ADMINISTERING OXYGEN

THERAPY

Prepared By:

EMILY G. GUNDAYAO, RN
ADELFA ANGELITA DE
LEON, RN

Administering Oxygen Therapy

OUTLINE:

Aim and objective of Oxygen Therapy

Human Respiration Pathophysiology
Definition
Benefits of Oxygen Therapy
Indications and contraindications
Safety Precaution
Methods of Administration for adults and Pedia
Potential complications while administering Oxygen
Nursing care

AIM AND OBJECTIVES OF

OXYGEN THERAPY
AIM
To ensure that
patients in need of
oxygen therapy are
provided the correct
measures for
treatment and comfort

OBJECTIVES
To give clear guidance on
the clinical indications for the
use of oxygen therapy in
pallative care setting
To list the equipments
needed for each method of
administration.

HUMAN RESPIRATION

 Is an odorless, tasteless, colorless, transparent

gas that is slightly heavier than air.
Oxygen is essential for cell metabolism, and
in
return, tissue oxygenation is essential for
all normal physiological functions.

OXYGEN THERAPY
is the administration of oxygen as a medical
intervention, which can be for a variety of
purposes in both chronic and acute patient
care.
it is used to treat or prevent symptoms of
hypoxia and or hypoxemia.

BENIFITS OF OXYGEN THERAPY

OXYGEN

Indications:
For cardio pulmonary
emergencies with shortness
of breath and chest pain,
cardiac or respiratory arrest.
For severe trauma
Widely used in emergency
medicine, both in hospital
and by emergency medical
services or advanced first
aiders.

OXYGEN THERAPY
CONTRA INDICATION
Oxygen treatment is contraindicated
in all patients with unfavourable
ventilation response to oxygen
treatment. In case of non-effective O2
treatment, mechanical ventilation
must be turned to as well as in all
cases with patients in respiratory
coma.

OXYGEN THERAPY
(A patient has a higher risk of complications but might still be able to receive treatment.

Asthma It could result in a pneumothorax.

High Fever It could lower the threshold for seizures;
temperature should be lowered before attempting
therapy
Optic Neuritis Rare cases of worsening vision and
blindness have occurred
Pregnancy It is unknown if any stress is caused to
the fetus.

Emphysema:
It is a type of COPD involving damage of the air sacs (alveoli) with
carbon dioxide retention.
With high levels of CO2 in their bodies so become immune to it and
respiration is triggered by low levels of oxygen
Therefore if you give a high concentration of oxygen, you are removing
their trigger to breath.
Leading to respiratory depression or even arrest (stop breathing
completely) known as hypoxic drive.
Effect of oxygen on COPD is to cause increased
carbon dioxide retention, which may cause drowsiness, headaches,
and in severe cases lack of respiration, which may lead to death

COPD versus healthy lung

Management of COPD
to assess and monitor the disease,
reduce the risk factors, manage
stable COPD, prevent and treat acute
exacerbations and manage
comorbidity.
The only measures that have been
shown to reduce mortality is smoking
cessation and supplemental oxygen.

Hyperventilation/Overbreathing

Increase of air in the lungs above the normal amount

Abnormally prolonged and deep breathing, usually associated with

acute anxiety or emotional tension
This results in reducing the carbon dioxide (CO2) level of the body that
provides the necessary stimulus for breathing. It can cause dizziness
and may even lead to unconsciousness.

Immediate Treatment
Breathing into a paper bag is not recommended
(CO2 levels in the blood will rise too much)
Relaxation techniques (Standard treatment)
Breathing slowly and purposefully = by
breathing through only one nostril (by
holding the other nostril closed with the fingers)
then focus on breathing as well as reduce the
amount of air entering the lungs.

Oxygen Therapy Safety Precautions:

Place cautionary signs reading No
Smoking: Oxygen in use on the clients
door.
Make sure that electric devices (such as
razors, hearing aids, radios, televisions,
and hearing pads) are in good working
order to prevent the occurrence of
short-circuit sparks.

Oxygen Therapy Safety Precautions: Cont.

Avoid the use of flammable materials

such as oils, greases, alcohol, ether, and
acetone(e.g. nail polish remover), near
clients receiving oxygen.
Make known the location of the fire
extinguishers, and make sure personnel
are trained in their use.

METHODS OF OXYGEN ADMINISTRATION

FOR ADULTS
I. Nasal Cannula:

Is a tube that has two prongs to go in the nose passages (nostrils)

Nasal prongs delivers low flow of oxygen concentration of 25% to 33%

at 1-3 L/min.

EQUIPMENTS:
Oxygen source
Plastic nasal cannula with
connecting tubing (disposable)
Humidifier filled with sterile
water
Flowmeter
No smoking sign

PROCEDURE:
1. Show the nasal prong to the patient and explain the
procedure.
2. Make sure the humidifier is filled to the appropriate
mark.
3. Attach the connecting tube from the nasal prong to
the humidifier outlet.
4. Set the flow rate at the prescribed liters per minute.
5. Place the tip of nasal prong in the patients nose
and adjust the strap.

 Nasal cannula- is low flow system, oxygen

concentration will vary, depending on the patients
respiratory rate and tidal volume. Approximate
concentrations delivered are:
1L= 24%-25%
3L= 30%-33%
2L= 27%-29%
Room Air = 21% + 4 % in each L/min
concentration
Example: 21% + 4% (1L) = 25%
21% + 8% (2L) = 29%
21% + 12% (3L)= 33%

of O2

FAC E M A S K
mask that delivers
moderate oxygen flow to
nose and mouth.
Delivers oxygen
concentrations of 40%60% at 4L-6L/min.

EQUIPMENTS:

Oxygen source
Humidifier bottle with distilled
water
Simple face mask with
tubing(disposable)
Flowmeter

PROCEDURE:
1.
2.
3
4
5

Show the mask to the patient and explain

the procedure.
Make sure that the humidifier is filled to the
appropriate mark
Attach the tubing from the mask to the
humidifier outlet
Set the desired oxygen concentration as
prescribed.
Apply the mask to the patients face and
adjust the straps so the mask fits securely

III. Non Rebreathing Mask

Has an inflatable bag to store 100%

oxygen and one way valve between the
bag and mask to prevent exhaled air
from entering the bag.
- one way valves covering one or both the
exhalation ports to prevent entry of
room air on inspiration

Delivers oxygen concentrations of

60%-100% at 6L-10L/min.

PARTIAL REBREATHER MASK

has an inflatable bag that stores
100 % oxygen
a) On inspiration, the patient inhales
from the mask and bag; on
expiration, the bag refills with
oxygen and expired gases exit
through perforations on both side
of the mask and some enters the
bag
b) High concentrations of oxygen 50%
to 75% can be delivered.

TYPES OF FACE MASK

PROCEDURE: For Non Rebreathing Mask

And Partial Rebreathing Mask
1. Show the mask to the patient and explain the
procedure
2. Attach the tubing to the flowmeter
3. Set and adjust the flowmeter to 6- 10 L/min
4. Place mask on patients face and adjust the straps
5. Stay with the patient to make the patients
comfortable and observe reactions
6. Remove mask periodically

V. Venturi Mask

Mask with device that mixes air

and oxygen to deliver constant
oxygen concentration.

Mask that delivers oxygen

concentration of 24% - 40% at
4 8 L/min.

VENTURI
MASK
type of disposable mask used
to deliver a controlled oxygen
concentration to a patient. The
flow of 100% oxygen through the
venturi draws in a controlled
amount of room air (21%
oxygen).
Commonly available masks
deliver 24, 28, 31, 35 or 40%
oxygen.

PROCEDURE: For Venturi mask

1. Show the venturi mask to the patient
and explain the procedure.
2. Connect the mask to the oxygen
flowmeter
3. Set the prescribed rate (usually
indicated on the mask
4. Place the mask over the patients nose
and mouth then under the chin. Adjust
the elastic strap
5. Determine the patients comfort with
oxygen use

VI. Bag-Valve Mask (Ambubag)

Delivers high concentration of
oxygen to patient with insufficient
inspiratory effort.
Delivers O2 concentration
of 15L/min at 100% with reservoir.

VI. Bag-Valve Mask (Ambubag)

Purpose :
Manually ventilate client
when off ventilator and
unable to breath
independently.
Promote oxygenation
until able to breathe
independently.

Equipment/Supplies
Hand held Ambu bag.
Cuffed face mask
Oxygen source,
Oxygen tubing.
Gloves

PROCEDURE: For Manual

Resuscitation Bag
1. Wash hands. Refer to the Hand Washing procedure.

2. Explain procedure to client.

3. Connect to oxygen by attaching one end of tubing
to flow meter adapter and one end to the Ambu bag.
Turn the flowmeter to flush position.
4. Place mask over nose and mouth - use dominant
hand to ventilate by compressing the bag oxygenation
until able to breathe independently.
5. Observe chest rise and fall to determine
effectiveness of compressions.
6. Observe client color, comfort level.

VII. T- PIECE ( BRIGGS) adapter

Is used to administer oxygen to patient

with ET or tracheostomy tube who is
breathing spontaneously.
A device for connecting two inputs
to one output or vice versa

PROCEDURE: For T-piece (Briggs) adapter

1. Show the T-tube to patient and
explain the procedure
2. Make sure the humidifier is filled to
the appropriate mark
3. Attach the large bore tubing from
the T-tube to the humidifier outlet.
4. Adjust the flow rate as ordered
5. Drain the tubing frequently by
emptying condensate into a separate
receptacle, not into the humidifier

VIII. CONTINOUS POSITIVE AIRWAY PRESSURE

(CPAP)
Is a method of respiratory ventilation
used primarily in the treatment of
sleep apnea
Commonly used for critically ill
patient with Respiratory Failure, CHF
and COPD who are admitted in ICU,
CCU or other specialized respiratory
unit

PROCEDURE: For
CPAP
1. Show the mask to the patient and
explain the procedure.
2. Insert NG tube if ordered
3. Attach NG tube adapter
4. Set the desired oxygen
concentration.
5. Place the mask on the patients
face and adjust the strap.
6. Organize care to remove the mask
as infrequently as possible

IX. Transtracheal
Catheter
Accomplished by way of a small (8 French)
catheter inserted between the second and third
tracheal cartilage
Oxygen delivery is more efficient because all
oxygen enters the lungs.
Delivers oxygen concentrations of 60% - 100%
at 4L-6L/min.

Administering Oxygen By Transtracheal

Catheter

OXYGEN THERAPY FOR

CHILDREN AND INFANTS

Children with respiratory problems may receive oxygen

therapy via nasal cannula, face mask, face tent, oxygen
hood and Closed Incubator may also be used for infants
and young children.

Oxygen Concentration in Infants

High levels of oxygen given to
infants causes blindness by
promoting overgrowth of new blood
vessels in the eye obstructing sight.
This is called
retinopathy of prematurity (ROP).

Pediatric Assessment and

Management

INITIAL
ASSESSMENT
Begins before you touch the
patient
Form a general impression.
Determine a chief
complaint.
The Pediatric Assessment
Triangle can help.

Pediatric Assessment Triangle

Appearance
Awake
Aware
Upright

Work of breathing
Retractions
Noises

Skin circulation

General Principles Regarding Oxygen Delivery

The choice of system will depend upon the clinical status of

the patient and the desired dose of oxygen
Oxygen should be humidified, whenever possible, to prevent
dried secretions from obstructing smaller airways.
The effectiveness of oxygen delivery should be monitored
with pulse oximetry.
Young children in respiratory distress may become
frightened or agitated when oxygen is administered, causing
their clinical conditions to deteriorate. Therefore, they should
remain in a position of comfort whenever possible

HOW IS OXYGEN DELIVERED?

NASAL CANNULA
A thin, soft, plastic tube and
has soft prongs that gently
fit into your babys nose.
Oxygen flows through the
tube. The baby must be able
to breathe without
assistance in order to use
this type of oxygen therapy.

OXYGEN BY MASK
Choose an appropriate size of mask that
covers the mouth and nose of the patient.
Rationale: Extra space under the mask and
around face may decrease effectiveness of
the therapy.
Do not use the mask for comatose infants or
children
Rationale: Such children are most likely to
vomit. The risk of aspiration may be
increased with mask therapy because of
obstruction of the flow of vomitus.

HOW IS OXYGEN DELIVERED?

OXYGEN HOOD

- is used for babies who

can breathe on their own
but still need extra oxygen.
- A hood is a plastic dome
or box with warm, moist
oxygen inside. The hood is
placed over the baby's
head.

 Continously monitor the oxygen

concentration, temperature, and

humidity inside the hood.
Rationale: Oxygen should be
warmed to prevent a neonatal
response to cold stress, including
oxygen deprivation and reduction
of blood glucose levels.

OXYGEN
HOOD

OXYGEN THERAPY FOR

CHILDREN
FACE TENT
are available in adult size only
a flow of 8- 10 L/min should
be used to flush the system
and provide a stable oxygen
concentration

Face Tent

It can replace oxygen masks

when masks are poorly tolerated
by clients.
Soft and lightweight face tent
designed for patients with facial
skin burn or trauma.
Latex-free elastic head strap for
better fit and less skin irritation.

CLOSED INCUBATOR OR ISOLETTES

The incubator is used to provide a controlled
environment for the neonate.
When a baby is relatively stable but still
premature or requiring intravenous fluids or other
special attention, he or she is cared for in an
"incubator."
The incubator keeps the baby warm with
moistened air in a clean environment, and helps
to protect the baby from noise, drafts, infection
Keep sleeves of incubator closed - to prevent
loss of oxygen

PROCEDURE : O2 Therapy for Children

1. Explain the procedure to the child and allow
the child to feel the equipment and the
oxygen flowing through the tube and mask
2. Maintain a clear airway by suctioning, if
necessary.
3. Provide source of humidification
4. Observe the childs response to oxygen
5. Terminate oxygen therapy gradually
6. Continually monitor the childs response
during weaning.
7. Observe for restlessness, increased pulse rate,
respiratory distress, and cyanosis.

POST PROCEDURE
Monitor the effect of therapy with pulse oximetry and/or
blood gas analysis.
Assess the patient for tolerance and appropriateness of
therapy
All continuous and prn oxygen therapy must be
verified for proper set up and function.
Change equipment as specified in the SFH Changing of
Equipment Policy.

POTENTIAL COMPLICATIONS
Impairment of respiratory drive in people with
COPD(those who retain carbon dioxide)
Discomfort secondary to drying of mucous membranes
Eye irritation
Mask can act as barrier against feeding and
communication
Creation of a fire hazard (smoking in same room must
be banned)
Restriction of activities.

NURSING CARE

Before commencing oxygen therapy ensure that it is

prescribed and that the patient understands why he/she
requires it. Reassurance and information can relieve the
distress significantly.
Reassure the patient and sit him/her up comfortably
supported by pillows before explaining how to use the
equipment.

NURSING CARE
Ensure the mask and elastic are not causing pressure marks,
especially on the nose or behind the ears. If using nasal prong, inspect
inside of the nose daily for evidence of pressure on the mucosa.
If the patient is able to transfer to and from the bed to the
chair/commode check that the oxygen tubing is long enough.
Offer advice and help with the use of nasal prong for eating or
drinking.

THANK YOU!!!