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You can Reverse Hypercapnia, you can't Reverse Death

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by Matt Bodell.
You can Reverse Hypercapnia, you can't Reverse Death

"You should never give oxygen to a patient with Chronic Obstructive Pulmonary Disease (COPD)". It's an age-old myth and more than anything it is wrong and endangering the lives of patients everyday.

When I was a Student Nurse I explicitly remember being told by many, many Nurses, that putting oxygen onto a patient with COPD will cause them to retain carbon dioxide (CO2), remove their hypoxic drive and promptly send them into irreversible type 2 respiratory failure. This is partly true, but it is missing several pieces of information.

RELATED: THE 10 RIGHTS OF MEDICATION ADMINISTRATION

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Let me start by saying, that not all COPD patients are CO2 retainers and chronic CO2 retention only stands at around 20% of patients with a chronic respiratory disease. Even then only a marginal PC02 increase can be detected with know retainers on 100% O2 for 20 minutes (Wilson, 2012). Acute CO2 retention is a possibility for ALL patients not just those with COPD.

I cannot stress to you enough - If your patient has low saturations - give them oxygen! In an emergency situation when your patient is acutely unwell, and/or their oxygen saturations are below any specified values for that individual patient, start at 15L via a non-rebreathable mask and titrate downwards as able, the saturations you are aiming for should be specified by a medic. You should never withhold oxygen from any patient when they urgently need it, as emergency Patient Group Directives (PGD's) are in place to implement this treatment, and guide your patient/oxygen management with support from the Resuscitation Council guidelines. You should ensure medics are made aware ASAP and an arterial blood gas (ABG) is completed, this is to assess for adequate oxygen saturation and to monitor for hypercapnia.

Ultimately it falls down to this - low oxygen saturations are going to cause multi-organ damage and cardiac arrest through hypoxic damage much, much faster than CO2 retention. Plus CO2 retention is, in most cases, reversible.

"You can reverse hypercapnia, you can't reverse death" is something that should be taught to Nurses and Students around the world in order to prevent unnecessary deaths. A fantastic fact sheet about COPD and CO2 retention can be found here.

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Education

NMC launches new educational standards to 'shape the future of nursing'

Part of the changes includes the removal of the cap on the number of hours students can spend on simulation activities.

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by Ian Snug.
NMC launches new educational standards to 'shape the future of nursing'

Student nurses will start to train against the new standards from January 2019.

Last week the Nursing and Midwifery Council (NMC) launched 'ambitious' new standards of proficiency that set out the skills and knowledge the next generation of nurses need.

Alongside the new proficiencies, the NMC has introduced a more modern and innovative approach to the way universities and their practise partners train nurses and midwives - the NMC claim these changes will allow greater independence of assessment, and greater innovation by placement providers.

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The NMC has also removed its standards for medicines management and instead encourages employers to instigate rigorous medicines management procedures.

Unlimited simulation.

Finally, part of the changes includes the removal of the cap on the number of hours students can spend on simulation activities - despite concerns this could reduce the total amount of time student nurses could spend on placements.

The new standards represent two years’ work and have been developed alongside nurses - as well as students, educators, healthcare professionals, charities and patient groups from across the UK.

Jackie Smith, NMC Chief Executive and Registrar, said: “Our new standards represent a huge leap forward. They raise the bar for the next generation of nurses and not only match the demands of the role but the ambition of the profession. This is vital as in the coming years many thousands of new professionals will join our register, delivering care to millions of people.

“We’ve also overhauled the way universities train nurses and midwives. They’ll be given more flexibility to harness new ways of working and embrace technology so they can equip the nurses and midwives of tomorrow with the skills they need to deliver world class care for years to come.”

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Do I really need to count a patients respiratory rate for a whole minute?

Just four breaths either side of the normal range could be indicative of impending clinical deterioration.

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by Matt Bodell.
Do I really need to count a patients respiratory rate for a whole minute?

Some staff feel that sixty seconds can be better spent.

It is well documented that the respiratory rate is the least accurately recorded vital sign but yet it can be the most important.

Reseach suggests that many students and registered nurses believe they are enhancing patients' outcomes by performing tasks other than counting a patient's respiratory rate for the full sixty seconds.

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The research, completed by Flenady et al, suggests that this debate isn't rooted in laziness but instead staff believe they are enhancing patients' outcomes by performing tasks other than counting a patient's respiratory rate.

Do I really need to count for a whole minute?

Yes! It is vitally important you count a patients respiratory rate for the full sixty seconds rather than counting for a shorter period and multiplying, or worse, estimating.

Respiration has differing patterns and without observing these for a whole sixty seconds you are unlikely to obtain an accurate measurement.

Do I really need to count a patients respiratory rate for a whole minute?

The critically unwell patient also sometimes tend to have apneic episodes and counting for a short period may not reveal these until a patient is in full respiratory arrest.

Just four breaths either side of the normal range could be indicative of impending clinical deterioration.

Finally, documenting an inaccurate respiratory rate could, potentially, have legal implications.

How should I count a respiratory rate?

You should count each full cycle of inspiration and expiration for a full sixty seconds.

Anecdotally, it is better to count a patients respiratory rate when a patient when they are not aware you are doing so - this ensures a patient is less conscious about their breathing and thus their respiratory rate is more natural.

Why is respiratory rate important?

Haemostasis and the bodies compensatory mechanisms mean that a change in respiratory rate could be one of the first indicators of deterioration in physiological condition.

Changes to a patients respiratory rate can indicate a number of things such as hypoxia, neurological or metabolic changes.

Picking up on these changes early should lead to earlier medical intervention and therefore better patient outcomes.

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Student nurses to receive ‘political lobbying lessons’

The session is designed to equip students with practical skills and knowledge they can use to develop a good relationship with their local MP.

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by James M.
Student nurses to receive ‘political lobbying lessons’

Nursing students will learn how they can work with MPs to promote the nursing profession in a new training session organised by the RCN.

Members of the RCN’s student committee and student information officers - the RCN’s representatives in universities - will learn their way around the UK parliament and the government from the UK Parliament Outreach and Engagement Service.

The session is designed to equip students with practical skills and knowledge they can use to develop a good relationship with their local MP.

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The RCN’s public affairs team will talk through the college’s approach to engaging with parliamentarians, especially the crucial role members can play. The team will explain different tactics and approaches students can take as well as what they can ask MPs to do to show their support for nursing staff in their constituencies.

Janet Davies, chief executive and general secretary of the RCN, said: “To work effectively, any union must be able to engage MPs and ministers.

“We know our members make the most powerful advocates for the profession. When frontline nursing staff sit in front of parliamentarians, you can see they listen.

“It’s through the hard work of members that vital issues such as safe staffing, harassment and health policy reach the top of the agenda.

“When nursing faces challenges on every front, the RCN wants to make sure our advocates are fully-equipped.”

Charlotte Hall, chair of the students’ committee, said: “Student nurses represent the future of the profession. Learning to engage with MPs is vital if we are to effectively shape that future and ensure the best possible care for patients.

“With these skills, committee members and student reps will be able to help other nurses make their voices heard on behalf of the profession and patients.”

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