Xavier University - Ateneo De Cagayan

College of Nursing

In Partial Fulfillment in:

CA 1
Case Study on Oxygenation

Submitted by:
ESCALA, Stephanie Joy
BSN 4 Block NB

Submitted to:
Mr. Philip Eli Nalzaro, RN, MN
Mrs. Leny Baguio, RN, MN
Mrs. Renzi Pepito, RN, MN
Mrs. Mildred Pinque, RN, MN
Mrs. Mary Grace Paayas, RN, MN

July 7, 2017
 You are caring for Mr. Landon, who has a history of chronic obstructive
pulmonary disease (COPD) that is well controlled. However, 2 weeks ago he
developed an upper respiratory tract infection and was treated with antibiotics. He
completed his full course of antibiotics, but his symptoms continued. He has a 4-day
history of fever greater than 102.8 F (39.4 C) fatigue, productive cough, worsening
dyspnea, and decreased activity tolerance. His health care provider does a complete
examination, orders a chest x-ray film examination, and obtains a sputum specimen.
Preliminary chest x-ray film results indicate right lower lobe pneumonia. Mr.
Landon is admitted to a general medicine floor for treatment with intravenous (IV)
antibiotics, supplemental oxygen, and pulmonary hygiene measures.
1. You observe Mr. Landon and notice that he is fatigued, has difficulty speaking,
and in general looks very uncomfortable. You decide to do a focused
assessment. Which systems will you assess, and what information will you
obtain? State your rationale for choosing these systems.
2. Mr. Landon is started on oxygen therapy via nasal cannula at 2 L/ min. What is
the approximate FiO2 level, and what are the hazards for oxygen
therapy in this patient?
3. Mr. Landon begins to remove the cannula because of discomfort at the nares
and ears from the device. What are the causes of this discomfort? What are
your interventions to reduce the discomfort?
4. One of the nurses suggests a partial rebreather mask for Mr. Landons oxygen
therapy. You do not think this is a good idea, and the rationale for your decision
is:
a. Increased inspired oxygen percentage
b. Decreased carbon dioxide retention
c. Decreased oxygen percentage
d. Increased carbon dioxide retention.

Source:
Perry, Anne Griffin., Potter, Patricia Ann.Ostendorf, Wendy. (2010) Clinical
nursing skills & techniques /St. Louis, Mo. : Mosby Elsevier

Answer:
1. Additional information may include the following:
a. Pulmonary system
1) Measure pulse oximetry.
2) Observe breathing pattern.
3) Observe for use of accessory muscles and nasal flaring.
4) Auscultate lungs for adventitious sounds and note if lung sounds
clear with coughing.
5) Observe sputum for color, thickness, amount, and patient ability
to clear airway.
b. Cardiac system
1) Vital signs
2) Heart rate and rhythm
c. Neurologic system
 1) Level of consciousness (LOC)
2) Orientation
d. Ability to follow instructions Mr Landon is very fatigued and short of
breath, which makes taking a history difficult. Obtaining cardiopulmonary
data through a focused assessment enables the nurse to identify
pertinent data about the patients status before treatment. In addition, a
brief neurologic examination obtains baseline LOC and orientation
and helps to determine the patients ability to follow instructions.
These baseline data help to determine the patients present
cardiopulmonary and oxygenation status without increasing his level of
fatigue. Remember, in patients without underlying cardiac disease, the
body adapts to decreased oxygenation or increased oxygen demands
by increasing heart rate and blood pressure. In addition, the nurse has
a sense of the patients understanding of care and ability to
participate in it (e.g., coughing and deep breathing, anticipated
oxygen therapy).
2. Administration of oxygen therapy
a. The FiO2 level is between 24% and 28%.
b. Hypercarbia is a risk for patients with COPD because the oxygen therapy
may override the adapted respiratory drive. As a result, CO2 is retained,
and there is an increased risk for respiratory failure in this patient.
3. The strap on the cannula may be too tight or placed incorrectly. Inspect the
external ears where the cannula strap rests to observe for any skin irritation
Adjust the fit of the cannula and place pressure relieving devices (e.g., ear
protectors or folded 4 4) under the elastic strap of the cannula.
The oxygen may dry out the nasal mucosa, and the cannula itself can
irritate the patients nares. Inspect nares for skin irritation. Evaluate the
humidification level of the oxygen therapy; perhaps more
humidification is needed.
4. D. Partial rebreather mask mixes exhaled carbon dioxide with oxygen and
causes an increase in carbon dioxide. Because Mr. Landon has underlying
COPD and pneumonia, he is at risk for carbon dioxide retention, and this risk
is further increased by the partial rebreather mask.

Reaction:
 The most important thing to do when caring a patient is to ensure patent
airway. It is critical as a nurse to assess this carefully because if not, the life of the
patient could be threatened. Without oxygen, life will end.
It is our duty as a nurse educator to teach our patient on how to manage
oxygenation. For example, Mr Landon was given oxygen therapy at the rate of 2L/min.
It is our duty to explain to them what is the purpose of this. In this way, he will cooperate
without any difficulties, however, it is important to monitor the patient if he is
comfortable. Yes, he understands that oxygen therapy is important for him but if he is
not comfortable, then all of the interventions will be in vain. Giving comfort to the
patients is one of our important duties as nurses.
Oxygen have a lot of benefits. It retards the aging of human cells, helps
relieve headaches, boosts the immune system, supports breathing of air in cases of
asthma and allergies, helps in cases of depression and improves physical
performance by up to 25%.
Another important factor is being knowledgeable about on how to promote
healthy breathing, the purpose of deep breathing exercises, how important hydration
is with regards to oxygenation and medications that can be used to help patients that
have oxygenation problems.
Questions:
1. Which of the following is not included as factors affecting respiratory function?
a. Stress
b. Gender
c. Age
d. Environment
Answer: B
2. The nurse is giving health teaching to a patient who is going to use an incentive
spirometer. Which instruction should be included?
a. Seal the lips tightly around the mouthpiece.
b. Hold your breath for the optimum of 8 seconds.
c. Do not remove the mouthpiece then exhale normally.
d. Observe the indicator for progress around the goal.
Answer: A
3. In suctioning a tracheostomy tube, how many seconds is intermittent
suctioning?
a. 15-20 sec
b. 10-15 sec
c. 5-10 sec
d. 10-20 sec
Answer: B
4. In providing tracheostomy care, which of the following is correct?
a. Soiled dressing should be remove lastly.
 b. Inner cannula should be first placed in normal saline.
c. In locking the cannula, it should be turned counter clockwise
d. Do not remove the old tie while placing the new tie
Answer: D
5. The normal respiratory rate for infants.
a. 16-25
b. 30-60
c. 12-20
d. 20-40
Answer: B