ADMINISTERING OXYGEN BY CANNULA, FACE MASK, OR FACE TENT Overview: Oxygen is a basic need; it is required for life.

Adequate oxygenation is essential for cerebral functioning. The cerebral cortex can tolerate hypoxia for only 3-5 minutes before permanent damage occurs. Nurses frequently assists clients in meeting oxygen needs. Indication: When a client has inadequate ventilation or impaired pulmonary gas exchange, oxygen (O2) therapy may be needed to prevent hypoxia. The primary care provider prescribes O2 therapy, the method of delivery, and the liter flow per minute. In hospitals and long-term care facilities, O2 is usually piped into wall outlets at the clients bedside. In other facilities, pressurized tanks or cylinders of O2 are used. Small, portable cylinders of O2 are available for clients who require oxygen therapy at home. O2 is a dry gas, so humidifying devices are essential to add water vapour to the inspired air, especially if the liter flow is >2 L/min. Oxygen Delivery Devices: Cannula The cannula is disposable plastic tube with two prongs for insertion into the nostrils. It fits around the head or loops over the ears to hold it in place and is connected by tubing to the O2 source. It is easy to apply, relatively comfortable, and allows the client to eat and talk. It is adequate for rates of 2-6 L/min. Above 6 L/min it is not effective. Face Mask Masks cover the clients nose and mouth. They have exhalation ports on the sides to allow exhaled carbon dioxide to escape. It is important that the mask be of appropriate size for the client. Simple face mask - Delivers O2 concentration of 40%-60% at flows of 5-8 L/min, respectively Partial rebreather mask Delivers O2 concentrations of 60-90% at flows of 6-10 L/min, respectively. Nonrebreather mask Delivers the highest possible of O2 concentration (95%-100%), except for intubation or mechanical ventilation, at flows of 10-15 L/min. Face Tent Some clients do not tolerate masks well; they may respond with anxiety or even panic. A face tent is similar to a mask, but larger and open at the top. It fits snugly around the clients jaw line, but is open at the top over the nose. It delivers a concentration of 30%-50% at 4-8 L/min. Transtracheal catheter is placed through a surgically created tract in the lower neck directly into the trachea. Once the trach has matured, the client removes and cleans the catheter two or four times per day. Oxygen applied to the catheter at less than 1 L/min need not be humidified, and rates above 5 L/min can be administered.

Safety Precautions: Place cautionary sings reading No Smoking: Oxygen is in Use on the clients door, at the foot or head of bed, and on the oxygen equipment. Instruct the client and visitors about the hazard of smoking with oxygen in use. Make sure that electrical equipment (e.g. razors, hearing aids, radios, televisions, and heating pads) is in good working order to prevent occurrence of short-circuit sparks. Avoid materials that generate static electricity, such as woollen blankets and synthetic fabrics. Cotton blankets are used, and nurses are advised to wear cotton fabrics. Avoid, the use of volatile, flammable materials, such as oils, greases, alcohol, and ether, near clients receiving oxygen. Avoid alcohol back rubs, and take nail polish removers and the like away form the immediate vicinity. Ground electric monitoring equipment, suction machines, and portable diagnostic machines Make known location of fire extinguishers, and make sure personnel are trained in their used. Assessment: Signs of hypoxia: tachycardia, tachypnea, dyspnea, pallor, cyanosis Signs of hypercabia: restlessness, hypertension, headache Signs of oxygen toxicity: tracheal irritation, cough, decreased pulmonary ventilation Special Considerations: Older adults are prone to dehydration that causes dry mucous membranes. Ciliary action decreases with age, causing decreased clearing of the airways. Muscular structures of the pharynx and larynx atrophy with age. Less ventilation in the lower lobes of the older adult causes secretions to pool or predispose to pneumonia. Equipment: Cannula Oxygen supply with a flow meter and adapter Humidifier with distilled water or tap water according to agency protocol Nasal cannula and tubing Tape Padding for the elastic band Face Mask Oxygen supply with a flow meter and adapter Humidifier with distilled water or tap water according to agency protocol Prescribed face mask of the appropriate size Padding for the elastic band

Face Tent Oxygen supply with a flow meter and adapter Humidifier with distilled water or tap water according to agency protocol Face tent of the appropriate size PROCEDURE Preparation 1. Determine the need for oxygen therapy, verify the order for the therapy. 2. Prepare the client and support people. Assist the client to a semi-Fowlers position if possible. Explain that oxygen is not dangerous when safety precautions are observed. Inform the client and support people about the safety precautions connected with oxygen use. By explaining the procedure the nurse can help to allay anxiety. RATIONALE To develop a baseline data if not already available This position permits easier chest expansion and hence easier breathing

Performance 1. Explain to the client what you are going to do, why is it necessary, and how he or she can cooperate. Discuss how the effects of the oxygen therapy will be used in planning further care or treatments. 2. 3. Wash hands and observe appropriate infection control procedures. Set up oxygen equipment and the humidifier. Attach flow meter to the wall outlet or tank. The flow meter should be in the OFF position. If needed, fill the humidifier bottle (This can be done before coming to the bedside). Attach humidifier bottle to the base of the meter. Attach the prescribed oxygen tubing and delivery device to the humidifier.

To prevent transfer of micoorganisms Dry gasses dehydrate the respiratory mucous membrane.

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PROCEDURE Turn on the oxygen at the prescribed rate, and ensure proper functioning.

RATIONALE Kinks of the tubes obstruct the flow of air to the client

Check that the oxygen is flowing freely through the tubing. There should be no kinks in the tubing, and the connections should be airtight. There should be no kinks in the tubing, and the connections should be airtight. There should be bubbles in the humidifier as the oxygen flows through. You should feel the oxygen at the outlets of the cannula, mask or tent. Set the oxygen at the flow rate ordered, for example.

Bubbles in the water indicate that oxygen flow is satisfactory

5. Apply the appropriate oxygen delivery device. Cannula Put the cannula over the clients face, with the outlet prongs fitting into the nares and the elastic band around the head. If the cannula will not stay in place, tape it at the sides of the face. Pad the tubing and band over the ears and cheekbones as needed.

Correct placement of the prongs facilitate oxygen administration.

Face Mask Guide the mask toward the clients face, and apply it from the nose downward. Fit the mask to the contours of the clients face. Secure the elastic band around the clients head so that the mask is comfortable but snug.

To reduce irritation and pressure on the cheek or behind the ears. The mask should mold to the face so that very little oxygen escapes into the eyes or around the cheek and chin

Mask that fits snugly to clients face minimizes the loss of oxygen. Padding will prevent irritation from the mask.

PROCEDURE Pad the band behind the ears and over bony prominences.

RATIONALE

Face Tent Place the tent over the clients face, and secure the ties around the head 7. Assess client regularly. Assess the clients vital signs, level of anxiety, color, and ease of respirations, and provide support while the client adjusts to the device. Continuous assessment provides information if the client is tolerating the oxygen therapy well or not and prevents possible complications.

Assess the client in 15-30 minutes, depending on the clients condition, and regularly thereafter Assess the client regularly for clinical signs of hypoxia, tachycardia, confusion, dyspnea, restlessness, and cyanosis. Review arterial blood gas if they are available.

Nasal Cannula Assess the clients nares for encrustations and irritation. Apply a water-soluble lubricant as required to soothe the mucous membranes. Face Mask or Tent

Inspect the facial skin frequently for dampness or chafing, and dry and treat it as needed.

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PROCEDURE Inspect the equipment on a regular basis Check the liter flow and the level of water in the humidifier in 30 minutes and whenever providing care to the client. Make sure safety precautions are being followed

RATIONALE

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Document findings in the client record using forms or checklists supplemented by narrative notes when appropriate.