Oxygen therapy

Oxygen therapy
Definition: Oxygen therapy is the administration of oxygen at
a concentration of pressure greater than that found in
. the environmental atmosphere
:Purpose
.To overcome clinical signs of tissue hypoxemia
.To decrease the work of breathing
. To decrease the stress on myocardium

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

:Using oxygen cylinders- 1

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- a reduction gauge that reduces the

pressure
to a working level and shows the amount of
.oxygen in the tank
b- a flow meter that regulates the control of
.oxygen in liters per minutes

:Wall outlet oxygen- 2

The oxygen is supplied from a central source

through a pipeline. Only a flow meter and
.a humidifier are required

:Methods of oxygen administration

Oxygen may be administered by a variety of

:means
, Nasal cannula (prongs): It is a disposable- 1
plastic devise with two protruding prongs for
insertion into the nostrils, connected to an
oxygen source. It is used when the patient
requires a low- to medium concentration of
.oxygen (24-44%)

This method is relatively simple to use and*

, allows the patient to move about in bed
cough and eat without interruption of oxygen
.flow
:Disadvantage
may cause irritation to the nasal and
pharyngeal mucosa if oxygen flow rates are
.above 6 liters/minute

:Face mask- 2
Most masks are made of clear, flexible
plastic or rubber that can be molded to fit
the face. They are 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

The most commonly used types of masks*

:include
:The simple Oxygen mask

The mask delivers 35% to 60% oxygen at 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(

:The partial rebreather mask

The mask is equipped with a reservoir bag

' for 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
L/min to ensure that the patient does not 6
rebreathe large amounts of exhaled air. The
. remaining exhaled air exits through vents

: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

:The venturi mask

It is high flow system that delivers exact
concentration of oxygen. Oxygen concentrations
vary from 24-40% or 50% at liters flow of 4 to
.L/min 15
The mask is so constructed that there is a constant flow of room air blended with a fixed
.concentration of oxygen

The venturi mask 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 percentage specified for
the particular jet adapter). The amount of air
drawn in is determined by the size of the
.orifice (jet adapter)

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

:The disadvantages of a face mask

are the mechanical restrictions it imposes

on eating, drinking, and talking. There is
also certain amount of discomfort
associated with the use of a mask for any
.length of time

:Oxygen toxicity
It is a condition in which ventilatory failure*
occurs due to inspiration of a high
concentration of oxygen for a prolonged
.period of time
Oxygen concentration greater than 60%*
over 24 to 48 hours can cause pathological
.changes in the lungs

: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 .

Technique of oxygen administration

:A-Administering oxygen by nasal cannula
Steps

Rational

* Assessment:
. Check the physician order. 1

*It is your responsibility to

ascertain the accuracy of the
physicians order prior to initiating
O2 therapy.
*Provides data with which to
compare future respiratory results.

Assess the laboratory results,. 2

.especially the ABG analyses
Identify the type of oxygen. 3
equipment and oxygen source in
.your facility

Steps

Rational

:Planning*
To prevent infection.
.Wash hands. 4
Plan for any assistance.5 To ensure the patient
safety.
. needed
6.Prepare equipment.

Steps
:Implementation*
7.Identify the patient.
8. Explain procedure to the patient.
9. Assist the patient to a semi-fowler's position if
possible.
10. Attach the oxygen supply tube with humidification
to the cannula.
a- Allow 3-5 L oxygen to flow through the tubing.
b- Place the prongs in the patient's nostrils and
adjust it comfortably.
c- Use gauze pads both behind the head or the ears
and under the chin and tighten to comfort.
d- Adjust the flow rate to the ordered level.
e- Encourage patient to breath through his nose
with his mouth closed.
f- Assess the patient nose and mouth and provide
oronasal care at least every 8 hours.
g- Check nose for evidence of irritation or
bleeding.
11. Wash your hands.

Rational
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
To facilitate oxygen administration and comfort the
.patient
To reduce irritation and pressure and protect the
.skin
.To provide optimal delivery of oxygen to patient
Oxygen dries the mucous membrane and cause
.irritation
.Lubricant counteracts the drying effect of oxygen

:Evaluation*
Evaluate using the following desired outcome - 12
:criteria
.a- breathing pattern regular and at normal rate
b- pink color in nail beds, lips, conjunctiva of
.eyes
c- no confusion, disorientation, difficulty with
.cognition
d- arterial oxygen concentration or hemoglobin
.oxygen saturation within normal limits

:Documentation*
:Document the following- 13
.a- date and time oxygen started
.b- method of delivery
.c- oxygen concentration and flow rate
.d- patient observation
e- add oronasal care to the nursing care
.
plan

A-Administering oxygen by mask:

Steps

Rational

:Implementation*

10. Attach the oxygen supply tube to the mask,

proceed flow:
a- Regulate the oxygen flow.
b- 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.
c- Adjust the elastic band around the patient's head
and tighten.
d- Use gauze pads both behind the head or the ears.
e- Adjust the flow rate to the ordered level.
f- Remove the mask and dry the skin every2-3 hours
if the oxygen is running continuously. Don't powder
around the mask.
11. Wash patient's mouth.
12. Wash patient's face.
13. Clean the equipment& keep oxygen device
sterile.

.To prevent leakage

.To ensure a tight fit

.To reduce irritation and pressure and protect the skin
There is danger of inhaling powder if it is placed on
.the mask
To overcome dryness of mucous membrane produced
.by oxygen
.For patient's comfort& safety against infection