MODULE: OXYGEN THERAPY

MODULE DESCRIPTION

This module is designed to provide students with the necessary knowledge and
skills to provide and support safe delivery of oxygen therapy. This will be used to promote
patient safety by enhancing the knowledge and skills of the students who will care for
adult patients receiving oxygen therapy. The student will learn more about the main types
of oxygen delivery device and their indications. The practical component of the oxygen
therapy training includes demonstration of the correct application of oxygen therapy.

COURSE LEARNING OUTCOMES

At the end of this module, the student will be able to:

a. learn about oxygen therapy

b. Identify the symptoms of low oxygen.
c. Identify delivery devices for oxygen therapy.
d. Identify benefits of oxygen therapy..
e. Identify the actions, therapeutic uses, excretion, contraindications/precautions,
nursing implications, and patient education for oxygen therapy
f. Apply the nursing process to the care of a patient with oxygenation issues.

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TOPIC

Oxygen Therapy is usually defined as the administration of oxygen at

concentrations greater than those found in ambient air. The main goal of oxygen therapy
is to treat or prevent hypoxemia thereby preventing tissue hypoxia which may result in
tissue injury or even cell death.
Oxygen is vital for metabolic processes in cells and therefore the function of tissues
within the body. The atmospheric content of oxygen within room air is only 21%. Although
this amount is adequate for healthy individuals, those with certain diseases or who are
acutely ill, can benefit from an increased oxygen fraction in the gas they breathe, which
will increase the oxygen content of their blood. In most of these situations, increasing the
oxygen fraction to around 30 % to 35% is enough to make a significant difference to the
blood oxygen level.
Oxygen may be administered as a medical intervention to manage acute or
emergency situations or as a part of chronic or long-term patient care. Oxygen therapy
may therefore be a key tool in the hospital setting to manage a medical emergency or in
the home setting, as a way of managing long-standing illness. The use of oxygen should
be planned, and in most circumstances should be a prescribed therapy.

What are the symptoms of low oxygen?

When you aren’t getting enough oxygen, you’ll experience a host of symptoms,
including:
• rapid breathing
• shortness of breath
• fast heart rate
• coughing or wheezing
• sweating
• confusion
• changes in the color of your skin
If you experience any of these symptoms, seek immediate medical attention.

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Delivery Devices for Oxygen Therapy

The oxygen delivery devices are grouped into two:

a. Low flow oxygen delivery system are those that the exact fraction of oxygen

in the inspired air (FiO2) will be based on the patient's anatomic reservoir and minute

ventilation. They are:

• Nasal Cannula: It can carry up to 1 – 6L of O2 Per

Minute with FiO2 0.24 – 0.44 (approximate 4% per liter
flow) and FiO2 decreases as Ventilation rate increases.
It is the recommended device for oxygen delivery in
children less than 5years of age. It is ideal for long term
oxygen therapy. It does not increase dead space and
there is no rebreathing.

• Simple Mask: It can carry up to 5 – 10Litres of O2 per Minute

with FIO2 0.35 – 0.55 (approximate flow rate of 40%). Flow rates
should be set at 5 L/min or more to avoid rebreathing expired CO2
retained in the mask. It slightly increases dead space and there is
little rebreathing. It is usually uncomfortable for patients, obstruct
eating and drinking and also, muffles speech.

• Partial Rebreather is a simple mask with a reservoir bag. Oxygen

flow should always be supplied to maintain the reservoir bag on
inspiration thus avoiding reservoir bag deflation. At a flow of 6-10
L/min the system can provide 50-70% oxygen.

• Non-rebreather: The non-rebreathing mask is similar to the partial rebreathing

mask except it has a series of one-way valves. One valve is placed between the
bag and the mask to prevent exhaled air from returning to the bag. There should
be a minimum flow of 10 L/min. The delivered FiO2 of this system is 7-10%. [Dat
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b. High flow oxygen delivery systems deliver a prescribed gas mixture (either

high or low) at flow rates that exceed patient demand.

• Venturi Mask: the flow rate is at about FiO2 0.24 – 0.50

with variable LPM. Flow and corresponding FiO2varies by
manufacturer.
• If air-entrainment masks is available it can be used to
accurately deliver preset oxygen concentration to the
trachea up to 40% but the inspiratory flow rates is usually
inadequate for adults in respiratory distress.

• Aerosol masks, tracheostomy collars, T-tube adapters, and face

tents can be used with high-flow supplemental oxygen systems but not all
aerosol generators can deliver high oxygen concentration at the needed
flows rate.

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Benefits of oxygen therapy?

Oxygen therapy can be extremely beneficial for those who frequently experience
low oxygen levels, regardless of the reason. If needed, regularly utilizing oxygen
therapy can allow people to be more active and mobile by decreasing shortness of
breath. It also can significantly improve quality of life, and in many cases extend life
expectancy.
Oxygen therapy can also reduce symptoms such as:
• headaches
• irritability
• fatigue
• swollen ankles
Oxygen therapy can help the growth and development of children who have
chronic lung conditions. It can also lessen symptoms such as headaches caused by low
oxygen levels, and behavioral changes or problems.

Oxygen Storage and Source

1. Vacuum insulated evaporator (VIE):

When a gas becomes liquid form, it occupies a much smaller volume.

Therefore, a large amount of oxygen can be stored in the form of liquid. A VIE is

a container designed to store liquid oxygen. The VIE system is used in large

hospitals which have a pipeline system. It is the most economical way to store

and supply oxygen.

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2. Oxygen cylinders: It is expensive, cumbersome, and often unreliable. It

usually serve as a backup in large hospitals and used mainly in out of

hospital settings.

c. Oxygen concentrators: It draws air from the atmosphere and extracts

nitrogen leaving up to 90-96% concentration of oxygen using zeolite

molecular sieve. It is safe, reliable, and cost efficient source of oxygen,

and more convenient than oxygen cylinder. It is important to have a

backup source of oxygen (Oxygen cylinder), as it needs continuous power

source and regular maintenance.

d. Central piped oxygen: Oxygen is distributed via copper pipes circulating from

a central source, that is situated outside the building. The source may be

liquid oxygen, high-pressure gaseous oxygen cylinders, a large oxygen

concentrator or a combination. It has the advantage of reduced risk of fire

and obviates handling and transporting heavy cylinders between hospital

wards. The high installment and maintenance cost is it’s daunting factor.

Indications for Oxygen Therapy

Oxygen therapy is prescribed for people who can’t get enough oxygen on their
own. This is often because of lung conditions that prevents the lungs from absorbing
oxygen, including:
• chronic obstructive pulmonary disease (COPD)
• pneumonia
• Severe asthma attack
• bronchopulmonary dysplasia
• late stage heart failure
• cystic fibrosis
• COVID-19
• sleep apnea
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• trauma to the respiratory system

To determine whether a person will benefit from oxygen therapy, doctors test the
amount of oxygen in their arterial blood. Another way to check is using a pulse oximeter
that indirectly measures oxygen levels, or saturation, without requiring a blood sample.
The pulse oximeter clips onto a person’s body part, like a finger. Low levels mean that a
person may be a good candidate for supplemental oxygen.
Normal levels of arterial blood oxygen are between 75 and 100 mmHg (millimeters
of mercury). An oxygen level of 60 mmHg or lower indicates the need for supplemental
oxygen. Too much oxygen can be dangerous as well, and can damage the cells in your
lungs. Your oxygen level should not go above 110 mmHg.
Some people need oxygen therapy all the time, while others need it only
occasionally or in certain situations. Some oxygen therapy is done at a doctor’s office,
and other times people have an oxygen supply in their homes, or a portable oxygen
system.

Risks Of Oxygen Therapy:

1. Depression of ventilation:

It is seen in COPD patients with chronic carbon dioxide (CO2)retention who have

hypoxic respiratory drive to breath. Increased arterial tension to normal can lose the

hypercapnic stimulus to maintain ventilation resulting in hypoventilation in these

patients.

2. Hyperbaric oxygen toxicity: Long term hyperbaric O2 therapy can lead to

pulmonary, optic and central nervous system toxicity.

3. Fire hazard:

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Oxygen enhance combustion of other fuels. Least level of supplemental oxygen

(FiO2 greater than the 21% oxygen in ambient air) should be administered during laser

bronchoscopy to avoid intratracheal ignition.

4. Absorption atelectasis:

Given only pure oxygen results in the collapse of the dependent part of the lungs

as it quickly taken up from the alveoli. It is also a risk in general anesthesia induction.

5. Retinopathy of prematurity (ROP):

It usually occur in low birth weight, very premature infant. That is why in preterm

infants, 50-80 mmHg PaO2 is recommended in infants receiving oxygen.

6. Bacterial contamination associated with certain nebulization and humidification

systems is a possible hazard.

7. Pulmonary toxicity:

Patients exposed to high oxygen levels for a prolonged period of time have lung

damage. The extent of lung damage is dependent on FiO2 and duration of exposure. It

is due to intracellular free radicals (such as superoxide, activated hydroxyl ions, singlet

O2 and hydrogen peroxide) formed which can damage alveolar-capillary membrane. It

starts with increased permeability of the capillaries with resultant edema, thickened

membranes and finally to pulmonary fibrosis.

General Considerations of Oxygen Administration

1. Oxygen is an odorless, tasteless, colorless, transparent gas that is slightly
heavier than air. [Dat
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2. Oxygen supports combustion, therefore, there is always a danger of fire when

oxygen is being used.
The following safety measures should be remembered:
a. Oil or grease around oxygen connections should be avoided.
b. Alcohol, ether and other inflammatory liquids should be used with
caution in the vicinity of oxygen.
c. No electrical device must be used in or near an oxygen tent.
d. Oxygen cylinders should be kept secure in an upright position and
away from heat.
e. There must be no smoking in the vicinity of oxygen.
f. A fire extinguisher should be readily available and all staff have a
responsibility to be competent in its use.

Dangers, Problems, and Contraindications for Oxygen Therapy

Oxygen administration can result in detrimental effects in some cases. These include:
⚫ COPD Patients – Some patients with COPD may become increasingly
hypercapnic (elevated levels of carbon dioxide in the blood) when treated with
excessive amounts of oxygen. In these patients, it is recommended to keep their
SpO2 in the range of 88% to 92%. If their oxygen flow rates need to be significantly
increased, clarification is required from the physician or nurse practitioner involved.
⚫ Bleomycin Induced Pneumonitis – Oxygen therapy is contraindicated.20 If
oxygen needs to be applied, it is at very low levels (i.e. 0.5LPM). In this scenario,
clarification of the parameters must be obtained from the physician or nurse
practitioner.
⚫ Absorption Atelectasis – About 80% of the gas in the alveoli is nitrogen. If high
concentrations of oxygen are provided, the nitrogen is displaced. When the oxygen
diffuses across the alveolar-capillary membrane into the blood stream, the nitrogen
is no longer present to distend the alveoli, which contributes to their collapse and
atelectasis.

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Oxygen (O2) is administered as a corrective treatment for conditions resulting in

hypoxia (low level of oxygen in the blood). Oxygen is classed as a medication and must
be prescribed by a doctor and administered correctly to prevent over- or under-
oxygenation.
Remember oxygen is NOT flammable, but it does aid combustion. Patients and
visitors should therefore be educated about the increased risk of fire and the precautions
necessary to reduce this risk when supplementary oxygen is in use.
Oxygen must only be administered at the rate and percentage prescribed, as over-
oxygenation can be dangerous for some individuals, particularly those with chronic lung
disease who are retaining carbon dioxide, and infants, where there is also a risk of
retinopathy.

Equipment
The equipment required consists of a mask or nasal cannula that enables the
administration of the prescribed dose (percentage); connection tubing; flow meter; wall
or cylinder oxygen supply (oxygen cylinders are black with a white collar); and a
humidifier with sterile water if required. The procedures and rationales are given below.

Procedure Rationale

1. Explain procedure, addressing health To promote client cooperation and safety.

and safety precautions and ensure
adequate understanding.

2. Wash hands following correct To prevent cross-infection.

procedure.

3. Assemble equipment – For rates of 40% To prevent dehydration of mucous

and over, humidification (moistening of the membranes.
oxygen prior to it reaching the client) is
essential.

4. Set flow meter to prescribed rate, e.g. 2 To prevent over/under-oxygenation.

LPM.
NB It may be necessary to monitor the
client’s oxygen saturation rate (O2Sat) to
ensure this, particularly clients with chronic
lung disease, where there is a risk of
apnea, and babies, where the O2Sat rate [Dat
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as there is a significant risk of brain

damage.

5. Assist client to position mask (if mouth To facilitate optimum administration,

breathing) or nasal cannula correctly, promote patient comfort and reduce the
ensuring a comfortable but not too tight a potential for pressure sores.
fit.

6. Clients undergoing prolonged oxygen To reduce the risk of dehydration and

therapy will require monitoring of mucosa promote patient comfort.
and frequent mouth/nasal care (minimum
2 hourly).

7. Encourage client to relieve the pressure To reduce the potential for pressure sores.
of the mask or cannula from the face,
nares and ears hourly as appropriate.

8. Continue to monitor the client and To ensure compliance and to optimize

promptly report any change in condition. treatment.

9. Update nursing care plan. To ensure consistency in care delivery.

Administering Oxygen by Nasal Cannula

A variety of devices are available for delivering oxygen to the patient. Each has a
specific function and oxygen concentration. Device selection is based on the patient’s
condition and oxygen needs. A nasal cannula, also called nasal prongs, is the most
commonly used oxygen delivery device. The cannula is a disposable plastic device with
two protruding prongs for insertion into the nostrils. The cannula connects to an oxygen
source with a flow meter and, many times, a humidifier. It is commonly used because
the cannula does not impede eating or speaking and is used easily in the home.
Disadvantages of this system are that it can be dislodged easily and can cause dryness
of the nasal mucosa. A nasal cannula is used to deliver from 1 to 6 LPM of oxygen.

EQUIPMENT • Flow meter connected to oxygen supply

• Humidifier with sterile, distilled water
(optional for low-flow system)
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• Nasal cannula and tubing

• Gauze to pad tubing over ears (optional)
• PPE, as indicated

ASSESSMENT Assess the patient’s oxygen saturation

level before starting oxygen therapy to
provide a baseline for evaluating the
effectiveness of oxygen therapy. Assess
the patient’s respiratory status, including
respiratory rate, effort, and lung sounds.
Note any signs of respiratory distress,
such as tachypnea, nasal flaring, use of
accessory muscles, or dyspnea.

NURSING DIAGNOSIS Determine the related factors for the

nursing diagnosis based on the patient’s
current status. Appropriate nursing
diagnoses may include:
⚫ Impaired Gas Exchange
⚫ Ineffective Airway Clearance
⚫ Ineffective Breathing Pattern
Other nursing diagnoses that may be
appropriate include:
⚫ Risk for Activity Intolerance
⚫ Fluid Volume Excess
⚫ Decreased Cardiac Output

OUTCOME IDENTIFICATION AND The expected outcome is that the patient

PLANNING will exhibit an oxygen saturation level
within acceptable parameters. Other
outcomes that may be appropriate include
the following: patient will not experience
dyspnea; and patient will demonstrate
effortless respirations in the normal range
for age group, without evidence of nasal
flaring or use of accessory muscles.
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IMPLEMENTATION

Action Rationale

1. Bring necessary equipment to the Bringing everything to the bedside

bedside stand or overbed table. conserves time and energy. Arranging
items nearby is convenient, saves time,
and avoids unnecessary stretching and
twisting of muscles on the part of the
nurse.

2. Perform hand hygiene and put on PPE, Hand hygiene and PPE prevent the spread
if indicated. of microorganisms. PPE is required based
on transmission precautions.

3. Identify the patient. Identifying the patient ensures the right

patient receives the intervention and helps
prevent errors.

4. Close curtains around bed and close the This ensures the patient’s privacy.
door to the room, if possible.

Explain what you are going to do and the Explanation relieves anxiety and facilitates
reason for doing it to the patient. Review cooperation. Oxygen supports combustion;
safety precautions necessary when a small spark could cause a fire.
oxygen is in use. Place “No Smoking”
signs in appropriate areas.

Connect nasal cannula to oxygen setup Oxygen forced through a water reservoir is
with humidification, if one is in use (Figure humidified before it is delivered to the
1). Adjust flow rate as ordered (Figure 2). patient, thus preventing dehydration of the
Check that oxygen is flowing out of mucous membranes. Low-flow oxygen
prongs. does not require humidification.

7. Place prongs in patient’s nostrils. Place Correct placement of the prongs and
tubing over and behind each ear with fastener facilitates oxygen administration
adjuster comfortably under chin. and patient comfort. Pads reduce irritation
Alternately, the tubing may be placed and pressure and protect the skin.
around the patient’s head, with the
adjuster at the back or base of the head.
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Place gauze pads at ear beneath the

tubing, as necessary.

8.Adjust the fit of the cannula, as Proper adjustment maintains the prongs in
necessary. Tubing should be snug but not the patient’s nose. Excessive pressure
tight against the skin. from tubing could cause irritation and
pressure to the skin.

9. Encourage patients to breathe through Nose breathing provides for optimal

the nose, with the mouth closed. delivery of oxygen to patient. The
percentage of oxygen delivered can be
reduced in patients who breathe through
the mouth.

10. Reassess patient’s respiratory status, These assess the effectiveness of oxygen
including respiratory rate, effort and lung therapy.
sounds. Note any signs of respiratory
distress, such as tachypnea, nasal flaring,
use of accessory muscles, or dyspnea.

11. Remove PPE, if used. Perform hand Removing PPE properly reduces the risk
hygiene. for infection transmission and
contamination of other items. Hand
hygiene prevents the spread of
microorganisms.

12. Put on clean gloves. Remove and The continued presence of the cannula
clean the cannula and assess nares at causes irritation and dryness of the
least every 8 hours, or according to mucous membranes.
agency recommendations. Check nares
for evidence of irritation or bleeding.

EVALUATION The expected outcome is met when the

patient demonstrates an oxygen saturation
level within acceptable parameters. In
addition, the patient remains free of
dyspnea, nasal flaring or accessory
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muscle use and demonstrates respiratory

rate and depth within normal ranges.

DOCUMENTATION Document your assessment before and

after intervention. Document the amount of
Guidelines
oxygen applied, the patient’s respiratory
rate, oxygen saturation and lung sounds.

Sample Documentation 9/17/12 1300 Oxygen via nasal cannula

applied at 2 LPM. Humidification in place.
Pulse oximeter before placing oxygen
92%; after oxygen at 2 LPM 98%.
Respirations even and unlabored. Chest
rises symmetrically. No nasal flaring or
retractions noted. Lung sounds clear and
equal all lobes.
—C. Bausler, RN

UNEXPECTED SITUATIONS AND • Patient was fine on oxygen delivered by

ASSOCIATED INTERVENTIONS nasal cannula but now is cyanotic, and the
pulse oximeter reading is less than 93%:
Check to see that the oxygen tubing is still
connected to the flow meter and the flow
meter is still on the previous setting.
Someone may have stepped on the
tubing, pulling it from the flow meter, or the
oxygen may have accidentally been turned
off. Assess lung sounds to note any
changes.
• Areas over ear or back of head are
reddened: ensure that areas are
adequately padded and that tubing is not
pulled too tight. If available, a skin care
team may be able to offer some
suggestions.
• When dozing, patient begins to breathe
through the mouth: Temporarily place the
nasal cannula near the mouth. If this does [Dat
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not raise the pulse oximeter reading, you

may need to obtain an order to switch the
patient to a mask while sleeping.

SPECIAL CONSIDERATIONS
Home Care Considerations • Oxygen administration may need to be
continued in the home setting. Portable
oxygen concentrators are used most
frequently. Caregivers require instruction
concerning safety precautions with oxygen
use and need to understand the rationale
for the specific liter flow of oxygen.
• To prevent fires and injuries, take the
following precautions:
⚫ Avoid open flames.
⚫ Place “No Smoking” signs in
conspicuous places in the patient’s
home. Instruct the patient and
visitors about the hazard of smoking
when oxygen is in use.
⚫ Check to see that electrical
equipment used in the room is in
good working order and emits no
sparks.
⚫ Avoid using oils in the area. Oil can
ignite spontaneously in the
presence of oxygen.
When a patient requires a higher
concentration of oxygen than a nasal
cannula can deliver (6 L or 44% oxygen
concentration), use an oxygen mask. Fit
the mask carefully to the patient’s face to
avoid leakage of oxygen. The mask should
be comfortably snug, but not tight against
the face. Disposable and reusable face
masks are available. The most commonly
used types of masks are the simple face [Dat
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mask, the partial rebreather mask, the

non-rebreather mask, and the Venturi
mask.

Administering Oxygen by Mask

EQUIPMENT Flow meter connected to oxygen supply
⚫ Humidifier with sterile distilled
water, if necessary, for the type of
mask prescribed.
⚫ Face mask, specified by physician.
⚫ Gauze to pad elastic band (optional)
⚫ PPE, as indicated

ASSESSMENT Assess patient’s oxygen saturation level

before starting oxygen therapy to provide a
baseline for determining the effectiveness
of therapy. Assess patient’s respiratory
status, including respiratory rate and depth
and lung sounds. Note any signs of
respiratory distress, such as tachypnea,
nasal flaring, use of accessory muscles, or
dyspnea.

NURSING DIAGNOSIS Determine the related factors for the

nursing diagnosis based on the patient’s
current status. Appropriate nursing
diagnoses may include:
⚫ Impaired Gas Exchange
⚫ Ineffective Airway Clearance
⚫ Ineffective Breathing Pattern
Many other nursing diagnoses may be
appropriate, possibly including:
⚫ Risk for Activity Intolerance
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⚫ Fluid Volume Excess

⚫ Decreased Cardiac Output

OUTCOME IDENTIFICATION AND The expected outcome is that the patient

PLANNING exhibits an oxygen saturation level within
acceptable parameters. Other outcomes
that may be appropriate include the
following: the patient will remain free of
signs and symptoms of respiratory
distress; and respiratory status, including
respiratory rate and depth, will be in the
normal range for the patient’s age.

IMPLEMENTATION

Action Rationale

1. Bring necessary equipment to the Bringing everything to the bedside

bedside stand or over bed table. conserves time and energy. Arranging
items nearby is convenient, saves time,
and avoids unnecessary stretching and
twisting of muscles on the part of the
nurse.

2. Perform hand hygiene and put on PPE, Hand hygiene and PPE prevent the spread
if indicated. of microorganisms. PPE is required based
on transmission precautions.

3. Identify the patient. Identifying the patient ensures the right

patient receives the intervention and helps
prevent errors.

4. Close curtains around bed and close the This ensures the patient’s privacy.
door to the room, if possible.

5. Explain what you are going to do and Explanation relieves anxiety and facilitates
the reason for doing it to the patient. cooperation. Oxygen supports combustion;
Review safety precautions necessary a small spark could cause a fire.
[Dat
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when oxygen is in use. Place “No

Smoking” signs in appropriate areas.

6. Attach face mask to oxygen source Oxygen forced through a water reservoir is
(with humidification, if appropriate, for the humidified before it is delivered to the
specific mask). Start the flow of oxygen at patient, thus preventing dehydration of the
the specified rate. For a mask with a mucous membranes. A reservoir bag must
reservoir, be sure to allow oxygen to fill the be inflated with oxygen because the bag is
bag before proceeding to the next step. the oxygen supply source for the patient.

7. Position face mask over the patient’s A loose or poorly fitting mask will result in
nose and mouth (Figure 4). Adjust the oxygen loss and decreased therapeutic
elastic strap so that the mask fits snugly value. Masks may cause a feeling of
but comfortably on the face (Figure 5). suffocation, and the patient needs frequent
Adjust the flow rate to the prescribed rate. attention and reassurance.

8. If the patient reports irritation or redness Pads reduce irritation and pressure and
is noted, use gauze pads under the elastic protect the skin.
strap at pressure points to reduce irritation
to ears and scalp.

9. Reassess patient’s respiratory status, This helps assess the effectiveness of

including respiratory rate, effort, and lung oxygen therapy.
sounds. Note any signs of respiratory
distress, such as tachypnea, nasal flaring,
use of accessory muscles, or dyspnea.

10. Remove PPE, if used. Perform hand Removing PPE properly reduces the risk
hygiene. for infection transmission and
contamination of other items. Hand
hygiene prevents the spread of
microorganisms.

11. Remove the mask and dry the skin The tight-fitting mask and moisture from
every 2 to 3 hours if the oxygen is condensation can irritate the skin on the
running continuously. Do not use face. There is a danger of inhaling powder
powder around the mask. if it is placed on the mask.

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EVALUATION The expected outcome is met when the

patient exhibits an oxygen saturation level
within accept- able parameters. In
addition, the patient demonstrates an
absence of respiratory distress and acces-
sory muscle use and exhibits respiratory
rate and depth within normal parameters.

DOCUMENTATION Document type of mask used, amount of

oxygen used, oxygen saturation level, lung
Guidelines
sounds, and rate/pattern of respirations.
Document your assessment before and
Sample Documentation after intervention.

9/22/12 Patient reports feeling short of

breath. Skin pale, respirations 30 breaths
per minute and labored. Lung sounds
decreased throughout. Oxygen saturation
via pulse oximeter 88%. Findings reported
to Dr. Lu. Oxygen via non-rebreather face
mask applied at 12 LPM as ordered.
Patient’s skin is pink after O2 applied.
Oxygen saturation increased to 98%.
Respirations even and unlabored. Chest
rises symmetrically.

UNEXPECTED SITUATIONS AND • Patient was previously fine but now is

ASSOCIATED INTERVENTIONS cyanotic, and the pulse oximeter reading is
less than 93%: Check to see that the
oxygen tubing is still connected to the flow
meter and the flow meter is still on the
previous setting. Someone may have
stepped on the tubing, pulling it from the
flow meter, or the oxygen may have
accidentally been turned off. Assess lung
sounds for any changes.
• Areas over ear or back of head are
reddened: Ensure that areas are
adequately padded and that tubing is not [Dat
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pulled too tight. If available, a skin-care

team may be able to offer some
suggestions.

[Dat
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REFERENCES

Ashurst S (1995) Oxygen therapy. British Journal of Nursing 4(9): 508–515.

Allen D (1989) Making sense of oxygen delivery. Nursing Times 85(18): 40–42.

Dunn L, Chisholm H (1998) Oxygen therapy. Nursing Standard 13(7): 57–60.

Ergan B, Nava S. Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the
Actual Recommendations. COPD, 2017;14(3):351-366. doi:
10.1080/15412555.2017.1319918.

Fell H, Boehm M (1998) Easing the discomfort of oxygen therapy. Nursing Times
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