OXYGEN THERAPY and NEBULIZATION
Oxygenation
- is a basic human
need.
- refer to the process
of treating a patient
with oxygen, or of
combining a
medication or other
substance with
oxygen.
The respiratory system
replenishes the body’s
oxygen supply and
eliminates waste from the
blood in the form of carbon
dioxide.
Respiration
- is the process of
gaseous exchange
between the
individual and the
environment.
Respiration includes the
following processes:
1. Ventilation, or breathing,
which is the movement of air
into and out of the lungs
2. The exchange of oxygen
(O2 ) and carbon dioxide
(CO2 ) between the air in the
lungs and the blood
5. Hyperventilation
- very deep, rapid,
rapid respirations
6. Hypoventilation
- very shallow
respirations.
7. Eupnea
- normal respiration
that is quite,
rhythmic and
3. The transport of O2 and effortless.
CO2 in the blood
8. Bradypnea
4. The exchange of O2 and
- slow respirations,
CO2 between the blood and
less than 12 breaths
the tissues.
/ minute in adult.
9. Tachypnea
DEFINITION OF TERMS:
- fast respirations,
1. Internal Respiration above 20 breaths /
minute in an adult.
• Exchange of
gases between 10. Dyspnea
the cells and the
- difficulty and labored
blood
breathing.
2. External respiration
11. Orthopnea
• Occurs in the
- ability to breath only
lungs. Exchange
in upright position.
of gases
between blood
and alveoli.
3. Apnea
- Temporary cessation
of breathing
4. Dyspnea
- Difficult or labored
breathing
Functions of the Upper
Airways
- Transport of gases to the
lower airways.
- Protection of the lower
airway from foreign matter.
- Warming, filtration and
humidification of inspired
air.
Functions of the Lower
Airways
Clearance Mechanism
• Cough
• Mucociliary
system
• Macrophages
Immunologic Responses
• Cell-mediated
immunity in the
alveoli Functions of
the Lower Airways
Pulmonary protection
• Respiratory
epithelium
• Mucociliary system
Lung Airway Passages
1. Primary bronchi
2. Lobar (secondary) bronchi
3. Segmental (tertiary)
bronchi
4. Bronchioles
5. Terminal bronchioles
6. Respiratory bronchioles
7. Alveolar ducts
8. Alveoli
Low Flow Administration
Devices
Nasal cannula (24%- 45% at
2-6 LPM)
Simple Facemask ( 40%- 60%
at 5-8 LPM)
Rhythmic Ventilation
• Normal respiratory
rate is 12 to 20
respirations per
minute (adults).
• In children, the rates
are higher and may
vary from 20 to 40 Partial Rebreathing Mask
per minute. (60%-90% at 6-10 LPM)
• The rhythm is
controlled by NON-REBREATHING MASK
neurons in the • Has an inflatable bag
medulla oblongata. to store 100%
Primary respiratory oxygen and a one-
center. way valve between
• Pons contain the the bag and mask to
following: prevent exhaled air
❖ Pneumotaxic from entering the
center - responsible bag.
for the rhythmic • delivers the highest
quality of breathing. possible oxygen (60-
90%)
Apneustic center
- responsible for deep, High Flow Administration
prolonged Devices
inspiration. Venturi Mask (require 2-3
❑ Rate is determined by the LPM or 28% oxygen) oIt
number of times respiratory provides accurate amount of
muscles are stimulated. oxygen.
Note: Oxygen is colorless,
odorless, tasteless and dry
gas that supports
combustion.
Nursing Planning,
Intervention and
Evaluation in the
Administration of Oxygen
Therapy
1.Assess signs and symptoms
of hypoxemia.
2.Check doctor’s order.
3.Position patient, preferably
semi-Fowler’s. To enhance
lung expansion.
4.Regulate oxygen flow
accurately. Excessive
administration of oxygen can
cause oxygen narcosis
(respiratory alkalosis).
5.Humidify oxygen. Place
sterile water into the oxygen
humidifier. To prevent
dryness and irritation of
mucous membrane in the
airways.
6. Provide good oronasal
hygiene. To prevent dryness
and irritation of mucous.
7. Lubricate nares with
water-soluble lubricant to
soothe the mucous
membrane. Do not use oil.
Oil ignites when exposed to
compressed oxygen.
8. Assess effectiveness of
oxygen therapy. Check VS,
especially RR; note quality of
respiration; evaluate arterial
blood gas results (ABG
analysis).
9. Make relevant
documentation.
Indications for Oxygen
Administration
• The need of oxygen
administration is
assessed by arterial
blood gas analysis,
oximetry monitoring
and clinical
examinations.
1. Reduced arterial blood
oxygen
2. Increased work breathing
3. To decrease myocardial
workload
Hazards of Oxygen
Administration
• Oxygen toxicity
• Suppression of
ventilation
• Combustion
Equipments:
• Oxygen source (wall unit,
cylinder, liquid tank or
concentrator)
• Flow meter/gauge
• Adapter, if using a wall unit
or pressure reduction gauge
if cylinder
• Sterile humidity bottle and
adapters
• Sterile distilled water
• Oxygen precaution sign
• Appropriate oxygen
delivery system
• Small-diameter and large-
diameter connection tubing
• Flashlight (for nasal
cannula)
• Water-soluble lubricant
• Gauze pads and tape for
oxygen mask
• Jet adapter for venturi
mask
• Oxygen analyzer (optional)
Preparation:
• Check the oxygen outlet
port to verify flow.
• Pinch the tubing near the
prongs to ensure that an
audible alarm will sound if
the oxygen flow stops.
Implementation:
1. Determine the need for
oxygen therapy and verify
the order for the therapy.
Assess the patient’s
condition
2. Prepare the client and
support people. Assist the
client to a semi fowler's
position if possible.
3. Check the patient’s room
to make sure it’s safe for
oxygen administration.
Whenever possible replace
electrical devices with no
electric ones and post a NO-
SMOKING sign inside the
patient’s room.
4. Explain the procedure to
the patient and let him/her
know why he/she needs
oxygen.
5. Wash hands and observe
appropriate infection control
procedures.
6. Provide for client privacy,
if appropriate
7. Set up the oxygen
equipment and the
humidifier.
8. Turn on the oxygen at the
prescribed rate and ensure
proper functioning.
9. Apply the appropriate
oxygen delivery device.
10. Place an OXYGEN
PRECAUTION sign over the
patient’s bed and on the
door to his room.
11. Observe the patient’s
skin integrity to prevent skin
breakdown on pressure
points from the oxygen
delivery device.
12. Inspect the equipment on
a regular basis.
13. Document relevant data.
Record the initiation of the
therapy and all nursing
assessments.
METHODS OF OXYGEN 3. Slide the adjuster upward
ADMINISTRATION under the chin to secure the
tubing.
1. NASAL CANNULA
• Nasal prongs that 4. If using an elastic strap to
deliver a relatively secure the cannula, position
low flow of oxygen it over the ears and around
when only minimal the back of the head. Avoid
oxygen support is applying too tightly.
required.
• Advantage: safe and 2. SIMPLE MASK
simple; comfortable • Mask delivers
and easily tolerated; moderate oxygen
nasal prongs can be flow to nose and
shaped to fit any mouth.
face; effective for • Advantage: Delivers
low oxygen oxygen
concentrations; concentrations of 40-
allows movement 60% (5-8L/min).
when eating and • Disadvantage: hot
talking; inexpensive and confining; may
and disposable. irritate patient’s skin;
• Disadvantage: can’t tight seal may cause
deliver discomfort as
concentrations required for higher
higher than 40%; oxygen
can’t be used in concentrations;
complete nasal interferes with
obstruction; may talking and eating.
cause headaches or
dry mucous PROCEDURE
membranes if flow 1. Select the mask size that
rate exceeds 6L/min; offers the best fit.
can dislodge easily.
2. Place the mask over the
PROCEDURE patient’s nose, mouth, and
to the chin and mold the
1. Inspect nostrils with a
flexible metal edge to the
flashlight one side at a time.
bridge of the nose.
2. If patent, hook the cannula
tubing behind the ears and 3. For elderly or cachectic
under the chin. patients with sunken cheeks,
tape gauze pads to mask
over the cheek.
4. Flow oxygen at a minimum 4. NON-REBREATHING MASK
of 5L/min.
3. PARTIAL-REBREATHER
MASK
• Has an inflatable bag
to store 100%
oxygen.
• Advantage:
effectively delivers
concentrations of 40-
60%; openings in
mask allow patient
to inhale room air if
oxygen source fails.
• Disadvantage: tight
seal required for
accurate oxygen
concentration may
cause discomfort;
interferes with
eating and talking;
hot and confining;
may irritate skin; bag
may twist or kink;
impractical for long
term therapy.
PROCEDURE
1. Follow procedures enlisted
for the simple mask.
2. If the reservoir bag
collapses more than slightly
during inspiration, raise the
flow rate until you see only a
slight deflation.
3. Keep reservoir bag from
twisting or kinking.
impractical for long
• Has an inflatable bag term therapy.
to store 100%
oxygen and a one- PROCEDURE
way valve between 1. Follow the procedures
the bag and mask to enlisted for the simple mask.
prevent exhaled air Make sure that mask fits
from entering the snugly.
bag.
• An ideal non- 2. Make sure that one-way
rebreather mask valves or flaps are secure and
does not permit air functioning.
from the
surrounding 3. Raise the flow rate until
environment to be you see only a slight
inhaled, hence an deflation.
event of a source gas
failure (i.e., the 4. Keep the reservoir bag
oxygen cylinder from twisting or kinking.
being drained
completely) is life 5. VENTURI MASK
threatening. • Advantage: deliver
• Advantage: delivers highly accurate
the highest possible oxygen
oxygen (60-90%) concentration
short of intubation despite patient’s
and mechanical respiratory pattern
ventilation; effective because the same
for short-term amount of air is
therapy; doesn’t dry always entrained;
mucous membranes; dilute jets can be
can be converted to changed, or dial
a partial rebreather turned to change
mask, if necessary, oxygen
by removing the one- concentration;
way flap. doesn’t dry mucous
• Disadvantage: membranes;
requires a tight seal, humidity or aerosol
which may be can be added.
difficult to maintain • ▪ Disadvantage:
and may cause confining and may
discomfort; may irritate skin; oxygen
irritate patient’s skin; concentration may
be altered if mask
 fits loosely. Tubing cause a fire if there is leakage • Commonly used at
kinks, oxygen intake of oxygen. home on a long-term
ports become basis especially for
blocked, or flow is ❑Avoid materials that those patients with
insufficient; generate static electricity, Chronic Obstructive
interferes with such as woolen blankets and Pulmonary Disease
eating and talking; synthetic fabrics. Use cotton (COPD) to dispense
condensate may blankets. inhaled medication.
collect and drip on
the patient if NEBULIZATION
humidification is Indications
- a method of
used. administering a drug
• Administration • Indicated to patient
by spraying it into
guideline: make sure having difficulty in
the respiratory
that the oxygen flow raising/expectorating
passages of the
rate is set at the respiratory
patient. The
amount specified on secretions.
medication may be
each mask and that given with or without
the venturi valve is • Reduced vital
oxygen to help carry
set for the desired capacity and less
it into the lungs.
fraction of the costly method of
Nebulizer
inspired oxygen loosening secretions.
– the device/machine used
(FiO2). to change liquid medicine
into fine droplets (in aerosol
SAFETY MEASURES or mist form) that are Contraindications
inhaled through a
❑Place a “No Smoking” sign mouthpiece or mask • Inability of patient to
at the bedside/ delivered directly into the cooperate in taking
• Strictly enforce this lungs. deep breathes
warning.
• Oxygen greatly Purposes • Adverse reaction
accelerates • To open the collapse encountered with
combustion and alveoli and deliver the medication
could cause a fire medicated aerosol
from a small spark. therapy. Equipment's
• Nebulizer machine
❑Avoid use of oil, greases, • To relieve patient • Nebulizer kit/set (tubing,
alcohol, and near the client from having mouthpiece, manifold, mask)
receiving oxygen. These may shortness of breath. • Syringe 3 cc
further support combustion. • Saline solution (NSS)
• Help expand the • Air compressor, wall air,
❑Check electrical appliances lungs thus loosen wall oxygen (O2 driven)
before use. Small spark may secretions. • Medication administration
record • Baffle (controls the
air, helps in the convention) • Determine the cause of
• T-piece respiratory distress.
• The client’s ability to use
the nebulizer (determine the
ability to hold and
manipulate the equipment,
this allows the nurse to
determine the need for the
client education to promote
compliance.
Medications
• Medications currently
• Albuterol/Salbutamo
ordered; action, purpose,
l: Hivent
common side effects, time of
• Salbutamol +
onset and peak of action
Ipratropium:
(this permits the nurse to
Combivent, Duavent
anticipate what to observe to
• Inhaled steroids:
form the client).
Budesonide,
Flixotide
• The oral medications the
• Bricanyl nebule
client is currently taking
• Ventar solution in (some meds can interact;
bottle form beta-blockers like atenolol
• and propranolol that can
Common side-effects antagonize the beta
• Tachycardia, antagonist and can cause or
palpitations, drying increase asthma symptoms).
of the oral mucosa,
dizziness, • The client knowledge
nervousness, nausea regarding the medication – in
order to determine the client
Assessment ability to understand and
• Check client respiratory follow directions.
status (note if patient use
accessory muscles or nasal Health Teachings
flaring).
• Explain the purpose and
• Respiratory distress is the need for this type of
primary reason to administer treatment, show the client
nebulizer medications. how to hold the nebulizer
upright to prevent spilling of
• Determine the cause of the medications.
respiratory distress (COPD).
• Remind the client to keep
the mouth sealed around the
mouthpiece and breathe in
slowly and deeply to get the
maximum benefit.
• Have the client return
demonstrate the procedure
to ensure understanding on
the importance of the length
of time for the treatment,
proper placement of the
mouth.
• Alert the client to the
common side effects of the
medications being used.
PREPARATION OF
MEDICATION
1. Place the air compressor
on a sturdy surface. Plug the
cord from the compressor
into a properly grounded
(three prong) electrical
outlet.
2. Wash your hands with
soap and warm water, and
dry completely with a clean
towel.
3. Carefully measure the
medicine exactly as you have
been instructed. Use a
separate, clean measuring
device (eyedropper or
syringe) for each medicine.
Look the medication at eye
level.
4. Remove the top part of
the nebulizer cup as shown.
Place your medicine in the
bottom of the nebulizer cup.
5. Cover the cup and fasten.
Connect and fasten the
mouthpiece/T-piece or face
mask to the cup. Then
connect the tubing to both
the aerosol compressor and
nebulizer cup.
PREPARATION OF THE
PATIENT
6. Monitor patient’s heart
rate before and after
treatment.
7. Explain the procedure to
the patient. This therapy
depends on patient’s effort.
8. Place the patient in a
comfortable sitting or semi-
fowler’s position.
WORKING PHASE
9. Turn on the compressor
with the on/off switch. Once
you turn on the compressor,
you should see a light mist
coming from the back of the
tube opposite the
mouthpiece.
10. If using a mask, position
it comfortably and securely
on patient’s face. If using a
mouthpiece, instruct patient
to place it between teeth
and seal lips around. Nose
clips are sometimes used if
the patient has difficulty
breathing through the
mouth.
11. Instruct patient to take
slow, deep breaths through
your mouth. If possible, let
him/her hold each breath for
two to three seconds before
breathing out until all of the
medication is nebulized.
12. Simultaneously do chest
physiotherapy.
13. Turn the compressor off.
Instruct patient to take
several deep breaths and
cough to clear any secretions
he/she might have his/her
lungs. Also instruct patient to
cough the secretions into a
tissue and dispose of it
properly then wash hands.
FOLLOW-UP PHASE
14. Record medication given
and the description of
secretions and side-effects if
any.
Care of the nebulizer
• Cleaning should be
done in a dust-and
smoke-free area
away from open
windows.
• After each
treatment, rinse the
nebulizer cup with
warm water, shake
off excess water and
let it air dry.
• At the end of each
day, the nebulizer
cup, mask, or
mouthpiece should
be washed in warm,
soapy water using
mild detergent,
rinsed thoroughly
and allow to air dry.
• Every third day, after
washing your
equipment, disinfect
the equipment using
a vinegar/water
solution or the
disinfect solution
your supplier
suggests.
• To use the vinegar
solution, mix ½ cup
white vinegar with 1-
1/2 cups of water.
Soak the equipment
for 30 minutes and
rinse well under a
 steady stream of
water.

• Shake off the excess

water and allow to
air dry on a paper
towel. Always allow
the equipment to
completely dry
before storing in a
plastic, zipper
storage bag.

Note:
There is no need to clean the
tubing that connects the
nebulizer to the air
compressor. Cover the
compressor with a clean
cloth when not in use. Keep
it clean by wiping it with a
clean, damp cloth as needed.
Unplug the compressor
before cleaning it.