Oxygen Therapy

The provision of therapeutic oxygen is required whenever hypoxemia occurs, i. e. reduced O2 in the blood stream.

Sources of oxygen:

1. Wall outlet

2. Portable cylinders or tanks

Parts of the Oxygen Tank:

Regulator – use to release O2

safely with a desirable rate.

– controls rate of oxygen output

Flow rate meter – indicates # of liters per minute of O2 being released

Pressure Gauge – the one nearest to the tank which shows the pressure or amount of oxygen in the tank.

Precautions when administering Oxygen:

1.Avoid open flames in patients room such as burning candles & striking match.

2.Place “NO SMOKING” signs in conspicuous places in the patient’s room.

3. Check all electrical equipments. Ensure that it emits no sparks.

4. Avoid wearing & using synthetic fabrics.

5. Avoid using oil, or wearing clothing stained with oil in the area.

Clinical Alert: Oxygen is used very conservatively on anyone with chronic lung disease because high levels of oxygen will disrupt carbon dioxide center & lead to respiratory arrest.

1.Administration of Oxygen Therapy by Nasal Cannula.

Description: This equipments the simplest method & the one best set tolerated by most patients.

Cannula-is a disposable plastic device with two protruding prongs for insertion into the nostrils

Equipments: Oxygen supply

Regulator

Humidifier

Nasal Cannula

PROCEDURE:

1.Explain purpose & procedures of oxygen to patient

R- To alleviate anxiety & gain patient’s cooperation

2. Take actions to minimize fire hazards.

3. Attach humidifier bottle to regulator & attach nasal cannula to connecting tube of water reservoir.

R- Prevents dryness & irritation of nasal mucosa

4. Lubricate cannula prongs with water soluble lubricant & start flow of Oxygen at 2-4 LPM

R- Oil soluble lubricants emit heat.

5. Place prongs in patient’s nostrils. Prongs should curve outward in nostrils. Position tubing over & behind each ear & slide the adjuster under skin so that the cannula fits snugly but comfortably.

R- Correct placement of prongs & fastener facilitates oxygen administration & comfort for the patient.

6. Use gauze pads as necessary under nostril, cheeks or behind the ears,

R- To reduce irritation & pressure.

7. Instruct patient to breath through nose.

R- For maximum efficiency of cannula.

8. Monitor vital signs & check patient’s condition frequently.

R- To note any signs of distress.

9. Provide nose care at least every four (4) hours.

R- To promote comfort & prevent dryness of nasal mucosa.

10. Change equipment daily (tubing and cannula)

11.Administration of oxygen via Nasal Catheter:

Description: Nasal or oropharyngeal catheter is a very efficient means of administering oxygen because it delivers a higher concentration of oxygen.

Equipments: Nasal Catheter-sizes: No. 8-10 F for children

No 10-12 F for women

No 12-14 F for men

Water soluble lubricating jelly, adhesive tape, humidifier, flashlight & tongue depressor, oxygen supply, regulator.

PROCEDURES:

1.Explain procedure to patient.

R- To alleviate anxiety & gain patient’s cooperation.

2. Attach catheter to connecting tubing. Attach humidifier to flow meter, then to wall of oxygen tank after cracking tank.

R- To prevent dryness of the nasal mucosa.

3. Measure catheter by holding it in a horizontal line from tip of nose to the earlobe. Mark it with narrow strip of the tape.

R- approximates the lengths of catheter that is needed to be inserted.

4. Lubricate tip of catheter with water-lubricant.

R- To facilitate catheter insertion.

5. Turn oxygen to 3 LMP & test oxygen flow by placing over your hand to feel for flow.

R- assuring that oxygen will be delivered at concentration needed

6. Position patient with neck hyper extended.

R- To facilitate catheter insertion.

7. Ensure flow of oxygen.

8. Slowly insert catheter no more than 5 cm into nares.

R- Make sure that injury will not be done to the nasal mucosa.

9. Examine placement by depressing the patient’s tongue depressor & observe throat.

R- To make sure that oxygen is being delivered at concentration needed.

10. Adjust flow rate to liters ordered (Limited to 5 LPM).

R- Nasal Catheters delivers a higher concentration of oxygen

11. Secure catheter to bridge of the patient’s nose with tape.

R- To prevent catheter to be dislodged.

12. Instruct patient to breath through his nose.

13. Palpate the epigastrium.

R- To asses for gastric distention

14. Remain with patient

R- To provide psychological support

15. Provide mouth & nostril care every 2-3 hours.

R- To promote comfort.

16. Remove & change catheter in the opposite nare every 8 hours.

III. Administration of Oxygen by Face Mask

Description: The use of disposable & reusable face mask for oxygen.

Points to Remember:

1. Mask should be fitted carefully to the patient’s face to avoid leakage of oxygen

2. Mask should be comfortable, snug but not too tight against the patient’s face.

Types of Face Mask:

1.Disposable Plastic Mask- simplest, less expensive; with open vents for elimination of exhaled air.

2. Concentration Mask- Designed to supply specific concentration of oxygen up to about 40%. This mask permits the more precise administration of oxygen at low concentration.

3. Partial Rebreathing Mask- No respiratory valve so that the beginning portion of exhaled air returns to the bag & mixes with

the inspired air. Ports are present so that expired air escapes.

4. Nonbreathing Mask- Provides highest concentration for the patient & offers the most precise method of administration. With valve which closes during expiration so that any exhaled air is forced thru the expiratory valve on the face piece.

5. Venturi Mask- Use to control low oxygen concentration; Allows a fixed predicted FIO2 to be delivered. It is utilized effectively on patients with COPD when accurate FIO2 is necessary for proper treatment. CO2 build up is kept at minimum.

EQUIPMENTS: Oxygen mask, Oxygen source, Flow-meter, Humidifier

PROCEDURES:

1.Explain procedure & rationale for administering oxygen to patient.

R- To relieve anxiety & gain patient’s cooperation.

2. Observe precautions to prevent fire

R- Oxygen supports combustion

3. If used, attach a water humidifier bottle to the oxygen regulator or flow meter.

R- Humidifiers prevent mucosal dryness.

4. Measure size of face mask for patient’s use

R- To make sure it fits the patient.

5. Turn on oxygen flow to LPM (prescribed). If reservoir bag is attached, partially inflate it with oxygen.

R- So that the patient will not feel suffocated as the mask is fit.

6. Place patient in semi or higher fowler’s position

R- To promote maximum vital capacity

7. Fit mask to patient’s face from nose downward during expiration. If reservoir bag is attached, oxygen flow must be at level.

R- A tight fit prevents oxygen from escaping around eyes or nose.

8. Place elastic band around patient’s head

R- To avoid mask displacement.

9. Attach tubing to pillows & bed keeping tubing free of kinks.

R- To facilitate a good oxygen flow

10. Use gauze pads on patient’s ear & scalp.

11. Instruct patient to breath thru nose if nasal mask has been used.

12. Stay with the patient until patient feels at ease with the mask.

R- Some patient may be afraid of the mask

13. Asses patient’s condition frequently

R- To monitor any signs of distress

14. Remove & clean face mask every 2-3 hrs. if oxygen is running continuously.

R- Promotes comfort.

15. Check the equipment & water level of humidifier frequently.

16. Observe for any change in patient’s condition.

17. Check with physician to order a nasal cannula during meals.

IV. Administering Oxygen by Tent.

Oxygen tent:

-A light portable structure made of clear plastics & attached to a motor driven unit.

-A useful for high concentrations of oxygen (50-60%) & for circulation of moist air around the patient.

-It will provide low moderate concentration of oxygen in a temp. controlled environment.

Equipments: Oxygen tent, Oxygen machine, Oxygen analyzer, non-electrical call bell, draw sheets

PROCEDURES:

1.Secure tent & place machine at head of bed with control knobs on opposite side where working area is required.

R- Provide enough space for delivery of care

2. Connect regulator to oxygen source. Plug machine.

3. Set up humidifier & check to make sure that water level (tray at back of machine) is adequate.

R- To ensure circulation of moist air around the patient.

4.Turn on oxygen flow & flush with high liter rate, or press

flush button for one minute until desired concentration is reached.

5. Position canopy ½ to 1/3 over length of bed.

6. Flush oxygen with 15 LPM flow rate for 1-2 minutes.

R- To prevent feeling suffocated as client is placed inside the tent.

7. Tuck all sides of canopy into mattress

R- To avoid oxygen to leak.

8. Regulate flow meter to 12-15 LPM (minimum of 10 LPM)

R- To provide a moderate concentration of oxygen to the patient.

9. Give patient a special call button that can be attached to bed.

R- To facilitate communication of needs.

10. During use open tent if necessary.

R- To maintain tent efficiency.

11. If patient complains of coldness, furnish, additional clothing, wrap patient’s head & shoulders, or adjust the temp. of the bed.

12. Check equipment every 4 hours. Oxygen vent should remain unobstructed.

R- Equipments must function adequately.

13. Observe patient’s progress & report to physician any untoward signs & symptoms.