Case study - Supplemental oxygen: Nursing

Nurse. Emad works on an inpatient medical surgical unit and is caring for Marietta, a 72 year old who underwent a surgical procedure three days ago.

In collaboration with the registered nurse, RN Laura nurse Ahmad goes through the steps of the clinical judgment measurement model to make clinical decisions about Marietta's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, simo recognizes cues including Marietta's vital signs which are temperature 98.6 °F or 37 °C, heart rate, 90 BPM, respirations, 24 breaths per minute BP, 133/66 millimeters of mercury and oxygen saturation.

87% on room air nurse. AAD notes that Marietta is taking short shallow breaths and appears anxious.

He also sees that Marietta is lying on her side with the head of the bed flat. Nimmo raises the head of her bed and assists Marietta to reposition herself.

Hi, Marietta, it looks like youre having trouble breathing. It's hard to take a deep breath.

I have repositioned you which should help your lungs expand. Focus on taking deep breaths in through your nose and out through your mouth.

Then a nsima applies oxygen to Marietta via nasal cannula at 2 L per minute according to his units protocol nso then analyzes these cues.

He reviews the electronic health record or EHR and notes that despite seeing documentation that Marietta was taught how to use her incentive spirometer to help keep her lungs expanded.

The device isn't in her room. He also knows that anesthesia during surgery can reduce surfactant production in the lungs which is needed to keep the little air sacs called alveoli open and full of air.

He understands that when there's less surfactant, the walls of the alveoli tend to collapse leading to atelectasis where portions of the lungs are not fully expanded.

Nur sood realizes that this impairs gas exchange and can lead to hypoxemia which occurs when blood oxygen levels are low and hypoxia where there isn't enough oxygen available to the tissues to meet the needs of the body cells.

He understands that Marietta low oxygen saturation, tachypnea, increased heart rate and anxiety are likely related to hypoxia from impaired gas exchange.

Simo realizes that Marietta needs effective management of her oxygenation. Now, using the information he has gathered along with Marietta's medical history.

Nsima discusses his findings with R and Laura and they choose a priority hypothesis of impaired gas exchange. Then they generate solutions to address Marietta's oxygenation and they establish the expected outcome that Marietta's oxygen saturation will rise above 90% within one hour nur sood then takes action to implement these solutions.

While RN Laura calls the health care provider to report Marietta's current respiratory findings, he checks on Marietta and notices her breathing has slowed and she appears more comfortable.

He measures her oxygen saturation which is now 89% on oxygen. Then he gathers supplies to reinforce teaching on use of the incentive spirometer.

Ok, Marietta, I understand you were instructed on how to use this device and your preoperative teaching with the RN. Can you show me how to use it?

I haven't used it yet since surgery, but I remember the nurse told me to use it like this. Marietta demonstrates proper use of the device but stops halfway through ouch.

My incision hurts when I do that. I understand that it can be uncomfortable.

Do you remember how to splint your incision with a pillow to make it easier to take a deep breath? I think.

So, Marietta places a pillow over her incision and holds it in place while using the incentive spirometer. One hour later, Nur AAD evaluates the outcome of his actions.

He takes Marietta's vital signs which are temperature, 98.6 °F or 37 °C, heart rate, 70 BPM, R 16 breaths per minute BP.

125/78 millimeters of mercury and oxygen saturation, 94% on 2 L of oxygen per nasal cannula. Marietta reports.

Shes used the incentive spirometer 10 times since the last time, nurse iod exited the room and feels her shortness of breath has improved.

All right, as a quick recap, nsima recognized and analyzed cues related to Marietta's oxygenation and in collaboration with RN Laura prioritized hypotheses and generated solutions to address this problem.

Nurim and RN Laura then took action and evaluated Marietta's outcomes and compared them to the expected outcome. Since Marietta's oxygen saturation was over 90% within an hour.

They determined the plan of care was successful.