The client with a chronic obstructive respiratory disease is receiving oxygen via a nasal cannula. Which of the following interventions does the nurse plan to include in the client’s care?
1. Assess nares for skin breakdown every 6 hours.
2. Check patency of the cannula every 2 hours.
3. Inspect the mouth every 6 hours.
4. Check oxygen flow every 24 hours.
ANSWER
ANS: 1
The nurse caring for the client with a nasal cannula should plan to assess the client’s nares and superior surface of both ears for skin breakdown every 6 hours. The nurse should check patency of the cannula every 8 hours. The nurse does not need to check the client’s mouth in relation to the client’s use of a nasal cannula. The nurse should continue providing oral hygiene and may as-sess the mouth (i.e., tongue) for cyanosis, along with other assessment measures. Oxygen flow should be checked every 8 hours, not every 24 hours.
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