The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [480]
Postprocedure
10 Document results clearly, including the time and date of the reading. Records must be kept of all assessments made and care provided (NMC 2009, C).
11 Clean the pulse oximeter according to manufacturer’s recommendations and local policy. It may become colonized and be a source of infection to another patient (Woodrow 1999, E).
Action Figure 7 Position of an oxygen probe.
Problem-solving table 12.4 Prevention and resolution (Procedure guideline 12.4)
Postprocedural considerations
Immediate care
Any abnormalities of respiration discovered during the respiratory assessment should prompt rapid action (Higginson and Jones 2009). If there is risk of a compromised airway or respiratory insufficiency/failure then senior nursing and medical assistance, including an anaesthetist, will be required urgently (Docherty 2002). Further information will be needed, including obtaining:
a history of their current condition and any past medical history, including a list of the medications they are taking (Bickley and Szilagyi 2009)
a full set of observations including temperature, blood pressure and heart rate (Higginson and Jones 2009).
In addition, other tests may be required depending on the condition of the patient, including the following.
Arterial blood gases to check for level of carbon dioxide, oxygen level, pH, acid/base balance (Higginson and Jones 2009).
Sputum collection to assess for an infection or specific diseases such as tuberculosis (Docherty 2002, Simpson 2006).
Chest Xray or CT scan (Simpson 2006).
Blood tests including a full blood count, urea and electrolytes, clotting and crossmatch (Docherty 2002).
Fluid balance to monitor for signs of fluid overload or dehydration (Docherty 2002).
Airway management and administration of oxygen
For further information on this, see Life support and Chapter 10.
Ongoing care
As well as involving senior nurses, the medical team and potentially anaesthestists in the care of the patient, it may also be useful to refer the patient to the physiotherapy team (Docherty 2002).
Documentation
It is vital that all documentation on oxygen saturations should state whether the patient was breathing air or oxygen, and the flow of oxygen and method of administration (O’Driscoll et al. 2008). If the oxygen is being given in an emergency situation without a prescription then subsequent documentation must state the rationale for the administration of oxygen and the flow rate (O’Driscoll et al. 2008).
Education of patient and relevant others
One of the key focuses of education to patients with respiratory conditions should be to ascertain if they smoke and if they do, to encourage them to stop as smoking cessation can help to improve their prognosis (Tonnesen et al. 2007). For more information on this topic see Chapter 10.
Complications
It is recommended that to prevent any tissue damage, the pulse oximeter sensor is not taped in place (unless recommended by the manufacturer) and that the sensor should be resited every 4 hours or more frequently if necessary, depending on the patient’s condition and the manufacturer’s recommendations (MHRA 2001).
Peak flow
Definition
Peak expiratory flow (PEF) is the maximum flow of air which can be achieved when air is expired with maximum force following maximal inspiration (Quanjer et al. 1997).
Anatomy and physiology
The factors which determine PEF are:
the dimensions of the extra and intrathoracic airways, including their diameter and compliance
the force the expiratory muscles generate, which is related to the degree of lung inflation
the volume of the lungs, which is affected by the stature of the person, and speed and degree of maximal alveolar pressure that the person can reach
the degree of stretch the lungs have been subjected to previously and the recoil ability of the lung
the resistance of the instrument used to measure peak expiratory flow.
(Quanjer et al. 1997)
Therefore,