Far Eastern University: Module #3 - Oxygenation (Oxygen Therapy)

FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020-2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
MODULE #3 - OXYGENATION (OXYGEN THERAPY)
INTRODUCTION
Respiratory disorders are among the most common causes of illness and hospitalization
in children. Overall, respiratory dysfunction in children tends to be more serious than in adults
because the lumens of a child’s respiratory tract are smaller and therefore more likely to
become obstructed. Because respiratory disorders range from minor illnesses such as a simple
upper respiratory tract infection to life-threatening lower respiratory tract diseases, such as
pneumonia, and because the level of acuity can change quickly, respiratory disorders are often
difficult for parents to evaluate. Both a child and parents need a great deal of nursing support
when disease interferes with the function of breathing, because even very young children can
panic when breathing becomes labored. Early diagnosis and treatment are essential in
preventing a minor problem from turning into a more serious one (Merelle et al., 2009).
Improving oxygenation almost automatically relieves breathing distress. Oxygen
administration elevates the arterial oxygen saturation level by supplying more oxygen to red
blood cells through the respiratory tract. Performing nebulization and suctioning also improves
oxygen saturation.
LEARNING OUTCOMES:
1. Assess the at -risk/ high risk child with alterations in Oxygenation to address existing
health needs.
2. Formulate with the client with alterations in Oxygenation a plan of care to address
problems of at -risk/high risk child.
3. Implement safe and quality nursing interventions to address problems of at- risk/ high
risk child.
4. Evaluate with the client the health outcomes of the nurse-client working relationship.
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NUR1210- SKILLS LABORATORY (Jennifer C. Padual, RN, RM, MAN)
Prepared by MCN FEU Faculty Lecturers January ,2021
CONTENT
I. History taking
1. Difficulty breathing
2. Chest pain with breathing (Describe pain, occurrence, What relieves it)
3. Cough
(When does it occur, any phlegm, description of phlegm, hemoptysis)
Yellow-green colored sputum - bacterial
Rust-colored sputum - pneumonia
4. Shortness of breath (Occur at rest or with activity)
5. Any breathing problems at night (Relieved by using pillows)
Abnormal Respiratory Patterns
Cheyne-Stokes
♦ Gradually increasing rate and tidal volume, which
increases to a
maximum, then gradually decreases
♦ Occurs in brain stem injuries
Biot’s
♦ Irregular pattern and volume, with intermittent periods
of apnea
♦ Found in patients with increased intracranial pressure
Agonal
♦ Slow, shallow, irregular respiration
♦ Results from brain anoxia
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Kussmaul’s
♦ Deep gasping respirations, representing
hyperventilation,
"blowing off" of excess carbon dioxide & compensation
for an
abnormal accumulation of metabolic acids in the blood
♦ Possible in any patient with metabolic acidosis, best
known with
diabetic ketoacidosis
6. Any allergies (does it affect breathing)

7. Smoker or have you ever smoked (how many years and how many packs daily)
8. Occupation (Exposure to substances as asbestos, chemicals, or cigarette smoke)
9. History of asthma, tuberculosis, lung cancer, cystic fibrosis, bronchitis, emphysema,
or any other lung disease
10. Read the pulmonary function test results
♦ chronic obstructive lung disease
♦ restrictive lung disease
♦ occupational lung disease
II. Inspection
1. Use of pursed lips during expiration
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2. Activity and development of the sternocleidomastoid muscles
Tripod position
3. Use of accessory muscles of ventilation
Chest Retractions
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4. Presence of jugular vein distention 5. Flaring of nasal alae
6. Presence of cyanosis and clubbing
7. Level of consciousness (LOC)

♦ describe a patient's awareness of his/her surroundings and arousal potential
a. Alert
♦ Awake and aware of their surroundings
b. Drowsy
♦ Tired and may be dozing but can easily be aroused
c. Lethargic
♦ sluggish and drowsy and has to work hard to focus on their surroundings
d. Obtunded
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♦ Unconscious and can only be aroused with strong physical stimuli
e. Coma
♦ Unconscious and unable to be aroused
8. Observe for thoracic cage deformity
a. Pectus excavatum b. Pectus carinatum

♦ sternum sunken into the chest ♦ sternum protrudes from the chest
c. Scoliosis d. Kyphosis
♦ abnormal lateral curvature of spine ♦ abnormal anterior-posterior
curvature of the spine
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e. Surgical or traumatic scars
f. Thoracoplasty g. Gynecomastia
h. Barrel chest deformity

♦ chest wall increased anterior-
posterior
III. Palpation
1. Position of the trachea
2. Rib deformities, nodules, areas of tenderness

3. Chest or Diaphragmatic excursion
♦ symmetry, synchrony, and volume of each breath
♦ examiner's thumbs together at midline (posteriorly) at level of 10th rib, hands
grasping lateral rib cage; thumbs separate by 2 - 3 cm
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4. Tactile or Vocal Fremitus

♦ Vibrations transmitted to the surface of the thorax as upper airways sounds
are generated by
breathing or speaking
♦ Patient asked to say boy-O-boy or ninety-nine, and the physician feel the
changes in sound conduction.
a. Egophony
♦ an increased resonance of voice sounds often caused by lung
consolidation and fibrosis
b. Whispered pectoriloquy
♦ an increased loudness of whispering noted on the lung fields on a
patient's torso
IV. Percussion
♦ Done to determine if the area under the percussed finger air filled (resonant like a
drum), fluid filled (dull sound) or solid (flat sound)
♦ Percuss the posterior, lateral, and anterior chest wall in such a manner that the long
axis of the percussed finger is parallel to the ribs.
♦ Compare one side to the other
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V. Auscultation
Types of "normal" breath sounds:

1. Vesicular sounds
♦ Produced by gas movement through the distal most portions of lung units
♦ Low in pitch, predominantly inspiratory in timing, and have a breezy character.
2. Bronchial or tracheal sounds
♦ Produced high in the upper airways and trachea
♦ Loud and high pitched. The expiratory phase is longer than inspiration & follows a
"silent gap."
3. Bronchovesicular sounds
♦ Intermediate between the two
♦ Air-filled lung units act as high-frequency filters so that the bronchial breath sounds
generated in the upper airways are poorly transmitted through air-filled lung
Types of abnormal breath sounds or Adventitious breath sounds:
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1. Wheeze
♦ A continuous musical sound on expiration/inspiration
♦ A result of narrowed airways
♦ Common causes are asthma & emphysema
♦ May be appreciated over the entire thorax
2. Gurgle or Rhonchi
♦ Continuous sound similar to the sound produced when one exhales through
a straw placed in a glass of water
♦ Produced by airflow through liquid of varying viscosities in the airways
♦ The result of viscous fluid in the airways
3. Crackle or “Rale"
♦ Noncontinuous bubbly sounds heard during inspiration
♦ The result of alveoli opening due to increased air pressure during inspiration
♦ Common causes include congestive heart failure
♦ Sounds like the rubbing of a lock of hair over the ear
a. Early inspiratory crackles - heard during the initiation of inspiration
b. Late inspiratory crackles – occur toward the terminal portion of the
inspiratory maneuver
c. Paninspiratory crackles - heard throughout the inspiratory phase
4. Stridor
♦ a rasping noise during inspiration
♦ Causes are typically obstructive, including foreign bodies, tumours, infection
and anaphylaxis
OXYGEN THERAPY
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♦ The administration of oxygen to a client to prevent or relieve hypoxia
Oxygen Tank Oxygen Humidifier Oxygen Gauge
Flow control valve Oxygen stand Wrench
I. NASAL CANNULA / Nasal Prong

« most common device used to administer O2
« consists of a rubber or plastic tube that extends around the face, with 0.6 to 1.3 cm
curved prongs that fit into the nostrils.
« One end of the tube connects to the oxygen tubing and oxygen supply.
« The cannula is often held in place by an elastic band that fits around the client’s
head or under the
chin.
Advantages :
1. Easy to apply
2. Does not interfere with client’s ability to eat or talk
3. Comfortable and permits some freedom of movements
4. Deliver a relatively low oxygen concentration (23 – 44 %) at flow rate 2-4 L/ min.
Materials :
Oxygen supply with a flow meter
Nasal cannula and tubing
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Humidifier with sterile distilled water
Tape (optional)
A. Preparation
A. PREPARATION
1. Checks doctor’s order
2. Introduces self to patient and verifies patient’s
name
3. Informs patient of the procedure and its
importance
4. Performs handwashing
5. Assembles articles and equipments needed to
the bedside
6. Positions patient accordingly
7. Drapes patient
B. PROCEDURE
1. Measures the prescribed amount of drug with
a syringe and puts
it into the nebulizers’ drug compartment
2. Connects the nebulizer directly into the
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electric outlet
3. Holds the nebulizer in an upright manner
4. Directs the nebulizer towards the patient’s
mouth and instructs to inhale the mist deeply
through the mouth, pause and hold breath for 3 to 4
seconds. Exhale slowly through pursed lips
5. Instructs patient to continue until the solution
vaporized
6. Puts the switch off and unplug from the
electric outlet
C. AFTER CARE
1. Puts patient in a comfortable position
2. Gives thorough mouthwash
3. Does after care of all articles and equipment
used
Documentation
1.Documents the procedure and nursing
assessment
a. Time and duration nebulization was done
b. Reason for doing the procedure
c. Condition of the client before and after the
treatment
d. Drug used if any
e. Effect of treatment
B. PROCEDURE
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1. Sets up the oxygen equipment and the humidifier

a. Attaches the flow meter to the wall outlet or
tank
b. Fills the humidifier bottle
c. Attaches the humidifier bottle to the base of
the flow meter
2. Attaches the prescribed oxygen tubing and

delivery device to humidifier
3. Turns on the oxygen at the flow rate ordered
4. Checks if the oxygen is flowing freely through the

tubing
5. Applies the appropriate oxygen delivery device.
NASAL CANNULA
1. Put the cannula over the patient’s face
2. Tapes and/or pads the tubing and bend over the

ears and cheekbones as needed.
3. Assesses client’s nares for encrustations and

irritations
II. FACE MASK

« Face masks are made of clear, pliable plastic or rubber that can be molded to fit the
face
« Designed to cover the nose and mouth
« are held to the head with elastic band
« Several holes are in the sides of the mask (exhalation ports) to allow the escape of
exhaled carbon
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dioxide.
Materials:
Oxygen supply with a flow meter Appropriate sized face mask
Humidifier with sterile distilled water Padding for the elastic band
Types of Oxygen Mask Oxygen Liter Flow

Concentration
Delivered
Simple Face Mask 40 –60 % 5 to 8 LPM
• Low flow system
Partial Rebreather mask 35 to 60 % 6 to 15

LPM
• An oxygen reservoir bag is
attached which allows client to
rebreathe about the first third of
the exhaled air
Non-Rebreather Mask 60 to 90 % 6 to 15
LPM
• Client breathes only the source
gas from the bag. It prevent the
room air and client’s exhaled air
from entering the bag
Types of Oxygen Mask Oxygen Concentration Liter Flow

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Delivered
Venturi Mask 24 to 60 % 4 to 15 LPM
• Designed with wide bore tubing & various

color-
coded jet adapters which correspond to a
precise
oxygen concentration and a specific liter
flow.
• Room air dilutes the oxygen entering the
tubing to
a certain concentration.
• The smaller the orifice, the larger the
amount of
room air drawn in, the greater the air
dilution thus
the lower the oxygen concentration
a. Blue - 24 % at 2 L /min
b. White - 28 % at 4 L /min
c. Orange - 31% at 6 L /min
d. Yellow - 35% at 8 L /min
e. Red - 40% at 8 L /min
f. Pink - 50% at 12 L /min
g. Green - 60% at 15 L /min
Procedure
1. Follow Procedure 1 to 5 of O2
administration via nasal cannula
2. Guide the mask toward the client’s face,
and apply it from the nose downward. Fit
the mask to the contour of the client’s face
3. Pad the band behind the ears and over
bony prominence
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III. Oxygen Hood / Head box

« A clear plastic hood that surrounds the baby’s head, and has an opening for the
baby’s neck, which leaves the body accessible for nursing care
« Maintains a stable concentration of warm and humidified oxygen titrated to achieve
the desired oxygen saturation
« Used for babies who can breathe on their own but still need extra oxygen
Materials:
Oxygen blender/oxygen & air flow meters with nipples
Green oxygen tubing
Humidifier base, water chamber & sterile water for irrigation
Heater hose/corrugated tubing
Headbox (with sponge, optional)
Headbox thermometer
Oxygen analyser
Procedure:
1. Assemble the humidifier base and water filled chamber
2. Connect oxygen tubing from the oxygen blender to the water filled chamber.
Alternatively connect tubing from oxygen and air flow meters via a "Y" connector and then
attach the single piece of tubing from the “Y” connector to the water filled chamber
3. Connect the heater hose to the water filled chamber
4. Place the headbox over the baby’s head, taking care when positioning the headbox
around the baby’s neck
5. Connect the heater hose to the headbox
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6. Blend the oxygen to obtain the necessary oxygen concentration to achieve the
desired oxygen saturation. The total flow of gases should be at least 6 to 8 L/min to prevent
accumulation of carbon dioxide in the headbox
7. Calibrate oxygen analyser and place into the headbox, alongside the baby’s nose
8. Maintain the inspired gas temperature at the appropriate neutral thermal
environment for the baby
9. Observe baby’s neck for irritation & pressure areas hourly, and ensure position of
headbox is correct
10. Remove accumulated water in the heater hose hourly
11. Calibrate the oxygen analyser every eight hours
12. Check baby’s temperature hourly for four hours or until stable then four hourly
IV. OXYGEN TENT

« A light portable structure made of clear plastic and attached to a motor-driven unit.
The motor circulates air in the tent; A thermostat in the unit keeps the tent at a
comfortable
temperature
« Can provide 30 to 55 % concentration of oxygen at 4 to 8 L/min.
« Fits over the top part of the bed so that either the client’s head and chest or the
wholebody fits
inside
Articles :
Oxygen supply with a flow meter
Oxygen tent of appropriate size
Humidifier with sterile distilled water
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Procedure
1. Follow procedure 1 to 5 of administration of
oxygen via nasal cannula
2. Position the tent securely and tucks the sides
3. Turn on the oxygen at the prescribed flow rate
4. Inspect facial skin frequently for dampness or
Chaffing; Dry and treat as needed
5.. Wipes mist from the inside of the tent time to
time
After Care
1. Positions patient comfortably in bed
2. Does after care of all articles and equipments
used.
Documentation
1. Documents the procedure and nursing assessment
a. Baseline vital signs
b. Patient’s color and breathing pattern
c. Time oxygen inhalation was started
d. Reason for the procedure
e. Type of oxygen delivery used
f. The flow rate by which oxygen inhalation is
delivered
g. Effect of oxygen inhalation
SUCTIONING
The aspiration of secretions, often through a rubber or polyethylene catheter connected to a
suction machine or wall outlet

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I. OROPHARYNGEAL / NASOPHARYNGEAL SUCTION

♦ a method of aspirating mucus or other secretions and / or fluids from the nose,
mouth, and pharynx using a suction catheter attached to a suction apparatus.
Purposes :
1. To maintain patent airway on clients whose swallowing
reflex is
limited in cases of :
a. client recovering from anesthesia
b. Unconscious client
c. Critically ill clients
2. To facilitate respiratory ventilation
3. To obtain secretions for diagnostic purposes
4. To prevent infection that may result from accumulated
secretions
General Considerations :
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1. Label each bottle with “Oral” / “Nasal”
2. Suction catheter maybe inserted through a nostril if the mouth cannot be opened or access
around the teeth is impossible.
3. Coughing is encouraged while catheter is being inserted to expel mucus blocking the
bronchi
4. Suction is “off” or pinched when inserting the catheter.
5. Client should be given the chance to breath between aspirations with catheter to avoid
creating oxygen deficit
(Limit period of suctioning at 15 secs. interval and allow 2 to 3 min. rest periods.)
6. Suction catheters vary in sizes :
a. Adults - Fr. 12 to 18 b. Children - Fr. 8 to 10 c.
Infant - Fr. 5 to 8
7. Suction devices are calibrated according to three pressure ranges :
a. High – 120 to 150 mm Hg b. Medium - 80 to 120 mm Hg c. Low
- 0 to 80 mm Hg
Generally :
Adults - 100 to 120 mm Hg Infants - 50 to 75 mm Hg
Equipments :
Suction machine Bottle with antiseptic sol’n Suction catheter
Gloves Bottle with sterile water o normal saline
Clean towel or paper drape
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PREPARATION
1. Introduces self to patient and verifies patient’s name
2. Informs patient of the procedure and its importance
3. Does handwashing
4. Assembles articles and equipment needed at the bedside
6. Drapes patient
7. Checks suction machine’s working condition and adjusts the pressure
of the machine
B. PROCEDURE
1. Cleans the nares
2. Pre-oxygenates client with 100 % oxygen for 1-2 min.
3. Attaches catheter to suction tubing and turns on suction machine
4. Puts on sterile gloves
5. Dips catheter tip in water to check and lubricate
6. Measures length of catheter to be inserted from the tip of the nose
to the ear lobe to the thyroid cartilage
7. Grasps catheter about 6 inches from the tip & gently pass it into the
nares with suction off by leaving the vent open
8. Applies suction intermittently by putting thumb over the control vent
intermittently while moving the catheter around gently to aspirate
mucus
(not to exceed 15 seconds interval and allow 2 - 3 minutes rest
periods)
9. Withdraws catheter (suction on) with a rotating motion
10. Suctions sufficient water through catheter to clear tubing
11. Rinse and puts catheter in a bottle with antiseptic solution
12. Gets/changes to another suction catheter for the mouth
13. Attaches catheter to suction tubing and turns suction machine on
14. Puts catheter tip in water to draw a small amount of water through
it to lubricate the tip
15. Suctions the sides of the mouth, cheeks, and under the tongue in
the same manner as procedure # 8 and 9
16. Rinse and puts catheter in a bottle with antiseptic solution
17. Turns suction equipment off
C. Aftercare:
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2. Does after care of all articles and equipment used
D. Documentation
1. Documents the procedure and all nursing assessment
a. Time suctioning was done
c. Note color, consistency and amount of secretions suctioned
d. Effect of the procedure to the patient
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Nebulization
- Drawing into the respiratory tract, a non-volatile drug, transformed into a fine mist with the
use of nebulizer, or aerosol apparatus.
Purpose:
To deliver finer mist at a faster rate
Special Considerations:
1. Administer the inhalation not too close to meal time
2. Give the therapy prior to coughing exercises or postural drainage
Equipment's:
nebulizer
prescribed drug
sterile syringe & needle or medicine
glass
normal saline solution
spout with medicine container
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A. PREPARATION
1. Checks doctor’s order
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2. Introduces self to patient and verifies patient’s name
3. Informs patient of the procedure and its importance
4. Performs handwashing
5. Assembles articles and equipments needed to the bedside
7. Drapes patient
B. PROCEDURE
1. Measures the prescribed amount of drug with a syringe and puts
it into the nebulizers’ drug compartment
2. Connects the nebulizer directly into the electric outlet
3. Holds the nebulizer in an upright manner
4. Directs the nebulizer towards the patient’s mouth and instructs to
inhale
the mist deeply through the mouth, pause and hold breath for 3 to 4
seconds. Exhale slowly through pursed lips
5. Instructs patient to continue until the solution vaporized
6. Puts the switch off and unplug from the electric outlet
C. AFTER CARE
2. Gives thorough mouthwash
3. Does after care of all articles and equipment used
Documentation
1.Documents the procedure and nursing assessment
a. Time and duration nebulization was done
c. Condition of the client before and after the treatment
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d. Drug used if any
e. Effect of treatment
Nursing Diagnosis
1.Activity intolerance related to insufficient oxygenation
2. Fatigue related to impaired gas exchange
3. Fear related to inability to breathe without effort
4.Impaired social interaction related to difficulty in keeping up with physical activities of peers
5.Deficient knowledge related to need for continued Treatment
6. Ineffective airway clearance related to edema and constriction of airway
7. Ineffective breathing pattern related to hypoxia
Outcome Identification/ Planning
1.If a child is experiencing an acute respiratory problem, the expected outcomes and plan of care will
focus on supporting the child and family through prescribed therapy and keeping parents informed
about their child’s health status and response to treatment.
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2. If the treatment period for respiratory illness is prolonged, so parents of children with chronic
conditions need to learn how to continue therapy at home.
Evaluation
1. Respiratory rate is below 22 breaths per minute; no cyanosis is present; PO2 is 80to100
mm Hg; SaO2 is over 95%.
2. Infant, at 3 months, maintains respiratory rate of atleast 30 breaths per minute.
3. Child describes a reduced program of school activities he will maintain to reduce fatigue.
4.Child lists steps she will take if breathing becomes impaired while at school.
5.Parents demonstrate correct techniques for performing respiratory therapy at home.
Learning Resources
Fundamental of Nursing by: Kozier
Fundamental of Nursing by: Potter and Perry
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FAR EASTERN UNIVERSITY

MODULE #3 - OXYGENATION (OXYGEN THERAPY)

5. Any breathing problems at night (Relieved by using pillows)

Abnormal Respiratory Patterns

6. Any allergies (does it affect breathing)

♦ chronic obstructive lung disease

♦ restrictive lung disease

♦ occupational lung disease

1. Use of pursed lips during expiration

2. Activity and development of the sternocleidomastoid muscles

3. Use of accessory muscles of ventilation

6. Presence of cyanosis and clubbing

7. Level of consciousness (LOC)

8. Observe for thoracic cage deformity

a. Pectus excavatum b. Pectus carinatum

h. Barrel chest deformity

2. Rib deformities, nodules, areas of tenderness

4. Tactile or Vocal Fremitus

Types of "normal" breath sounds:

Types of abnormal breath sounds or Adventitious breath sounds:

Oxygen Tank Oxygen Humidifier Oxygen Gauge

Flow control valve Oxygen stand Wrench

I. NASAL CANNULA / Nasal Prong

1. Sets up the oxygen equipment and the humidifier

2. Attaches the prescribed oxygen tubing and

3. Turns on the oxygen at the flow rate ordered

4. Checks if the oxygen is flowing freely through the

5. Applies the appropriate oxygen delivery device.

1. Put the cannula over the patient’s face

2. Tapes and/or pads the tubing and bend over the

3. Assesses client’s nares for encrustations and

II. FACE MASK

Types of Oxygen Mask Oxygen Liter Flow

• Low flow system

Partial Rebreather mask 35 to 60 % 6 to 15

Types of Oxygen Mask Oxygen Concentration Liter Flow

• Designed with wide bore tubing & various

III. Oxygen Hood / Head box

IV. OXYGEN TENT

suction machine or wall outlet

I. OROPHARYNGEAL / NASOPHARYNGEAL SUCTION

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