Lecture Notes on Oxygen Therapy Prepared By: Mark Fredderick R Abejo R.

N, MAN Clinical Instructor

One way valves on the mask and between the reservoir bag and the mask prevent the room air and the clients exhaled air from entering the bag so only the oxygen in the bag is inspired. Venturi Mask Delivers oxygen concentrations varying from 24% - 40% or 50% at liter flows of 4 10 L/min. Has wide-bore tubing and color coded jet adapters that correspond to a precise oxygen concentration and liter flow Face Tent

NURSING SKILLS OXYGEN THERAPY Lecturer: Mark Fredderick R. Abejo RN,MAN

Administration of oxygen at greater than 21% (the concentration of oxygen in room air) to provide adequate transport of oxygen in the blood, to decrease the work of breathing, and to reduce stress on the myocardium Clients who have difficulty ventilating, those whose gas exchange is impaired or people with heart failure may require oxygen therapy to prevent hypoxia. Oxygen Delivery System Nasal Cannula

Can replace oxygen mask when mask is poorly tolerated by clients Face tents provide varying concentrations of oxygen. NOTE: Clients using face mask and face tent, frequently check and inspect the clients facial skin for dampness or chafing and dry and treat as needed.

Transtracheal Oxygen Delivery May be used for oxygen dependent client. Oxygen is delivered through a small, narrow plastic cannula surgically inserted directly into the trachea. Clients require less oxygen .5 2 L/min, because all of the flow delivered enters the lungs

It delivers a relatively low concentration of oxygen (24% 45% ) at flow rate of 2 6 L/min. Simple Face Mask

It delivers oxygen concentrations from 40% - 60% at liter flows of 5 - 8 L/min Partial Rebreather Mask Delivers oxygen concentrations of 60% - 90% at liter flows of 6 10 L/min. The oxygen reservoir bag that is attached allows the client to re-breathe about the first third of the exhaled air in conjunction with oxygen. Non- Rebreather Mask Delivers the highest oxygen concentration possible 95% 100% at liter flows of 10 15 L/min.

Oxygen Therapy Safety Precautions Place cautionary signs reading No SMOKING: Oxygen in Use on the clients door at the foot or head of the bed and on the oxygen equipment Note: Oxygen is colorless, odorless, tasteless and a dry gas that support combustion, therefore leakage cannot be detected.

Lecture Notes on Oxygen Therapy Prepared By: Mark Fredderick R Abejo R.N, MAN Clinical Instructor

Instruct the client and visitors about the hazard of smoking with oxygen in use. Make sure that electric device are in good condition in order to prevent the occurrence of short-circuit sparks. Flow Meter with Humidifier Avoid materials that generate static electricity, such as woolen blankets and synthetic fibers. Cotton blankets should be used. Avoid the use of volatile, flammable materials such as oils, greases, alcohol and acetone near clients receiving oxygen. Make known the location of fire extinguishers

Administering Oxygen by Cannula, Face Mask or Face Tent Flow Meter and Adapter Purposes: Cannula To deliver a relatively low concentration of O2 when only minimal O2 support is required. To allow uninterrupted delivery of oxygen while the client ingest food or fluids. To provide moderate O2 support and a higher concentration of oxygen or humidity than is provided by cannula. To provide high humidity To provide O2 when a mask is poorly tolerated. To provide a high flow of 02 when attached to a Venturi system.

Face Mask

Face Tent

Oxygen Humidifier attached to a wall-outlet oxygen flow

Equipment: Cannula - Oxygen supply with a flow meter and adapter - Humidifier with distilled/sterile water - Nasal Cannula and Tubing Face Mask - Oxygen supply with a flow meter and adapter - Humidifier with distilled/sterile water - 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/sterile water - Face tent of the appropriate size

Lecture Notes on Oxygen Therapy Prepared By: Mark Fredderick R Abejo R.N, MAN Clinical Instructor

Assessment: Assess Skin and Mucous membrane color: Note whether cyanosis is present. Breathing Pattern Alteration Rate: Tachypnea Rapid RR Bradypnea Slow RR Apnea Cessation of breathing Volume: Hyperventilation - Excessive amount of inspired air in the lungs. - Deep rapid respirations. Hypoventilation - Dec. rate/ depth of resp. - Excessive CO2 retention Rhythm: Cheyne-stokes marked rhythmic waxing and waning of respiration from very deep to very shallow breathing and temporary apnea. Kussmauls Increased rate and depth of breathing to remove excess CO2 in the lungs. Apneustic Prolong gasping inspiration followed by a very short, usually inefficient expiration. Biots Shallow breaths interrupted by apnea Ease of Effort Dyspnea Difficullty or labored breathing Orthopnea Inability to breath except in upright or sitting position. Chest movement Lung sound Sign of Hypoxemia - tachycardia ( early sign ) - tachypnea - restlessness - dyspnea - cyanosis - confusion ( late sign ) Sign of Hypercapnia (Excess CO2) - restlessness - HPN - Headache - lethargy - tremor Sign of Oxygen Toxicity - tracheal irritation - substernal discomfort - cough - dyspnea - paresthesia - dec. pulmonary ventilation

Steps / Procedure Determine the need for oxygen therapy and verify doctors order. Identify and inform the client and explain the procedure. Assist the client to a semifowlers position if possible. Wash hands and observe appropriate infection control Set up the oxygen equipment and the humidifier filled with distilled/sterile water

Rationale

To allay anxiety Permits easier chest expansion and breathing

- Attach the flow meter to the wall or tank. The flow meter should be in the off position. - Attach the humidifier bottle to the base of the flow meter - Attach the O2 tubing Turn on the oxygen at the prescribed rate and ensure proper functioning

To prevent air leakage

Apply the appropriate devices CANNULA - Put over the clients face, with the outlet prongs fitting into the nares. FACE MASK - Fit the mask to the contours of the clients face, apply it from the nose downward FACE TENT - Place the tent over the clients face

So that very little of O2 escapes around the cheeks and chin

Assess client regularly NOTE: * Client using cannula, check the nares for irritation, apply water sol.lubricant as needed

* Clients using face mask and face tent, frequently check and inspect the clients facial skin for dampness or chafing and dry and treat as needed.

Inspect equipment regularly Document relevant information