Oxygen Therapy

Supplementary oxygen therapy is a treatment for hypoxemia, otherwise known as low oxygen levels in the blood. Oxygen is commonly used in the hospital, and also can be used by patients for long-term therapy at home. Oxygen should be considered as a drug, and therefore requires a formal prescription. It can be dangerous if administered excessively or insufficiently. For patients who are at risk of type 2 respiratory failure, such as those with COPD, severe chronic asthma, neuromuscular disorders, kyphoscoliosis, and obesity hypoventilation; the target saturation range should be 88 to 92 percent. For all other patients, the target saturation range should be 94 to 98 percent.

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Oxygen Saturations

Transcutaneous monitoring of oxygen saturations is carried out using a device called a pulse oximeter. It is a simple, non-invasive test that can be used to estimate the amount of oxygenated haemoglobin in the blood. This monitoring can take place continuously, or on an intermittent basis. A probe is placed on a finger, toe, or earlobe. The probe contains a light source which transmits red and infrared wavelengths through a pulsating capillary bed. The light is transmitted through the tissue, and a photodetector on the other side measures the light which passes through. The monitoring unit analyses this, and works out the amount of light that has been absorbed by the oxygenated blood in the tissue. The amount of oxygenated blood is then displayed as a percentage saturation.

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Nutritional Assessment

Malnutrition occurs when a person’s diet does not contain the right balance of nutrients. A deficiency in nutrients may have detrimental effects on health, putting a patient at higher risk of developing disease; or delaying recovery from disease. The term malnutrition is generally used to refer to under-nourishment. It is also possible to eat a diet high in calories but containing few vitamins and minerals, causing malnutrition, even though a person might be overweight or obese. Making an assessment of a patient’s state of nutrition is essential to identify those in need of further investigation and subsequent nutritional support. This includes an evaluation of their diet; their general physical condition; and measurement of height, weight and body mass index. The Malnutrition Universal Screening Tool or M.U.S.T, is a commonly used, and validated screening tool. It is used in the assessment of adults in hospitals and community care settings, to detect malnutrition, those at risk of malnutrition, or those that are obese. It also includes management guidelines, which can be used to develop a nutritional care plan. It is important to note that in some situations where a patient’s height or weight measurements may be altered; such as patients with fluid disturbances, during pregnancy, in patients with amputations, or plaster casts; the M.U.S.T. tool may need to be adapted.

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Nebuliser Therapy

A nebuliser is a device used for the administration of medication in the form of an aerosol for inhalation. Oxygen, or compressed air, is used to convert medication in the form of a liquid, to an aerosol which is inhaled via a mask or mouthpiece. This allows medications, such as broncho-dilators and steroids, to be delivered directly to the respiratory tract. In acutely unwell patients with asthma, the nebuliser should be driven by oxygen. In stable patients with asthma, compressed air can be used. For patients at risk of hypercapnia, such as those with chronic obstructive pulmonary disease, the nebuliser should be driven by compressed air.

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Measuring Pulse Rate (Manual)

The pulse rate is a peripheral measure of the heart rate. It can be measured using manual techniques or automatic electronic devices. The pulse rate is a simple measurement that clinicians use, along with other observations, to assess patients’ physiological status. Serial measurements are useful in monitoring patients, and identifying changes in a patient’s condition. When measuring the pulse manually, in addition to the rate, the rhythm and character of the pulse can also be assessed.

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Measuring Blood Pressure (Manual)

Blood pressure is the force exerted by the flow of blood against the walls of the blood vessels. It varies with the strength of the heartbeat, the elasticity of the arterial walls, the volume and viscosity of the blood. Blood pressure is affected by a person’s health, age, and physical condition. It is frequently used to monitor patients. Blood pressure can be measured manually using a sphygmomanometer or automatically by using an electronic device. In this film, we will show the use of a Greenlight sphygmomanometer, to measure blood pressure manually.

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Male Urinary Catheterisation

A urethral catheter is a flexible plastic or latex tube which is inserted into the bladder via the urethra to drain urine, or instil medications into the bladder. When selecting the type of catheter, do so considering the reason for insertion, and the intended duration required. The aim to use the smallest size which will allow free urinary drainage between size 12 – 16 for males. Larger sizes may be required if there is debris or blood clots, which may block a smaller diameter catheter. Ensure you use the correct length of catheter; the standard length for a male catheter is 40-44cm. Female catheters are shorter, as the female urethra is shorter. If a catheter that is too short is inserted into a male, when the balloon is inflated, it may cause trauma in the urethra. When inserting a urethral catheter, it is important to maintain an aseptic technique, in order to reduce the risk of introducing infection into the urinary tract. In this film, due to the sensitive nature, this procedure will be performed on a catheterisation simulator model.

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Local Anaesthetic Infiltration

Local anaesthetic drugs can be used to perform a reversible blockade of motor and sensory nerves. Local anaesthetic drugs act by temporarily blocking sodium channels in excitable tissues such as nerves and muscle. This prevents the influx of sodium across the cell membrane, leading to an inhibition of action potential propagation along axons of nerves. Local anaesthetic can be used for infiltration. This is where the drug is infiltrated into an area of skin to block sensation and pain. There are many different local anaesthetic agents. The two commonly used drugs for local infiltration include lidocaine, also known as lignocaine and bupivacaine.

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Transferring a Patient with a Hoist

Manual Handling refers to the process of transporting or supporting of a load by hand or bodily force. This may be a person or an object. To create a safe environment for all staff, patients and visitors, manual handling should be avoided when possible if the option of using other techniques or equipment is feasible. Where it is necessary to undertake manual handling activities, suitable and sufficient assessment of all such operations should be carried out, and appropriate steps should be taken to reduce the risk of injury. Anybody undertaking manual handling activities should be provided with suitable information, instruction and training. When moving patients, an assessment should be made to look at the patient’s mobility and their ability to carry out moving and handling activities. These should be regularly reviewed, as the risks are dynamic. Also, you should always remember that not all patients need assistance and that you should aim to facilitate independent movement as much as possible. In some situations, it may be necessary to use equipment to aid a movement. For example, a hoist should be used for patients that do not have the ability to assist in their own movements, or who are very heavily dependent, in order to eliminate the risks of manually lifting them. Due to the complexity of hoist manoeuvres’ it is imperative that two individuals are involved with the fitting and transfer at all times.

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Intramuscular Injections

An intramuscular injection deposits medication into well-perfused muscle tissue. The vascularity of muscle aids the rapid absorption of the medication into the systemic circulation. Intramuscular injections are used to deliver medications that would otherwise be absorbed too slowly or made ineffective if taken orally; when intravenous access is difficult; or if other routes are contraindicated. The intramuscular route should not be used in cases where muscle size and condition is not adequate to support sufficient uptake of the drug. Intra muscular injections are of limited use in patients who have impaired peripheral circulation and oedema. Intramuscular injections should be avoided where possible in patients with thrombocytopenia or impaired clotting.

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