Oxygen Therapy

TIP SHEET
Safety Concerns
Requires health care provider order (except for an emergency)
Place oxygen in use sign on patients door and in room
No smoking
No open flames
Make sure all electrical equipment working properly & grounded
Secure O2 cylinders (chained or in holders)
When transporting patient make sure adequate O2 in cylinder
Oxygen Delivery Devices
See handout on Common Oxygen Delivery Devices
General Nursing Considerations for Using Oxygen Therapy
Delegation
May be delegated to nursing assistive personnel (NAP) but the RN is
responsible for:
o Assessment of patient respiratory system
o Assessment of response to oxygen therapy
o Set-up of oxygen equipment including setting flow rate
Instructions for NAP from RN
o How to safely position & adjust device (such as loosening strap on
mask) and clarifying correct placement and positioning
o Inform RN immediately about VS changes, skin irritation, patient
reports pain or breathlessness, patient presents with decreased LOC
or increased confusion
o Having NAP provide skin care around nose/ears
Assessment Before Initiating Device
Check order note delivery method, flow rate and duration
ID patient (2dentifiers)
Assess respiratory status
o Be sure to include chest wall expansion, chest wall abnormalities
(kyphosis), temporary conditions (pregnancy) affecting ventilation
o Respiratory rate, depth, sputum production, and lung sounds
o Observe patent airway and remove secretions by hacving patient
cough or perform suctioning
o Obtain most recent SPO2 or arterial blood gas (ABG) if available

Implementation
See skill checklist
Unexpected Outcomes and Related Interventions
Patient experiences continued hypoxia
o Check O2 delivery device is it patent, kinked, attached to flow
meter?
o Check oxygen level on flow meter is it consistent with order?
o Obtain order for follow-up SPO2 or ABG
o Consider measures to improve airway patency coughing,
suctioning
o Notify HCP
Dry nasal or upper airway or epistaxis
o If flow rate >4L/min determine need for humidification
o Assess patient fluid status and administer fluids if appropriate
o Provide frequent oral care
o Obtain HCP order for nasal saline
Skin irritation or breakdown (ears, nose etc.)
o Adjust tightness of strap
o Provide good hygiene and skin care around ears
o Use soft, woven 4x4 as pad between elastic and ears
o Reposition strap frequently
Documentation
Type of delivery device and liter flow
Patient/family education
Respiratory assessment findings
Patient response to therapy including adverse reactions or side effects
Report unexpected outcomes to HCP and/or charge nurse
How to Read a Flow Meter
Turn on flow meter, the floating metal ball should be at the midpoint of
the desired flow rate.

How to Use an Oxygen Cylinder

http://www.youtube.com/watch?v=AtyUn0aBYiw