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

1) The patient remains hypoxic after initiation of nasal O2 therapy

Intervention:-

If a patient is not improving with oxygen therapy.

Perform a respiratory assessment along with a complete set of vital signs, including oxygen saturation indicated via pulse oximetry. After assessing your patient, also document the patient's skin color, level of consciousness, and other signs and any manifestations of hypoxia.

Causes might be :-

Improper position of equipment

Incorrect flow rate of oxygen

Malfunctioning of the device

Recommendations :-

Check to make sure the equipment is functioning properly, the correct oxygen delivery device is in use, and the flow rate is set correctly.

2) A patient with chronic COPD becomes lethargic and disoriented soon after being placed on a nasal cannula at 5 lpm

Reduce flow to 2 LPM or switch to air-entrainment mask at 24% - 28%. Closely monitor patient.

3) A Physician orders oxygen via simple mask at 2 LPM for an adult patient :-

Flow should be set at a minimum of 5 LPM

Or switch to 2 LPM cannula

4) Nasal cannula at 2 LPM is in use on a patient with a high or unstable minute ventilation who requires an FIO2 of 28%.

Recommend a high-flow device at 28%.