A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen, the first nursing action would be to:
A. Wait until the client’s lab work is done.
B. Not administer oxygen unless ordered by the physician.
C. Administer oxygen at 2 L flow per minute.
D. Administer oxygen at 10 L flow per minute and check the client’s nail beds.
Correct Answer: C. Administer oxygen at 2 L flow per minute.
Administer oxygen at 2 L/minute and no more, for if the client is emphysemic and receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function. With prolonged oxygen therapy there is an increase in blood oxygen level, which suppresses peripheral chemoreceptors; depresses ventilator drive and increase in PCO2. high blood oxygen level may also disrupt the ventilation: perfusion balance (V/Q) and cause an increase in dead space to tidal volume ratio and increase in PCO2.
Option A: This is the ‘gold standard’ monitor of ventilation. Arterial blood gases are needed to obtain accurate data, in particular, evidence of hypoventilation (raised PaCO2) as a reason for hypoxemia. Arterial blood gases may also give an indication of the metabolic effects of clinically important hypoxemia.
Option B: Although history taking and clinical examination may clarify the diagnosis, oxygen at 40%–60% should be continued until blood gas results are available unless the patient is drowsy or is known to have had previous episodes of Hypercapnic respiratory failure.
Option D: Low intravascular volume either due to acute blood loss as in trauma can result in poor oxygen transport and tissue hypoxia. So, these patients should be given high concentration oxygen to maintain oxygen saturation above 90% until arrival at an emergency department. This can be achieved in most cases by the use of approximately 40%–60% oxygen via a medium concentration mask at a flow rate of 4–10 l/ min.
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