A nurse knows that a patient can receive highest oxygen by?

AIIMS Rishikesh & Jodhpur NO - 2017

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017

Explanation

The Non-Rebreather Mask (NRBM) is a high-flow device specifically designed to deliver the highest possible concentration of oxygen to a spontaneously breathing patient.
It features a reservoir bag that stores nearly 100% oxygen and one-way valves that prevent the patient from rebreathing exhaled air and entraining room air.
This design allows the NRBM to deliver a Fraction of Inspired Oxygen (FiO₂) ranging from 60% to 95%, which is the highest among the options provided.
It is typically used in emergency situations for patients with severe hypoxemia.

Option B: The Venturi mask is a high-flow device, but it is known for delivering a precise and controlled oxygen concentration, not the highest. Its maximum FiO₂ is typically around 50-60%.
Option C: A nasal cannula is a low-flow device that delivers a low concentration of oxygen (24-44% at 1-6 L/min). It is suitable for stable patients who only need minimal oxygen support.
Option D: A simple mask delivers a moderate oxygen concentration (35-50% at 6-12 L/min), which is significantly lower than an NRBM. It does not have a reservoir bag or one-way valves.

Clinical Relevance

Nursing practice connection: Use the key finding related to Oxygen Delivery Devices and FiO₂ Concentration to guide bedside assessment, documentation, and the next nursing action.
Selecting the correct oxygen delivery device is a critical nursing skill to effectively manage hypoxemia and prevent respiratory failure. Using the wrong device can lead to inadequate oxygenation or, in some cases, respiratory depression.
When using an NRBM, the nurse must ensure the reservoir bag remains at least two-thirds inflated throughout the respiratory cycle. A collapsing bag indicates the flow rate is too low, causing the patient to rebreathe CO₂.
What if? If the patient had COPD and was a known CO₂ retainer, using an NRBM would be risky. The high FiO₂ could suppress their hypoxic drive to breathe. In this scenario, a Venturi mask would be the safer choice to provide a precise, lower FiO₂ (e.g., 24% or 28%).

How to Approach the Question

First, identify the key term in the question: "highest oxygen". This immediately directs you to compare the maximum oxygen concentration (FiO₂) delivered by each device.
Mentally categorize the options as low-flow or high-flow systems. Nasal cannula and simple mask are low-flow. Venturi and NRBM are high-flow.
Recall the primary purpose of each device. The nasal cannula is for low-level support. The simple mask is for moderate, short-term support. The Venturi mask is for precise delivery. The NRBM is for maximum delivery.
Based on this, the NRBM is designed specifically for delivering the highest concentration of oxygen to a spontaneously breathing patient, making it the correct answer.

Concept Tested & Keywords

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