Question

Jennifer Hoffman
Scenario Details:
Patient data: Female – Age 33 years. Weight 99 pounds (45 kg). Height 61 inches (1.55 meter)
Allergies: Seasonal allergic rhinitis
Prior Medical History: History of asthma since childhood with multiple emergency visits within the past year. Medications used at home include beclomethasone dipropionate (Qvar), salmeterol xinafoate inhaled (Serevent), and albuterol sulfate (ProAir) inhaler.
Recent Medical History: Jennifer Hoffman is a 33-year-
old female brought to the Emergency Department by her
neighbor. She has a history of asthma since childhood with multiple emergency visits within the last year. She appears to be in respiratory distress, struggling to breathe. She is unable to speak other than simple one-word statements.
Primary Medical Diagnosis: Acute Severe Asthma Provider’s Orders:
Advanced Care Planning
 Goals of Care Designation – R1, Designation Definition: Patient is expected to benefit from and is accepting of any appropriate investigations/ interventions that can be offered including attempted resuscitation and ICU care.
Medication and IV’s
 IV normal saline at 150 mL/hour
 Albuterol 2.5 mg every 20 minutes × 3 doses
 Ipratropium 500 mcg QID
Respiratory Care
 O2 therapy – Titrate to Saturation – Oxygen to maintain SpO2 greater than 92%
Patient Care
 Vital signs every 30 min
 Continuous SP02 monitoring
  

Simulation Preparation Questions:

5. Identify orders and equipment required to administer oxygen therapy to Jennifer. Research the following oxygen delivery equipment, what each are used for and in what situation each should be used.

o Nasal cannula
o Simple face mask
o Rebreather/non rebreather mask o Venturimask
o Highflowtubingequipment

6. Identify information to be reported and documented regarding the administration of oxygen therapy to Jennifer.

7. Outline the steps required to safely administer a medication via nebulizer to Jennifer, consider safety, the nursing process, and patient teaching required in this scenario.

8. Describe the comfort and safety factors to consider when caring for Jennifer holistically as she experiences a severe acute asthma attack.

9. List criteria for evaluating the effectiveness of the interventions ordered for Jennifer, such as oxygen therapy and/or inhalant medications.

Answer 1

5) Prescription order for oxygen - O2 therapy – Titrate to Saturation – Oxygen to maintain SpO2 greater than 92%

#. Articles required for oxygen therapy :-

1. oxygen source - oxygen cylinder/central supply

2. Oxygen application device - oxygen face mask, oxygen hood, nasal pongs, nasal catheters, oxygen tent or canopy.

3. Humidifier

4. Flow meter

5. Gauze pieces

6. Adhesive tapes

7. ‘No-smoking’ board

8. Spanner to remove main valve of oxygen supply

9. Bowl with water to check the patency the tube

#. Oygen delivery equipment :

1. Nasal cannula

most commonly used oxygen delivery device

a disposable plastic device with two protruding prongs that are inserted into the nostrils

it is connected to an oxygen source with a flow meter and many times a humidifier

does not imped eating/speaking

easily used at home

disadvantages:can be dislodged easily and can cause dryness of the nasal mucosa

2. face masks

mask is fitted carefully to the pt's face to avoid leakage of oxygen

simple face mask

connected to oxygen tubing, a humidifier, and a flow meter.

has vents on its sides that allow room air to leak in at many places, thereby diluting the source of oxygen.

the vents allow exhaled carbon dioxide to escape.

used when an increased delivery of oxygen is needed for short periods (less than 12hrs).

skin breakdown is a possibility.

eating and talking with the mask in place can be difficult.

never apply the simple face mask with a delivery flow rate of less than 5L/min

3. Partial rebreather mask

equipped with a reservoir bag for the collection of the first part of the patient's exhaled air, the remaining exhaled air exits through vent, the air of the reservoir is mixed with 100% oxygen for the next inhalation, the pt receives 1/3 expired air from the bag.

permits the conversation of oxygen.

the pt can inhale room air through opening in the mask if the oxygen supply is briefly interrupted.

disadvantages- eating/talking are difficult, a tight seal is required,potential for skin breakdown.

monitor the bag carefully, should deflate slightly with inspiration;if it deflates completely, the flow rate should be increased until only a slight deflation is noted.

4. Nonrebreather mask

delivers the highest concentration of oxygen via a mask to a spontaneously breathing pt.

two 1-way valves prevent the pt from rebreathing exhaled air.

the reservoir bag is filled with oxygen that enters the mask on inspiration, exhaled air escapes through side vents.

a malfunction of the bag could cause CO2 buildup & suffocation.

can be used to administer other gases such as heliox.

5. Oxygen tent

a light, portable structure made of clear plastic and attached to a motor-driven unit.

thermostat keeps the tent at comfortable temperature.

fits over the top part of the bed; has side openings through which nursing care can be administered.

commonly used with children who need a cool and highly humidified airflow.

6. Information to be reported and documented regarding the administration of oxygen therapy include :-

- Patients vitals

- Rate of Oxygen flow

- Oxygen delivery equipment

- Ordered by physician name

- frequency of oxygen therapy

7. Medication administration through nebulizer :

Step 1

Identifies indication for medication, dosage and that no contraindications are present

Step 2

Explains procedure to patient

Step 3

Assess peak flow prior to nebulized medication assembly

Step 4

Assembles equipment (includes correct medication and dosage, checking expiration dates, purity)

Step 5

Pours correct amount of medication into reservoir well of nebulizer

Step 6

Connects nebulizer to oxygen source and adjusts oxygen flow

Step 7

Encourages patient to inhale normally through the mouthpiece or nebulizer mask until medication is depleted

Step 8

Reassess patient

Step 9

Asses peak flow after nebulized medication administration

Step 10

Notifies hospital or contacts medical control when indicated

8. Comfort and safety factors to be considered for Jennifer are :-

- calm environment

- proper lighting

- avoid stress

- avoid and remove allergic agents

- manage wheather changes

- keep beds at low height

- keep floors dry

- availability of handrails in the washroom and bathroom