Question

Clinical Scenario	Possible Cause (s)	Intervention/Recommendation
The patient remains hypoxic after initiation of nasal 02 therapy
A patient with chronic COPD becomes lethargic and disoriented soon after being placed on a nasal cannula at 5 lpm
The physician orders oxygen via a simple mask with an input flow of 2 lpm for an adult patient
A nasal cannula at 2 lpm is in use on a patient with high or unstable minute ventilation who requires a FiO2 0f 0.28
The patient has facial injury or burns, but the order is for 40% aerosol
Non-partial rebreather mask bag fails to remain inflated
Air-entrainment aerosol mask delivers higher FiO2 than set
A victim of a house fire with a SpO2 of 98% is placed on N/C at 5 lpm
An oxygen dependent homecare patient who desires greater mobility, but whose activity is limited due to a stationary oxygen concentrator
An infant or child receiving 50% O2 in an isolette must be removed for a special procedure
The SpO2 of an infant receiving CPAP via nasal prongs drops during episodes of crying.

Answer 1

Answer 5.

The paradoxic decrease in saturation during crying, which was found in a large percentage of infants of the younger group, is suggestive of the presence of a transitory venous-arterial shunt. This shunt could be either through atelectatic areas of the lung or through the foramen ovale, which is only functionally closed and can open whenever the pressure in the right auricle exceeds the left auricular pressure.