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.

 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.

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.

OXYGEN

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.

 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.

 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.

 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.

 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 shortcircuit sparks.

 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.

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 of O2 concentration Example: 21% + 4% (1L) = 25% 21% + 8% (2L) = 29% 21% + 12% (3L)= 33%

 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

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.

 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.

1. 2. 3.

4.
5. 6.

Show the mask to the patient and explain the procedure Attach the tubing to the flowmeter Set and adjust the flowmeter to 6- 10 L/min Place mask on patients face and adjust the straps Stay with the patient to make the patients comfortable and observe reactions 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.

 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.

1.

2.
3.

4.

5.

Show the venturi mask to the patient and explain the procedure. Connect the mask to the oxygen flowmeter Set the prescribed rate (usually indicated on the mask Place the mask over the patients nose and mouth then under the chin. Adjust the elastic strap 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

1.

2.
3.

4.
5.

Show the T-tube to patient and explain the procedure Make sure the humidifier is filled to the appropriate mark Attach the large bore tubing from the T-tube to the humidifier outlet. Adjust the flow rate as ordered 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

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.

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.

 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).

 Begins before you touch the

patient Form a general impression. Determine a chief complaint. The Pediatric Assessment Triangle can help.

 Appearance Awake Aware Upright Work of breathing Retractions Noises Skin circulation

 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

 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.

 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.

- 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.

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.

 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. Changing of Equipment Policy.

Change equipment as specified in the SFH

 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.

 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.

 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.