VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)

SKILLS LABORATORY MODULE NO. 1

OXYGEN THERAPY

LEARNING OBJECTIVES:
By the end of the module, the student will be able to:
1. Give the indications for oxygen therapy.
2. Identify different oxygen delivery systems (low-flow and high-flow).
3. Enumerate the parts of an oxygen setup (portable & in-line).
4. Describe procedure in administering oxygen through different oxygen delivery systems including how
to attach the device and regulate oxygen delivery.
5. Identify the parts of a bag-valve-mask resuscitator (Ambu®-bag).
6. Describe procedure in performing bag-valve-mask ventilation.
7. Explain accurately the rationale for each step of the procedure.

 Important Information related to this Module:

A. Indications for Oxygen Therapy:

▪ Hypoxemia (or insufficient oxygenation of arterial blood) resulting from a respiratory or

cardiac emergency or an increase in metabolic function such as in patients with high fever.
Clinical manifestations of include:
- Restlessness & change in mental status (earliest sign)
- Tachycardia
- Tachypnea, dyspnea & nasal flaring
- Substernal or intercostal retractions
- Cool extremities
- Central cyanosis (late sign)

B. Oxygen Delivery Devices:

1. Low-flow systems = contribute partially to the inspired gas the patient breaths. This means the
patient breathes some room air along with the oxygen. These systems do not provide a constant
or known concentration of inspired oxygen. The amount of inspired oxygen changes as the
patient’s breathing changes.

a. Nasal Cannula
• the most common method of oxygen administration
• oxygen is delivered through a flexible catheter that has
two short nasal prongs
• allows the patient to eat & talk, and it is generally more
comfortable than other oxygen delivery devices
• requires nose breathing for the device to be effective
• delivers a relatively low concentration of oxygen (24% to
45%) at flow rates of 2 to 6 L per minute.

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b. Simple Mask
• delivers oxygen concentrations from 40% to 60% at
liter flows of 5 to 8 L per minute, respectively.

c. Partial Breather Mask

• delivers oxygen concentration of 60% to 90% at liter
flows of 6 to 10 L per minute, respectively.
• on inspiration, the patient inhales from the mask
and bag; on expiration, the bag refills with oxygen
and expired gases exit through perforations on both
sides of the mask and some enters bag
• the oxygen reservoir bag that is attached allows the
client to rebreathe about the first third of the
exhaled air in conjunction with oxygen
• the partial rebreather bag must not totally deflate
during inspiration (Rationale: to avoid carbon
dioxide buildup )
• if this problem occurs, the nurse increases the liter
flow of oxygen so the bag remains 1/3 to ½ full

d. Non-breather Mask
• delivers the highest oxygen concentration possible -
95% to 100% - by means other than intubation or
mechanical ventilation, at liter flows of 10 to 15 L
per minute
• one-way valves on the mask and between the
reservoir bag and the mask prevent the room air
and the client’s exhaled air from entering the bag so
only the oxygen in the bag is inspired.
• The nonrebreather bag must not totally deflate
during inspiration (Rationale: high oxygen
concentration will not be achieved, and the mask
will provide only the flow rate setting on the
flowmeter)

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2. High-flow systems = provide the total amount of inspired air. A specific percentage of oxygen is
delivered independent of the patient’s breathing. High-flow systems are indicated

a. Venturi Mask
• the most reliable & accurate method for delivering
precise concentrations of oxygen through
noninvasive means
• the mask is constructed in a way that allows a
constant flow of room air blended with a fixed flow
of oxygen
• delivers oxygen concentrations varying from 24% to
40% or 50% at liter flows of 4 to 10 L per minute

b. Face Tent
• used when oxygen masks are poorly tolerated by
patients
• the tent is attached to the patient’s chin and
strapped around the neck; it is connected to an
oxygen source and humidifier through wide-bore
tubing
• provides varying concentrations of oxygen
• frequently inspect the client’s facial skin for
dampness or chafing and dry and treat as needed

c. Tracheostomy Collar
• a mask-like device that fits loosely over the
tracheostomy and is held in place with an
elastic band around the neck
• the collar is connected to a wide-bore
tubing that receives aerosolized oxygen
from a jet nebulizer
• provides varying concentrations of oxygen

d. T-piece/Briggs adapter
• is used to administer oxygen to patient with
endotracheal tube or tracheostomy tube
who is breathing spontaneously
• is useful in weaning patients from
mechanical ventilation
• provides varying concentrations of oxygen

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C. Parts of an Oxygen Setup:

▪ Portable Unit (oxygen is supplied from a tank/cylinder)
[1] Oxygen Tank/Cylinder
[2] Cylinder valve handwheel
[3] Humidifier Bottle
[4] Oxygen tubing to delivery device (e.g., cannula)
[5] Oxygen content or oxygen pressure gauge
[6] Flow meter or flow indicator gauge
 The flow meter type shown in the illustration is the
Bourdon gauge type or round type (the flow rate of
oxygen is normally read to where the gauge points))
[7] Flow control knob
[8] Cylinder wrench (made of brass that is non-sparking)

▪ In-Line/Wall Unit (oxygen is supplied from piped-in oxygen)

[1] Adapter (for attachment to wall source)
[2] Humidifier Bottle
[3] Port for oxygen tubing of delivery device
[4] Oxygen pressure gauge
[5] Flow meter or flow indicator gauge
 The flow meter type shown in the illustration is the vertical
type or tube type which usually has a silver ball or bullet
inside (the flow rate of oxygen is normally read at the
center of the ball/bullet)
[6] Flow control knob

D. Parts of a Bag-Valve-Mask Resuscitator (Ambu®-Bag):

[1] Clear oxygen face mask (cuffed or uncuffed; detachable)
[2] Adapter for endotracheal tube (ET) or tracheostomy tube
[3] Patient valve (contains exhalation valve or expiration diverter)
[4] Pressure regulator
[5] Ventilation bag (self-inflating)
[6] Intake valve
[7] Reservoir valve (may be detached from intake valve)
[8] Oxygen reservoir socket
[9] Reusable oxygen reservoir bag (may be detached from O2 reservoir socket)
[10] Oxygen inlet
[11] Oxygen connecting tubing

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 Nursing Skills to Develop in this Module & Materials/Equipment Needed: [materials/items with an
asterisk (*) are the materials the students should bring during skills laboratory period]

▪ Administering Oxygen Therapy:

- Disposable gloves*
- Stethoscope*
- Oxygen Setup (tank with content gauge, flowmeter & humidifier)
- Appropriate oxygen delivery device: e.g., simple face mask, nasal cannula, or T-piece with
adapter for artificial airway

▪ Performing Bag-Valve-Mask (Ambu®-Bag) Ventilation:

- Disposable gloves*
- Stethoscope*
- O2 connecting tubing
- Bag-valve-mask Resuscitator (Ambu®-bag) with appropriate size mask or artificial airway adapter
- Oropharyngeal or Nasopharyngeal Airway
- Appropriate personal protective equipment

 Procedure Guidelines:
A. Administering Oxygen Therapy
1. Determine client history and acute and chronic health problems.
2. Assess the client’s baseline respiratory signs, including airway, respiratory pattern, rate, depth, and
rhythm, noting indications of increased work of breathing.
3. Check the extremities and mucous membranes closely for color.
4. Review arterial blood gas and pulse oximetry results.
5. Note lung sounds for rales/crackles.
6. Assess the nares, behind the earlobes, cheek, tracheostomy site, or other places where oxygen tubing
or equipment is in constant contact with the skin to look for signs of skin irritation or breakdown.
7. Perform hand hygiene.
8. Verify the doctor’s order for prescribed liters per minute of oxygen.
9. Explain procedure and hazards to the client & SOs including NO smoking and keeping oxygen at least 6
feet away from any source of flame or electrical sparks.
10. If using humidity, fill humidifier to fill line with distilled water and close container (ready-to-use
humidifier systems are also available). Clients with artificial airway should use HUMIDIFIED oxygen.
11. Attach humidifier to oxygen flow meter.
12. Insert humidifier and flow meter into oxygen source in wall or portable unit.

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13. Attach the oxygen tubing and appropriate oxygen delivery device to the flow meter and turn it on to
the prescribed flow rate (1 to 5 liters per minute).
14. Use extension tubing for ambulatory clients so they can get up to go to the bathroom.
15. Check for bubbling in the humidifier which indicates that oxygen is flowing through it.
16. Apply appropriate delivery device to patient to commence oxygen therapy:
▪ For oxygen via nasal cannula: Place the nasal prongs in the client’s nostrils. Secure the cannula
in place by adjusting the tubing around the client’s ears and using the slip ring to stabilize it
under the client’s chin.
▪ For oxygen via simple face mask, partial rebreather & nonrebreather mask: Place the mask on
the client’s face, fasten the elastic band around the client’s ears and tighten until the mask fits
snugly. Allow the reservoir bag of the nonrebreathing or partial rebreathing mask to fill
completely.
▪ For oxygen via an artificial airway using a T-piece: Attach the T-piece to the client’s artificial
airway. Be sure it is firmly attached to the airway. Position wide-bore tubing of T-piece so that it
is not pulling client’s airway.
17. Monitor vital signs, oxygen saturation, and client condition every 4 to 8 hours (or as indicated or
ordered) for signs and symptoms of hypoxia.
18. Wean client from oxygen as soon as possible using standard protocols.

B. Performing Bag-Valve-Mask (Ambu®-Bag) Ventilation:

1. Put on gloves and other personal protective equipment
2. Before using the bag-valve-mask resuscitator, check the patient’s upper airway for foreign objects. If
present remove them.
3. Suction the patient for any secretions. If necessary, insert an oropharyngeal or nasopharyngeal airway.
If the patient has a tracheostomy or ET tube in place, suction the tube.
4. Secure oxygen connecting tubing to oxygen inlet of bag-valve-mask resuscitator. Adjust the flow
control knob of the portable/wall unit oxygen to deliver 10 L/min of oxygen. Make sure oxygen
reservoir bag is filled with air & collapses with each squeeze of the ventilation bag.
5. If appropriate, remove the patient’s headboard and stand at the head of the bed to help keep the
patient's neck extended and to free space at the side of the bed for other activities such as
cardiopulmonary resuscitation.
6. Tilt the patient's head backward, if not contraindicated, and pull his jaw forward to move the tongue
away from the base of the pharynx and prevent obstruction of the airway.

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7. Keeping your nondominant hand on the patient's mask, exert downward pressure to seal the mask
against his face.
8. If ventilating through an artificial airway, remove clear face mask from bag-valve-mask resuscitator
and insert adapter to client’s tracheostomy or endotracheal tube (ET). [see illustration A for ventilating
through a tracheostomy & illustration B through an endotracheal tube]

A B

9. For an adult patient, use your dominant hand to compress/squeeze the bag every 5 seconds.
(approximate amount of air delivered per ventilation in an adult is stated below)
▪ 1000 to 1500 mL = amount of air delivered after 1 full squeeze on ventilation bag with BOTH
hands
▪ 600 to 800 mL = amount of air delivered after 1 full squeeze on ventilation bag with ONE hand
ONLY.
10. For a child & infant, deliver 20 breaths/minute, or one compression of the bag every 3 seconds. Infants
and children should receive 250 to 500 mL of air with each bag compression. Use age-appropriate bag-
valve-mask resuscitator for pediatric clients [see accompanying illustration].

11. Deliver breaths with the patient's own inspiratory effort, if it's present. Don't attempt to deliver a
breath as the patient exhales.

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12. Observe the patient's chest to ensure that it rises and falls with each compression. Auscultate for
breath sounds with each ventilation. If ventilation fails to occur, check the fit of the mask and the
patency of the patient's airway; if necessary, reposition his head and ensure patency with an oral
airway.

 References & Suggested Readings:

▪ Berman, A., Snyder, S., & Frandsen, G.(2016). Kozier & Erb’s Fundamentals of Nursing: Concepts,
Process and Practice (10th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
▪ Nettina, S. & Mills, E.J. (2006). Lippincott manual of nursing practice (8th ed.). Philadelphia, PA:
Lippincott, Williams & Wilkins.
▪ Schilling-McCann, J. (2009). Lippincott’s nursing procedures (5th ed.). Philadelphia, PA: Lippincott,
Williams & Wilkins.
▪ Hinkle, J., & Cheever, K. (2014). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (13th ed.).
Philadelphia, PA: Wolter Kluwer Health/Lippincott, Williams & Wilkins.
▪ Williams, L. & Hopper, P. (2003). Understanding medical-surgical nursing (2nd ed.). Philadelphia, PA:
F.A. Davis Company.