BACHELOR OF SCIENCE IN NURSING:

CRITICAL CARE NURSING
COURSE MODULE COURSE UNIT WEEK
8 3 9

OXYGEN THERAPY

ü Read course and unit objectives

ü Read study guide prior to class attendance
ü Read required learning resources; refer to unit
terminologies for jargons
ü Proactively participate in classroom discussions
ü Participate in weekly discussion board (Canvas)
ü Answer and submit course unit tasks

At the end of this unit, the students are expected to:

Cognitive:
1. Discuss the different types of oxygen therapy.
2. Identify the different purpose of using oxygen therapy.
3. Identify proper technique when applying oxygen therapy in the patient care setting.
4. Identify the complication of oxygen therapy.

Affective:
1. Listen attentively to the discussions and opinions in the class
2. Initiate asking questions that challenge class thinking
3. Express freely the personal opinion with respect to others opinion

 
Psychomotor:
1. Participate actively during class discussions
2. Confidently express personal opinion and thoughts in front of the class

 
Chulay, Marianne, Burns Suzanne (2011) . AACN Essentials of Critical Care
Nursing (2nd edition). International: McGraw-Hill Medical

AIRWAY OBSTRUCTION

DEFINITION

Oxygen therapy is a treatment that provides an extra oxygen to breathe in. It is also called
supplemental oxygen. It is only available through a prescription from the health care provider. It is
available in the hospital and in any another medical setting, or at home. Some people only need it
for a short period of time. Others will need long-term oxygen therapy.

Common indications for oxygen therapy:

1. Decreased cardiac performance
2. Increased metabolic need for O2
3. Acute changes in level of consciousness
4. Acute shortness of breath.
5. Decreased O2 saturation.
6. Myocardial infarction.
7. Carbon monoxide (CO) poisoning
8. Acute anemia
9. Cardiopulmonary arrest

Conditions that causes hypoxemia

1. Low inspired O2 (FIO2)

2. Overall hypoventilation
3. Ventilation-perfusion mismatch
4. Diffusion defect
5. Shunt

 
Oxygen therapy Complications

1. Alveolar hypoventilation
2. Absorption atelectasis
3. Oxygen toxicity

Oxygen toxicity …

a. CNS oxygen toxicity

S/S: nausea, anxiety, numbness, visual disturbance, muscle twitching, grand mal seizures

Hyperbaric oxygen therapy is a method to bring compressed pure oxygen to every cell of the
body. We have one of the few hyperbaric oxygen therapy rooms in Arizona, and it is used as a
medical therapy to promote wound healing, treat infection, radiation injury, anemia and many other
medical conditions

b. Pulmonary oxygen toxicity

Prolonged High O2 à lung injury à ARDS
S/S: substernal discomfort, paresthesia, dyspnea, restlessness, fatigue, malaise,
progressive respiratory difficulty, hypoxemia

TYPES
1. Non-invasive oxygen delivery
2. Invasive oxygen delivery

I. Non-invasive oxygen delivery

(NIV) is the delivery of oxygen (ventilation support) via a face mask and therefore eliminating
the need of an endotracheal airway. Non-invasive oxygen delivery achieves comparative
physiological benefits to conventional mechanical ventilation by reducing the work of breathing
and improving gas exchange.

TYPES
A. Low-flow oxygen

1. Nasal cannula (NC) is a device used to deliver supplemental oxygen or increased airflow to a patient
or person in need of respiratory help. This device consists of a lightweight tube which on one end splits into
two prongs which are placed in the nostrils and from which a mixture of air and oxygen flows.  
§ 2 lpm = 28% (+ 4% per liter of O2) –prongs ,
§ pt can easily speak, eat and drink

2. Face mask / simple face mask (SFM) is a basic disposable mask, made of clear plastic, to
provide oxygen therapy for patients who are experiencing conditions such as chest pain (possible
heart attacks), dizziness, and minor hemorrhages. This mask is only meant for patients who are
able to breathe on their own, but who may require a higher oxygen concentration than the 21%
concentration found in ambient air.

• 5-8Lpm – Saunders, 6-10Lpm -AHA

§ 5 lpm = 30% / 10 lpm = 60%

 
B. High-flow oxygen

1. Venturi masks are considered high-flow oxygen therapy devices. This is because venturi
masks are able to provide total inspiratory flow at a specified FiO2 to patients therapy. The kits
usually include multiple jets, which are usually color-coded, in order to set the desired FiO2.

• best for COPD

§ Delivers precise O2 and can be titrated
§ Most accurate O2 device.

2.Non-rebreathing mask is a medical device that helps deliver oxygen in emergency situations. It
consists of a face mask connected to a reservoir bag that’s filled with a high concentration of
oxygen. The reservoir bag is connected to an oxygen tank. A non-rebreather mask is used in
emergency situations to prevent hypoxemia, also known as low blood oxygen. Conditions that
disrupt your lungs’ ability to uptake oxygen or your heart’s ability to pump blood can cause low
blood oxygen levels.

• Delivers Highest O2 concentration (10-15Lpm)

§ With one-way valve & reservoir bag– for exhalation
§ Minimum flow: 10lpm = 60-80%

3.Partial rebreathing mask (no valve) are designed to capture the first 150ml of the exhaled
breath into the reservoir bag for inhalation during the subsequent breath. This portion of the breath
was initially delivered at the end of inhalation and was therefore delivered to the "dead space"
anatomy where gas exchange did not occur. Therefore, there would be no depletion of oxygen nor
gain of carbon dioxide during the rebreathing component.

• 6-15 Lpm or 8-12Lpm

§ 6-10lpm = 40-70%

4.Open Face tent – face tents used to providea controlled concentration of oxygen and increase
moisture for patients who have facial burn or a broken nose or who are claustrophobic.

5. Aerosol mask- in which oxygen humidified by aerosolized saline is given to a patient.

Used for therapeutic administration of a nebulized solution, humidity or high airflow with oxygen
enrichment.

II. Invasive oxygen delivery

1. Manual resuscitation bag (MRBs) = 40 – 100% O2

A bag valve mask, abbreviated to BVM and sometimes known by the proprietary name Ambu
bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly
used to provide positive pressure ventilation to patients who are not breathing or not breathing
adequately.

 
2. Mechanical ventilators
A mechanical ventilator is a machine that helps a patient breathe (ventilate) when he or she is
recovering from surgery or critical illness, or cannot breathe on his or her own for any reason.
- provide accurate O2 delivery (21-100%)

3. T-piece
Tshaped tubing connected to an endotracheal tube; used to deliver oxygen therapy to an intubated
patient who does not require mechanical ventilation.

4. Transtracheal O2 therapy
is a method used to deliver oxygen directly to the lungs. It is used to treat chronic hypoxemia (low
blood oxygen). A small plastic catheter is surgically placed in your neck and sits in your windpipe
(trachea).

Oxygen is a gas that your body needs to work properly. Your cells need oxygen to make energy.
Your lungs absorb oxygen from the air you breathe. The oxygen enters your blood from your
lungs and travels to your organs and body tissues.

Reading assignment Basic electrophysiology Chapters 3. 2nd edition AACN Essentials of Critical
Care Nursing by Marianne Chulay and Suzanne M. Burns

https://en.wikipedia.org/wiki/Simple_face_mask
https://en.wikipedia.org/wiki/Nasal_cannula
www.healthline.com/health/airway-obstruction
https://medlineplus.gov/oxygentherapy.html

Study Questions

• Make a two different scenario using non- invasive and invasive oxygen deliver system.
State the comparison of this two methods: the condition of the patient and the reason of
using that method.

 
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