1. OXYGEN THERAPY Fluid, Electrolyte & Acid-Base Balance

3. Oxygen
is a colorless, odorless, tasteless gas that is essential for the body to function properly and to survive.
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.

4. OXYGEN THERAPY IS USED TO TREAT
Documented hypoxemia
Severe respiratory distress (acute asthma or pneumonia)
Severe trauma
Chronic obstructive pulmonary disease (COPD, including chronic bronchitis, emphysema, and chronic asthma)
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 .

5. SOURCES OF OXYGEN: Wall outlets Cylinder
Oxygen is moistened by passing it through a humidification system to prevent the mucous membranes of the respiratory tree from becoming dry.
The oxygen is supplied from a central source through a pipeline.
Only a flow meter and a humidifier are required

7. 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.
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.

8. 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.

9. 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

10. 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

12. 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%).

13. 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

14. FACE MASK The simple Oxygen mask The partial rebreather mask:
The non rebreather mask:
The venturi mask:

15. 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.
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).

16. 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

17. 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%.
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.

18. 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
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.

19. 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

20. 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

21. VENTURI MASK The narrower the jet adapter,
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
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 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 ,

22. 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

23. SIDE EFFECT & COMPLICATION OF OXYGEN THERAPY
Oxygen toxicity
Retrolental fibroplasia
Absorption atelectasis
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

24. OXYGEN TOXICITY Signs and symptoms:
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
Signs and symptoms:
Non-productive cough.
Nausea and vomiting.
Substernal chest pain.
Fatigue.
Nasal stuffiness.
Headache.
Sore throat.
Hypoventilation.
Nasal congestion.
Dyspnea.
Inspiration pain.

26. Retrolental fibroplasia Absorption atelectasis
-blindness due to vasoconstriction & ischemia ( premature infants )
Absorption atelectasis
100 % FLO2 breathing associated with decrease ventilation ( obstruction )
Hypoventilation (increase 30 /M )
Effect ( lung collapse )

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

28. Fluid, Electrolyte & Acid-Base Balance
Body Fluids
Your body is 66% water
Not evenly distributed – separated into compartments
Able to move back and forth thru the cell membranes to maintain an equilibrium

29. Fluid Compartments Intracellular fluid – fluid inside cells [ICF]
Extracellular fluid – fluid outside cells and all other body fluids --- ¼ is plasma [intravascular fluid], remaining ¾ is interstitial fluid. Small amount is localized as CSF, serous fluid, synovial fluid, humors of eye & endo/perilymph of ears

30. EDEMA
Condition in which fluid accumulates in the interstitial compartment. Sometimes due to blockage of lymphatic vessels or by a lack of plasma proteins or sodium retention

31. FLUID BALANCE Amount in = amount out
Average daily intake is 2500 ml [ fluids, food and metabolic water]
Average daily output is 2500 ml [ urine, feces, perspiration, insensible perspiration]
What can throw off these numbers?

32. ELECTROLYTE BALANCE
Def: - concentration of individual electrolytes in the body fluid compartments is normal and remains relatively constant.
Electrolytes are dissolved in body fluids
Sodium predominant extracellular cation, and chloride is predominant extracellular anion. Bicarbonate also in extracellular spaces
Potassium is the predominant intracellular cation and phosphates are the predominant intracellular anion
Cations are actively reabsorbed, anions passively follow by electrochemical attraction
Aldosterone works at kidney tubules to regulate sodium & potassium levels

34. ACID - BASE BALANCE Blood - normal pH of 7.2 – 7.45
< 7.2 = acidosis > 7.45 = alkalosis
3 buffer systems to maintain normal blood pH
Buffers
Removal of CO2 by lungs
Removal of H+ ions by kidneys

35. Buffers Protein Buffer Systems Amino Acid buffers Hemoglobin buffers
Plasma Protein buffers
Phosphate Buffer Systems
Carbonic Acid – Bicarbonate Buffer System

36. Maintenance of Acid-Base Balance
Respiratory System: removal of CO2 by lungs – stabilizes the ECF, has direct effect on Carbonic Acid – Bicarbonate Buffer System
Urinary System: removal of H+ ions by kidneys
Disturbances to Acid-Base Balance
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis [ lactic acidosis, ketoacidosis]
Metabolic Alkalosis