Oxygen management
Many of the clients in acute care settings will be on oxygen either for direct pulmonary disease process or secondary to decreased respiratory capacity from surgery/pain/etc. The mneumonic I have for this is rather long.
Really Old People's Skin Sag, Find Home Health Records
R - Response to activity. I will be assessing how the patient acts during and immediately after activity. I need to look for shortness of breath a change in pulse or respiratory rate,nostril flaring or use of accessory muscles.
O - oxygenation status.Look at the fingernail beds for the color,any clubbing, and capillary refill. Normal capillary refill is less than 3 seconds ,there should be no clubbing and the nail beds should be pink. Any deviance from normal could be considered an alteration in the oxygenation status, no matter what the cause.
P -Position for optimal oxygenation. This usually means high Fowler's position , with the head of the bed elevated upright. A patient may choose to be in an orthopnic postion,leaning forward ,perhaps resting on pillows on an overbed table. The orthopnic postion is favored by many who have Chronic lung conditions. An overriding area of care is Caring/emotional jeopardy and so you have to take in consideration their preference. I would verbalize to the CE that I advised the patient the optimal postion but due to the patient's desires I would invoke CDM here.
S -Skin assessment. The tubing of oxygen delivery system is unforgiving plastic and can be quite irritating. Check behind ears, in nares and around a face mask. Pad as needed and report skin breakdown to the primary nurse.It is allowed to tape the tubing to the face,but I would be hesitant to do this as tape can be an irritant too.
S - Sats. This is shorts for oxygen saturation. It is a measurement taken by a machine that dispays the O2 level. There is a probe that is attached to a finger or even and ear. Some people are on continuous O2 monitering. If there are parameters to notify the primary , it will be noted on the PCS assignment kardex.
F - Flow rate. This is the amount of flow on the O2 delivery system. If it is by mask, be sure it is the correct one, as this will affect flow rate.Adjust as needed.There may be an order to titrate O2 to keep sats above a certain number.
H -Hazards. Look around for anything that may cause a spark.Remember that oxygen is highly flammable and foremost a safety concern. Remove electric razors.
H - Humidity.Some on higher levels of oxygen flow or long term use use humidity attached to the flowmeter prior to the O2 delivery device. During the PCS keep an eye on it so that it does not run dry or become detached.
R - Records all of the above. Do not leave anything out.Include any change in the patient's condition weather positive or negative.
All together this should not be time consuming and ought to be able to be completed during other assessments and cares.
Really Old People's Skin Sag, Find Home Health Records
R - Response to activity. I will be assessing how the patient acts during and immediately after activity. I need to look for shortness of breath a change in pulse or respiratory rate,nostril flaring or use of accessory muscles.
O - oxygenation status.Look at the fingernail beds for the color,any clubbing, and capillary refill. Normal capillary refill is less than 3 seconds ,there should be no clubbing and the nail beds should be pink. Any deviance from normal could be considered an alteration in the oxygenation status, no matter what the cause.
P -Position for optimal oxygenation. This usually means high Fowler's position , with the head of the bed elevated upright. A patient may choose to be in an orthopnic postion,leaning forward ,perhaps resting on pillows on an overbed table. The orthopnic postion is favored by many who have Chronic lung conditions. An overriding area of care is Caring/emotional jeopardy and so you have to take in consideration their preference. I would verbalize to the CE that I advised the patient the optimal postion but due to the patient's desires I would invoke CDM here.
S -Skin assessment. The tubing of oxygen delivery system is unforgiving plastic and can be quite irritating. Check behind ears, in nares and around a face mask. Pad as needed and report skin breakdown to the primary nurse.It is allowed to tape the tubing to the face,but I would be hesitant to do this as tape can be an irritant too.
S - Sats. This is shorts for oxygen saturation. It is a measurement taken by a machine that dispays the O2 level. There is a probe that is attached to a finger or even and ear. Some people are on continuous O2 monitering. If there are parameters to notify the primary , it will be noted on the PCS assignment kardex.
F - Flow rate. This is the amount of flow on the O2 delivery system. If it is by mask, be sure it is the correct one, as this will affect flow rate.Adjust as needed.There may be an order to titrate O2 to keep sats above a certain number.
H -Hazards. Look around for anything that may cause a spark.Remember that oxygen is highly flammable and foremost a safety concern. Remove electric razors.
H - Humidity.Some on higher levels of oxygen flow or long term use use humidity attached to the flowmeter prior to the O2 delivery device. During the PCS keep an eye on it so that it does not run dry or become detached.
R - Records all of the above. Do not leave anything out.Include any change in the patient's condition weather positive or negative.
All together this should not be time consuming and ought to be able to be completed during other assessments and cares.
posted by taming the beast at 5:26 PM
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