO2 35 to 45 mm Hg; HCO3- 22 to 26 mEq/L.
Why does accumulation of CO2 in the blood leads to acidosis?Respiratory acidosis occurs when the lungs can't remove enough of the carbon dioxide (CO2) that the body produces. Excess CO2 causes the pH of your blood and other bodily fluids to decrease, making them too acidic. Usually, the body is able to balance the ions that control acidity.
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