UNIT FOUR
580
Clinical Skills and Care
Skill 28.4 (continued)
12. Allow the parts to drain on a clean paper towel and air dry to be ready for the patient’s next treatment. 13. Follow the Ending Implementation Steps located on the inside back cover. Evaluation Steps 1. Determine the effectiveness of the treatment. Auscultate the lungs to evaluate for decreased adventitious sounds. 2. Determine how the patient tolerated the treatment. Did it cause exhaustion? Was the patient able to follow directions? Did the patient inhale all the medication? Does the patient feel relief of dyspnea after treatment?
Sample Documentation
10/10/28 1340 C/o tightness in chest with inhalation. Lungs auscultated. Bilateral wheezes and coarse crackles noted bilaterally throughout lung fields. _________________________________________ ___________________________________________________ Nurse’s signature and credentials 10/10/28 1400 Nebulizer treatment with 2 mL DuoNeb administered per order. Able to use mouthpiece with deep inhalations. Tolerated without c/o discomfort or fatigue. States “breathing easier” afterward. Lungs auscultated. Scattered coarse crackles heard in bilateral lower lobes. ___________________________________________________ Nurse’s signature and credentials
Skill 28.5 Administering Supplemental Oxygen
5. Attach the tubing from the oxygen device to the humidifier. 6. Set the ordered liter flow. Turn the dial on the flowmeter so that the silver ball rises to the ordered liters per minute. The line of the selected liter number should cross the middle of the silver ball for correct flow. 7. Place the oxygen delivery device on the patient: • Nasal cannula: Place the prongs so that the curve is toward the nares and loop the tubing over the ears. Push the slider up under the patient’s chin to hold it securely in place.
Assessment Steps 1. Verify the health-care provider’s order for oxygen. Be cer- tain of liter flow and type of delivery device ordered because some types are contraindicated in certain lung diseases. 2. Assess the patient’s respiratory status, including pulse oxime- try, to document improved SaO 2 with oxygen. Planning Steps 1. Gather needed equipment and supplies: oxygen flowmeter, humidifier bottle, and ordered delivery device with tubing. 2. Obtain appropriate safety signs regarding smoking and open flames and post them in the home setting. Implementation Steps 1. Follow the Initial Implementation Steps located on the inside front cover. 2. Connect the oxygen flowmeter to the oxygen source. For piped-in oxygen, follow facility guidelines. The flowmeter may have to be positioned in a certain way to enter the valve, or a release button may have to be pressed for the flowmeter to enter. 3. Fill the oxygen humidifier with sterile water so that the level is between the minimum and maximum lines, if not using a pre- filled humidifier bottle. Safety: Oxygen at low flow rates (below 3 L/min) does not have to be humidified. Any flow rate of about 3 L/min or higher must be humidified to prevent excessive drying of the mucous membranes. 4. Attach the humidifier to the flowmeter by screwing it onto the connector completely.
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