Difficulty: Medium
Average Score: 73%
Simulated
The nurse assesses a client who has a nasal cannula delivering oxygen at 2 liters/minute. To assess for skin damage related to the cannula, which areas should the nurse observe? select all that apply.
Correct answer
A,B,C
Rationale
The nasal cannula rests on the upper lip, with the tubing extending over the cheeks and behind the ears. Pressure and friction from the cannula prongs can cause skin breakdown around the nostrils and on the upper lip. The tubing can cause pressure on the bridge of the nose and the tops of the ears, especially if it is too tight. The forehead and lower cheeks are not typically in contact with the cannula.