Oxygenic Therapy

Indication of Oxygen Therapy

The goal of oxygen therapy is to prevent or relieve hypoxia. Any client with impaired tissue
oxygenation can benefit from controlled oxygen administration. Oxygen is considered a drug that
requires a physician’s prescription for administration, because it has dangerous side effects. The
nurse must know the indication, dosage, route of administration, and potential complications of its
use.
Classification of Hypoxia
Hypoxia is classified into four categories based on the causes and characteristic of hypoxia.
Among four categories of hypoxia, oxygen therapy can raise PaO2, SaO2, and CaO2 and attain
good effect for clients with hypotonic hypoxia. Oxygen therapy may have effect on clients with
heart failure, shock, severe anemia, or carbon monoxide poisoning.

Classification of hypoxia Characteristics Causes

Hypotonic hypoxia Decreased level of PaO2 and Caused by a diminished

Circulatory hypoxia
CaO2 in arterial blood
Poor tissue perfusion with
oxygenated blood
concentration of inspired oxygen,
alterations of external respiration,
or venous blood shunting into the
arteries, such as high altitude
disease, COPD, or congenital heart
diseases
Caused by shock, heart failure, and
so on

Hemic hypoxia Inadequate or alterations of Caused by anemia, carbon

quality of hemoglobin lead to monoxide poisoning, or
hemic hypoxia methemoglobinemia

Histogenous hypoxia The inability of tissues to Caused by cyanide poisoning

extract oxygen from blood

Level of Hypoxia
Oxygen therapy and liters of oxygen flow per minute is administered according to assessment
of the client’s state of hypoxemia.
a. Mild Hypoxemia: PaO2>6.67kPa (50 mmHg), SaO2 >80%, no cyanosis. In general,
oxygen therapy is not indicated for clients in this level of hypoxemia. Clients who complain
dyspnea may receive low flow oxygen therapy (1-2 L/min).

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 b. Moderate Hypoxemia: PaO2 4-6.67kPa (30-50mmHg), SaO2 60-80%. Clients have
dyspnea or cyanosis. Clients need oxygen therapy.
c. Severe Hypoxemia: PaO2 < 4kPa (30 mmHg), SaO2<60%. Clients have severe
dyspnea or may have severe cyanosis. It is absolute indication for oxygen therapy.
Oxygen Flow Rate
The flow rate of oxygen is used to regulate the amount of oxygen available to the client,
measured in liters per minute. The rate varies depending on the condition of the client and the
route of administration of oxygen. Because there is leaking and mixing with atmospheric air, the
flow rate does not exactly reflect the concentration actually inspired by the client. More precise
doses are usually prescribed in terms of percent of inspired oxygen. The physician prescribes the
flow rate of oxygen administration. The nurse should monitor closely the flow rate for the client
with lung conditions. Most clients with chronic lung diseases can tolerate oxygen with a nasal
cannula at 2 L/min but arterial blood gas analysis should be monitored closely. The nurse must
know what flow rate produces a given percentage of inspired oxygen concentration. For low or
moderate flow oxygen therapy with nasal cannula method, inspired oxygen concentration is
calculated with the following formula:
Inspired oxygen concentration (%)=21+4×oxygen flow rate (L/min)
Humidifying Oxygen
Oxygen administered from a cylinder or wall-outlet system is dry. Dry gases dehydrate the
respiratory mucous membranes. Humidifying devices are commonly used for oxygen. Distilled or
sterile water is commonly used to humidify oxygen. Oxygen passing through water picks up water
vapor before it reaches the client.
Complications of Oxygen therapy and Prevention
Prolonged administration of high concentration of oxygen can result in some complications.
Oxygen Toxicity Prolonged administration of high concentration of oxygen leads to lung
substantive changes, causing oxygen toxicity. Clients may complain of uncomfortable, pain, and
burning sensation under sternum in early stage of oxygen toxicity, then have increased respiratory
rate, nausea, vomiting, restlessness, and dry cough. Methods for preventing oxygen toxicity
include avoiding prolonged administration of high concentration of oxygen, measuring oxygen
concentration and saturation of arterial blood regularly, and observing effects and side effects of
oxygen therapy closely.
Absorption Atelectasis When clients inspire oxygen of high concentration, in alveoli
most of nitrogen gas that is not absorbable, is replaced by oxygen. Once bronchia are obstructed

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by secretions, oxygen in alveoli is absorbed rapidly and absorption atelectasis occurs. The main
symptoms of this complication include restlessness, increased respiration rate and heart rate,
raised blood pressure, dyspnea, and even coma. Prevention of obstruction in respiratory tract is
essential for preventing absorption atelectasis. Clients are often encouraged to make deep breath
and effective cough, and change body position more often to prevent stasis of secretions.
Dryness of Respiratory Secretions Oxygen from cylinder system or wall-outlet system
is dry. Dry gases dehydrate the respiratory mucous membranes and secretions become thick and
viscous which is hard to remove. Humidification should be strengthened while delivering oxygen
to prevent dehydration of respiratory mucous membrane and dryness of respiratory secretions.
Retrolental Fibroplasia High arterial oxygen tensions are a major factor in causing
retrolental fibroplasias in neonates, especially in preterm newborns, which may result in
irreversible blindness. The condition is caused by blood vessels growing into vitreous, which is
followed later by fibrosis. Oxygen therapy for neonates should control concentration of oxygen
and time of therapy.
Respiration Depression It occurs among clients with type Ⅱ respiratory failure who
have decreased PaO2 and increased PaCO2. Clients with type Ⅱ respiratory failure have prolonged
high level of PaCO2 in arterial blood, respiratory center in the medulla is not sensitive to
concentration of CO2 and regulation of respiration mainly depends on the stimulation to peripheral
chemoreceptors of decreased O2. When clients inspire oxygen of high concentration, this
stimulation is eliminated leading to depression of respiration and even respiration cease.
Therefore, oxygen therapy of low concentration and low flow rate is administered for clients with
type Ⅱ respiratory failure to maintain clients’ PaO2 at 8kPa.

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