Management of Hypoxic Patient

• Management of Hypoxic Patient:

  • Oxygen therapy +/- humidification - to help moisten and clear secretions (this is always the priority)
  • Positioning
  • To maximise V/Q
  • To relieve breathlessness
  • To assist drainage of secretions
  • ACBT
  • breathing control + + if breathless
  • Tailored cycle
• Hypoxic patient with consolidated R lower lobe pneumonia:

  • would be breathless - due to hypoxia and pneumonia (inflammation of lungs so cant participate in gas exchange)
  • oxygen therapy - provide high (40-60%) fio2 (as pts is not as risk of hypercapnia e.g. copd or cf) via venturi mask - fixed o2 concentration and delivers high flowrate
  • pts in left sidelying (right side has disease) to optimise V/Q ratio
  • high left sidelying to mix optimising V/Q ratio and reduce breathlessness
  • ACBT focus on breathing control (promote relaxation and prevent hyperventilation) and remove secretions
• Hypoxic and breathless patient with L lower lobe atelectasis:

  • Oxygen therapy - 40 to 60% via a venturi mask as the pts is breathless, humidify o2 to mobilise secretions
  • right sidelying (to optimise V/Q ratio) as left lung as collapsed (atelectasis) - also assists drainage of sputum from left lower lobe (atelectasis could be caused by sputum block)
  • ACBT - focus on breathing control as the pts is breathless and modify thoracic expansion exercises (do 2 instead of 5 as the pts is breathless)
  • the bird - to mobilise secretions during thoracic expansion exercises
• Hypoxic and productive patient with a chest infection R middle lobe:

  • oxygen therapy at 40 to 60% (venturi mask as its high flowrate) with humidification to mobilise secretions
  • quarter left sidelying to mobilise secretions and optimise V/Q mismatch
  • use the bird to mobilise secretions
  • manual techniques to mobilise secretions
• Hypoxic and breathless patient with exacerbation of COPD:

  • 24% (low amount as they have copd so at risk of hypercapnia) o2 via venturi mask to keep it fixed
  • pts position in high sitting or right side lying
  • ACBT to mobilise sputum
  • breathing control to relax pts and reduce hyperventilation