Assisting with respiration and Oxygen therapy

Learning outcome Define the oxygen therapy Discuss the type of oxygen therapy List the purpose of using oxygen therapy Explain the procedure List Complication of oxygen therapy

Oxygen Therapy Definition: Oxygen: Is a colorless, odorless, tasteless gas that is essential for the body to function properly and to survive. What is meaning of Oxygen therapy? Oxygen therapy: Is the administration of oxygen at a concentration of pressure greater than that found in the environmental atmosphere (21%)

Supplemental oxygen is used to treat medical conditions in which the tissues of the body do not have enough oxygen. Oxygen Therapy cont’d

Purpose To increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury..

oxygen therapy is used to treat 1.Hypoxia,Severe respiratory distress 2. Severe trauma,Chronic obstructive pulmonary disease (COPD) 3. Pulmonary hypertension 4.Acute myocardial infarction Short-term therapy, such as a. post-anesthesia recovery b.to treat chronic lung disease patients during exercise.

Sources of oxygen Wall outletsCylinder or

2- Wall – outlet oxygen The oxygen is supplied from a central source through a pipeline. Only a flow meter and a humidifier are required.

Preparation A physician's order is required, except in emergency use. Clinical observations. Oxygen supplemental is determined by:  inadequate oxygen saturation, indicated in Arterial Blood Gas measurements  Pulse Oximetry.

Cautions For Oxygen Therapy 1.Oxygen toxicity can occur with FIO2 > 50% longer than 48 hrs 1.Danger of fire 2.Infection

Methods of oxygen administration Oxygen Therapy -Common Delivery Devices 1.Nasal cannula :  2 to 5ML - low flow/low concentration 2.Face Masks oSimple mask oVenturi mask -higher flow rate

Classification of Oxygen Delivery Systems Low flow systems – Nasal cannula High flow systems

Nasal cannula It is a disposable plastic devise with two protruding prongs for insertion into the nostrils, connected to an oxygen source. Used for low-medium concentrations of Oxygen (24-44%).

Classification of Oxygen Delivery Systems Low flow systems Nasal cannula Low flow % 1 L\min=24, 6 L\min=44% Note: Never deliver more than 2-3 L\min to client with chronic lung disease High flow systems

 Advantages of nasal cannula: 1.Client able to talk and eat with oxygen in place. 2.Easily used in home setting  Disadvantages of nasal cannula may cause irritation to the nasal and pharyngeal mucosa if oxygen flow rates are above 6 liters/minute Variable FIO2

Face mask  The simple Oxygen mask  The venturi mask:

The simple Oxygen mask  Simple mask is made of clear, flexible, plastic or rubber that can be molded to fit the face.  It is held to the head with elastic bands.

The simple Oxygen mask  It delivers 35% to 60% oxygen.  A flow rate of 6 to 10 liters per minute.  It has vents on its sides which allow room air to leak in at many places, thereby diluting the source oxygen.  Often it is used when an increased delivery of oxygen is needed for short periods  (i.e., less than 12 hours).

Advantages : Can provide increased delivery of oxygen for short period of time Disadvantages Difficult to keep mask in position over nose & mouth Potential for skin breakdown Uncomfortable for pt while eating or talking Nursing Interventions Monitor client to check placement of the mask. Secure physician's order to replace mask with nasal cannula during meal time

Venturi mask  It is high flow concentration of oxygen.  Oxygen from %  At liters flow of 4 to 15 L/min.  The mask is so constructed that there is a constant flow of room air blended with a fixed concentration of oxygen

Side effect & complication of oxygen therapy Oxygen toxicity: It is a condition in which ventilator failure  occurs due to inspiration of a high concentration of oxygen for a prolonged period of time.Oxygen concentration greater than 50% over 24 to 48 hours.

Nausea & vomiting, Non-productive cough. Substernal chest pain, Fatigue. Nasal stuffiness, Headache, Sore throat. Hypoventilation, Nasal congestion.. Dyspnea, Inspiration pain. Signs and symptoms of oxygen toxicity:

Technique of oxygen administration A-Administering oxygen by nasal cannula: Assessment:  Check the physician order.  Assesses physical condition  Assess vital signs,  Assess level of consciousness  Assess the laboratory results, especially the ABG analyses,  Assess risk of CO2retention with oxygen administration

Identify the type of oxygen equipment and oxygen source in your facility Planning:  Wash hands and prepare equipment  Oxygen therapy,plastic nasal cannula  connection tube, Simple face mask  The venturi mask  Humidifier filled with distilled water.  Flow meter  No smoking signs

 Identify the patient.  Explain procedure to the patient.  Assist the patient to a semi-fowler's position if possible.  Attach the oxygen supply tube with humidification to the cannula, face mask. Implementation:

RationalSteps  Low flow 1 L\min=24% 2 L\min=28% 3 L\min=32% 4 L\min=36% 5 L\min=40% 6 L\min=44%  To facilitate oxygen administration and comfort the patient.  To reduce irritation and pressure and protect the skin.  Allow 3-5 L oxygen to flow through the tubing.  Place the prongs in the patient's nostrils and adjust it comfortably.  Use gauze pads both behind the head or the ears and under the chin and tighten to comfort.

RationalSteps  To provide optimal delivery of oxygen to patient..  Oxygen dries the mucous membrane and cause irritation  Adjust the flow rate to the ordered level.  Encourage patient to breath through his nose with his mouth closed.  Assess the patient nose and mouth and provide oronasal care at least every 8 hours.

RationalSteps  Ensure pt receive flow sufficient to meet aspiratory demand & maintain accurate concentration oxygen  face mask  Produce the flow rate ( l/min )  Attach the oxygen supply tube to the mask.  Regulate the oxygen flow.  Position the mask over the patient's nose and mouth.  And fit it securely, shaping the metal band on the mask to the bridge of the nose.

RationalSteps  To ensure a tight fit.  To reduce irritation and pressure and protect the skin.  Adjust the elastic band around the patient's head and tighten.  Use gauze pads both behind the head or the ears.  Adjust the flow rate to the ordered level.

RationalSteps  There is danger of inhaling powder if it is placed on the mask.  Remove the mask and dry the skin every 2-3 hours if the oxygen is running continuously.  Don't powder around the mask.  Wash your hands.

RationalSteps  to ensure correct air / oxygen mix  The partial rebreather mask  The non rebreather mask  The venturi mask  Attach tubing to flow meter  Show the mask to pt & explain procedure  Turn on oxygen flowmeter & prescribed rate ( usually indicated on mask )  Place mask over pt nose & mouth under chin

Evaluation:  Breathing pattern regular and at normal rate.  pink color in nail beds, lips, conjunctiva of eyes.  No confusion, disorientation, difficulty with cognition.  Arterial oxygen concentration or hemoglobin  Oxygen saturation within normal limits.

Documentation: o Date and time oxygen started. o Method of delivery. o Oxygen concentration and flow rate. o Patient observation. o Add oronasal care to the nursing care plan