2. Oxygen therapy

3. Out line
Definition of the oxygen therapy
Types of oxygen therapy
purposes of using the oxygen therapy
Administration of oxygen therapy
Complication of oxygen therapy

4. Learning objectives: Define the oxygen therapy
Discuss the type of c oxygen therapy
List the purpose of using the oxygen therapy
Explain the procedure
Demonstrate the procedure
List Complication of oxygen therapy

5. Oxygen therapy
Definition:
Oxygen is a colorless, odorless, tasteless gas that is essential for the body to function properly and to survive.

6. What is meaning of O2 therapy
Oxygen therapy is the administration of oxygen at a concentration of pressure greater than that found in the environmental atmosphere
The air that we breathe contain approximately 21% oxygen
the heart relies on oxygen to pump blood.

7. What is meaning of O2 therapy
If not enough oxygen is circulating in the blood, it’s difficult for the tissues of the heart to keep pumping.
Supplemental oxygen is used to treat medical conditions in which the tissues of the body do not have enough oxygen.

8. Purpose
The body is constantly taking in oxygen and releasing carbon dioxide.
If this process is inadequate, oxygen levels in the blood decrease, and the patient may need supplemental oxygen.

9. Oxygen therapy is a key treatment in respiratory care.
Purpose
Oxygen therapy is a key treatment in respiratory care.
The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury.

10. oxygen therapy is used to treat
Example in case :-
Documented hypoxemia
Severe respiratory distress (acute asthma or pneumonia)
Severe trauma
Chronic obstructive pulmonary disease (COPD, including chronic bronchitis, emphysema, and chronic asthma)

11. oxygen therapy is used to treat
Pulmonary hypertension
Acute myocardial infarction (heart attack)
Short-term therapy, such as post- anesthesia recovery
Oxygen may also be used to treat chronic lung disease patients during exercise .

12. Methods of Dispensing Oxygen
Piped in
Cylinder
Oxygen concentrator

13. 2- Wall outlets. Sources of oxygen:
1- Cylinder.
2- Wall outlets.
Oxygen is moistened by passing it through a humidification system to prevent the mucous membranes of the respiratory tree from becoming dry.

14. 1- Using oxygen cylinders:
The oxygen cylinder is delivered with
a protective cap to prevent accidental force against the cylinder outlet.
To release oxygen safety and at a desirable rate, a regulator is used. It consists of two parts.

15. Using oxygen cylinders:
A reduction gauge that reduces the pressure to a working level and shows the amount of oxygen in the tank.
a flow meter that regulates the control of oxygen in liters per minutes.

16. 2- Wall – outlet oxygen:
The oxygen is supplied from a central source through a pipeline.
Only a flow meter and a humidifier are required.

17. Preparation
A physician's order is required for oxygen therapy, except in emergency use.
Clinical observations.
Oxygen supplemental is determined by inadequate oxygen saturation.
indicated in Artial Blood Gas measurements,(ABGs ) .
Pulse Oximetry.

18. Pulse oximetry

19. Cautions For Oxygen Therapy
Oxygen toxicity – can occur with FIO2 > 50% longer than 48 hrs
Suppression of ventilation – will lead to increased CO2 and carbon dioxide narcosis
Danger of fire
Infection

20. Methods
of oxygen
administration:

21. Classification of Oxygen Delivery Systems
Low flow systems
contribute partially to inspired gas client breathes
do not provide constant FIO2
Ex: nasal cannula, simple mask , non-re breather mask , Partial rebreather mask
High flow systems
deliver specific and constant percent of oxygen independent of client’s breathing
Ex: Venturi mask,, trach collar, T-piece

22. Methods of oxygen administration:
1- Nasal cannula

23. Nasal cannula (prongs):
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%).

24. F1o2 (Fraction Inspired Oxygen)
Disadvantages
Advantages
Priority Nursing
Interventions
Amount Delivered
F1o2 (Fraction Inspired Oxygen)
Method
may cause irritation to the nasal and pharyngeal mucosa
if oxygen flow rates are above 6 liters/minute Variable FIO2
Client able to talk and eat with oxygen in place
Easily used in home setting
Check frequently that both prongs are in clients nares
Never deliver more than 2-3 L\min to client with chronic lung disease
Low flow
24-44 %
1 L\min=24%
2 L\min=28%
3 L\min=32%
4 L\min=36%
5 L\min=40%
6 L\min=44%
Nasal Cannula

26. Face mask The simple Oxygen mask The partial rebreather mask:
The non rebreather mask:
The venturi mask:

27. 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.
Some have a metal clip that can be bent over the bridge of the nose for a comfortable fit.

28. 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).

29. F1o2 (Fraction Inspired Oxygen)
Disadvantages
Advantages
Priority Nursing
Interventions
Amount Delivered
F1o2 (Fraction Inspired Oxygen)
Method
Tight seal required to deliver higher concentration
Difficult to keep mask in position over nose and mouth
Potential for skin breakdown (pressure, moisture)
Wasting
Uncomfortable for pt while eating or talking
Expensive with nasal tube
Can provide increased delivery of oxygen for short period of time
Monitor client frequently to check placement of the mask.
Support client if claustrophobia is concern
Secure physician's order to replace mask with nasal cannula during meal time
Low Flow
6-10 L\min
35%-60%
Simple mask

30. The partial rebreather mask:
The mask is have with a reservoir bag must romaine inflated during both inspiration & expiration
It collection of the first parts of the patients' exhaled air.
It is used to deliver oxygen concentrations up to 80%.

31. The partial rebreather mask
The oxygen flow rate must be maintained at a minimum of 6 L/min to ensure that the patient does not rebreathe large amounts of exhaled air.
The remaining exhaled air exits through vents.

32. The non rebreather mask
This mask provides the highest concentration of
oxygen (95-100%) at a flow rate6-15 L/min.
It is similar to the partial rebreather mask
except two one-way valves prevent conservation of exhaled air.
The bag is an oxygen reservoir

33. The non rebreather mask
When the patient exhales air.
the one-way valve closes and all of the expired air is deposited into the
atmosphere, not the reservoir bag.
In this way, the patient is not rebreathing any of the expired gas.

34. F1o2 (Fraction Inspired Oxygen)
Disadvantages
Advantages
Priority Nursing
Interventions
Amount Delivered
F1o2 (Fraction Inspired Oxygen)
Method
Requires tight seal (eating and talking difficult, uncomfortable
Not as drying to mucous membranes
Clinet can inhale room air through openings in mask if oxygens supply is briefly interrupted
Set flow rate so mask remains tow-thirds full during inspiration
Keep reservoir bag free of twists or kinks
Low Flow
6 L\min
75%-80% oxygen
Partial Rebreather Mask

35. rebreather MASK Non Impractical for long term Therapy
Disadvantages
Advantages
Priority Nursing
Interventions
Amount Delivered
F1o2
Method
Impractical for long term Therapy
Malfunction can cause CO2 buildup
suffocation
Expensive
Feeling of suffocation
Uncomfortable
Costly
Delivers the highest possible oxygen concentration
Suitable for pt breathing spontaneous with sever hypoxemia
Maintain flow rate so reservoir bag collapses only slightly during inspiration
Check that valves and rubber flaps are function properly (open during expiration )
Monitor SaO2 with pulse oximeter
Low Flow
6-15 L \min
80%-100%
Non
rebreather MASK

36. Venturi mask Oxygen from 40 - 50% At liters flow of 4 to 15 L/min.
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

37. The venturi mask The venturi system,
is designed with wide- bore tubing and various color - coded jet adapters.
Each color code corresponds to a precise
oxygen concentration and a specific liter flow.
The venturi system,
Room air dilutes the oxygen entering the tubing to a certain concentration
The amount of air drawn in is determined by the size of the orifice (jet adapter).

38. The venturi mask The narrower the jet adapter,
the greater the air dilution, and the lower the concentration of oxygen.
It is used primarily for patients with
chronic obstructive pulmonary disease

39. Venturi Mask Disadvantages Advantages Priority Nursing Interventions
Amount Delivered
F1o2
Method
uncomfortable
Risk for skin irritation
produce respiratory depression in COPD patient with high oxygen concentration 50%
Delivers most precise oxygen concentration
Doesn’t dry mucous membranes (humidity
Requires careful mointoring to verify F1O2 at flow rate ordered
Check that air intake valves are not blocked
Oxygen from %
of 4 to 15 L/min.
Venturi Mask

40. Tracheostomy Collar/ Mask
Inserted directed into trachea
Is indicated for chronic o2
therapy need
O2 flow rate 8 to 10L
Provides accurate FIO2
Provides good humidity.
Comfortable ,more efficient
Less expensive

41. T-piece Used on end of ET tube when weaning from ventilator
Provides accurate FIO2
Provides good humidity

42. Side effect & complication of oxygen therapy
Oxygen toxicity
Retrolental fibroplasia
Absorption atelectasis

43. occurs due to inspiration of a high
oxygen toxicity
It is a condition in which ventilator failure
occurs due to inspiration of a high
concentration of oxygen for aprolonged
period of time.
Oxygen concentration greater than 50% over 24 to 48 hours can cause pathological changes in the lungs.

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

45. Side effect & complication of oxygen therapy
Retrolental fibroplasia
Blindness due to vasoconstriction & ischemia ( premature infants )

46. Side effect & complication of oxygen therapy
Absorption atelectasis
100 % FLO2 breathing associated with decrease ventilation ( obstruction )
Hypoventilation ( increase 30 /M )
Effect ( lung collapse )

47. Rational Steps Technique of oxygen administration
A-Administering oxygen by nasal cannula:
Rational
Steps
provide a baseline data for future assessment
Oxygen maybe depress the hypoxia drive ( decrease respiratory rate , alliterate mental states
*If Paco2 is decrease or normal ( PT not expression CO2 retention & can use oxygen without fear
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

48. Assessment
. Identify the type of oxygen equipment and oxygen source in your facility

49. *Planning: Rational Steps To prevent infection. Wash hands.
Prepare equipment
Oxygen therapy
plastic nasal cannula
connection tube,
Simple face mask
The partial rebreather mask
The non rebreather mask
The venturi mask

50. Rational
Steps
Humidification maybe not be ordered if the flow rate is <4 /l/min
Humidifier filled with distilled water .
Flow meter
No smoking signs

51. Rational
Steps
To be sure you are performing the procedure for the correct patient.
To gain his cooperation.
This position permits easier chest expansion and hence easier breathing.
To prevent dehydration of mucous membrane.
*Implementation:
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.

52. Rational Steps Allow 3-5 L oxygen to flow through the tubing.
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.

53. Rational Steps 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.

54. face mask Rational Steps
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.

55. Rational
Steps
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.

56. Rational
Steps
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.

57. The partial rebreather mask The non rebreather mask The venturi mask
Rational
Steps
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

58. 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.

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

60. O2 DELIVERY DEVICES Cont.
EQUIPMENT FLOW FIO SPECIAL NOTES
ANESTHESIA
BAG
L/M USE AT 12 L/M MIN.
POTENTIAL OF
BAROTRAUMA
OR ASPHYXIATION
*** SHOWS THAT FIO2 VARIES WITH DIFFERENT
F, VT, INSPIRATORY FLOW RATES.

61. O2 DELIVERY DEVICES Cont.
EQUIPMENT FLOW FIO SPECIAL NOTES
NASAL CANNULA 1/ L/M *** L/M MAX.
SIMPLE O2 MASK L/M *** USE 5 L/M
(WITHOUT BAG) MINIMUM
RESERVOIR MASK L/M *** PAGE RT IF USED
(MASK WITH BAG) (BAG TO NOT
COLLAPSE)
VENTI MASK L/M , 26, 31, READ ENCLOSED
6 L/M , .40, INSTRUCTIONS
NEBULIZER L/M OR > , .30, MIST MUST BE
.40, .50, VISIBLE
1.0***
ANESTHESIA
BAG
L/M USE AT 12 L/M MIN.
POTENTIAL OF
BAROTRAUMA
OR ASPHYXIATION
*** SHOWS THAT FIO2 VARIES WITH DIFFERENT
F, VT, INSPIRATORY FLOW RATES.

62. Thank you
kamlya