Question

1. Bill McDonald, 65 years of age, is a male patient diagnosed with chronic obstructive pulmonary disease (COPD). He is going to be discharged with home oxygen at 2 L/min per nasal cannula. According to Medicare guidelines, the patient falls into the group 1 patient category, the patient’s O2 saturation on room air was less than 88% and his PaO2 was less than 55 mm Hg, which was obtained from an arterial blood gas (ABG) at room air. The physician completed the script for the home oxygen therapy according to Medicare guidelines. The information that needed to be included on the script was the documented diagnosis, the prescribed liter flow, the frequency of use in hours per day, and the number of months in duration. The results of the pulse oximetry and the ABG were also included in the script to justify the need for the home oxygen therapy. The nurse needs to make arrangements with the social worker to obtain an agency to supply the oxygen equipment needed and to provide follow-up on a regular basis. The supplier makes arrangements to deliver an oxygen concentrator and portable tanks or concentrated oxygen and oxygen regulators, and needed supplies, including 50 feet of tubing, and nasal cannulas. (Learning Objectives 1 and 2)

What home care considerations need to be made before the patient is discharged and what considerations need to be made once the patient arrives home?

What patient and family education must the nurse provide in regard to home oxygen therapy?

Answer 1

1) Self-care
Know how and when to take your COPD medicines.

Take your quick-relief inhaler when you feel short of breath and need help fast.
Take your long-term drugs every day.
Eat smaller meals more often, such as 6 smaller meals a day. It might be easier to breathe when your stomach is not full. DO NOT drink a lot of liquid before eating, or with your meals.

Ask your provider what foods to eat to get more energy.

Keep your lungs from becoming more damaged.

If you smoke, now is the time to quit.
Stay away from smokers when you are out, and do not allow smoking in your home.
Stay away from strong odors and fumes.
Do breathing exercises.
Talk to your provider if you feel depressed or anxious.

Stay Away From Infections
Having COPD makes it easier for you to get infections. Get a flu shot every year. Ask your provider if you should get a pneumococcal (pneumonia) vaccine.

Wash your hands often. Always wash after you go to the bathroom and when you are around people who are sick.

Stay away from crowds. Ask visitors who have colds to wear masks or to visit when they're all better.

Save Your Energy at Home
Place items you use often in spots where you do not have to reach or bend over to get them.

Use a cart with wheels to move things around the house and kitchen. Use an electric can opener, dishwasher, and other things that will make your chores easier to do. Use cooking tools (knives, peelers, and pans) that are not heavy.

To save energy:

Use slow, steady motions when you are doing things.
Sit down if you can when you are cooking, eating, dressing, and bathing.
Get help for harder tasks.
Do not try to do too much in one day.
Keep the phone with you or near you.
After bathing, wrap yourself in a towel rather than drying off.
Try to reduce stress in your life.
Going Home With Oxygen
Never change how much oxygen is flowing in your oxygen setup without asking your provider.

Always have a back-up supply of oxygen in the home or with you when you go out. Keep the phone number of your oxygen supplier with you at all times. Learn how to use oxygen safely at home.

Follow-up
Your hospital provider may ask you to make a follow-up visit with:

Your primary care doctor
A respiratory therapist, who can teach you breathing exercises and how to use your oxygen
Your lung doctor (pulmonologist)
Someone who can help you stop smoking, if you smoke
A physical therapist, if you join a pulmonary rehabilitation program
When to Call the Doctor
Call your provider if your breathing is:

Getting harder
Faster than before
Shallow, and you cannot get a deep breath

Also call your provider if:

You need to lean forward when sitting in order to breathe easily
You are using muscles around your ribs to help you breathe
You are having headaches more often
You feel sleepy or confused
You have a fever
You are coughing up dark mucus
Your fingertips or the skin around your fingernails are blue.

2) Your doctor will write you a prescription to begin oxygen therapy. They’ll tell you how to use it and how often you should use it. This will include the flow rate, or how much oxygen you’ll need per minute. It is essential that you follow all of your doctor’s specific instructions. If you don’t think the oxygen therapy is working for you, see them before making any changes.

Some people only need oxygen during certain activities, like exercising or sleeping. Other people need oxygen constantly. Most types of oxygen therapy come with portable oxygen tanks so you can leave home with them if necessary.

Do not use drugs or alcohol while taking oxygen therapy, as they can slow your breathing. When discussing oxygen therapy with your doctor, make them aware of any other prescription medications you may be taking.

Many people with severe COPD require long-term oxygen therapy. COPD is an umbrella term that includes progressive lung diseases that lead to increased breathlessness. Some people will experience declining lung function over time, leading them to struggle to get enough oxygen.

Long term, regular oxygen therapy can significantly improve the quality and length of life for people with COPD. Many of them may need to receive oxygen therapy for at least 15 hours every day.
Oxygen therapy can be extremely beneficial for those who frequently experience low oxygen levels, regardless of the reason. If needed, regularly utilizing oxygen therapy can allow people to be more active and mobile by decreasing shortness of breath. It also can significantly improve quality of life, and in many cases extend life expectancy.

Oxygen therapy can also reduce symptoms such as:

headaches
irritability
fatigue
swollen ankles
Oxygen therapy can help the growth and development of children who have chronic lung conditions. It can also lessen symptoms such as headaches caused by low oxygen levels, and behavioral changes or problems.
How is blood oxygen tested?
There are two main ways to test blood oxygen levels:

A pulse oximeter: This device is placed on your finger or earlobe. It uses light to test the amount of oxygen in the blood.
A blood gas test: If you need a more exact reading, medical staff will usually take blood from an artery in your wrist.