clinical judgment

• clinical judgement process:

  • noticing
  • interpreting
  • responding
  • reflecting
• provider notification

  • emergency situations
  • admission
  • change in condition
  • clarification of orders or directions
• oxygen therapy is the administration of supplemental oxygen to a patient to prevent or treat hypoxemia
• routes of oxygen administration include:

  • nasal cannula
  • face masks
  • non-invasive ventilation
  • positive pressure ventilation
• nurses should treat oxygen therapy as a medication
• conditions that may require supplemental oxygen:

  • apprehension, anxiety, behavioural changes
  • decreased loc, confusion, drowsiness, fatigue
  • increased pulse rate
  • increased rate and depth of respiration or irregular respiration patterns
  • decreased lung sounds, adventitious lung sounds
  • dizziness
  • pulse oximetry less than 90% or less than 88% in patient risk of hypercapnia
  • use of accessory muscles of respirations, rib retraction
  • elevated bp evolving to decreased bp
  • pallor, cyanosis
• high flow oxygen delivery

  • provide a higher flow of o2 to meet the higher minute volume demands
  • can deliver a range of different inspired o2 concentrations
  • low flow nasal cannula
  • simple face mask
  • partial rebreather masks
  • non rebreather masks
• nasal cannula used to deliver 24% oxygen to 44% oxygen
• high flow nasal cannula used to deliver up to 60L/min
• simple face mask

  • covers mouth and nose
  • delivers between 35-50% humidified oxygen to flow rates of 6-12L/min
  • often used for short term therapy
• non rebreather mask

  • short term therapy
  • between 60-90% flow rates of 10-15 L/min
  • oxygen flows into the reservoir bas and mask during inhalation to attain high levels of oxygen
  • fits snugly over the nose and mouth
• venturi mask

  • deliver precise, high flow rates of humidified oxygen
  • light weight, fit to face
  • deliver 24%, 28%, 31%, 35%, 40%, and 50% oxygen
  • fits snugly over the nose and mouth