Bicol University

COLLEGE OF NURSING
Legazpi City

NCM112: Skills Laboratory

1st Semester, SY 2021-2022

TOPIC : Oxygen Therapy: Administration of Oxygen

TYPE OF ASSESSMENT : Summative

PLATFORM : Google Classroom

Case Scenario: Mrs Cruz, aged 50 years old is brought to the Emergency Room because of dyspnea. The
initial diagnosis is Bronchial Asthma
● Admission Vital signs: BP 130/70, CR= 100/minute, RR= 30/minute.

● Respiration is irregular, rise in sternocleidomastoid muscles, flaring of alai nasi

● Lungs- wheezes in both lung fields

● Cyanosis (+) - nail beds

● Arterial Blood Gas Result: Respiratory Acidosis with hypoxemia (Abnormal results)

pH- 7.30, pCO2 - 7.50, HCO3- 22, O2 saturation- 75 %

Physician’s Order:

● Intravenous fluids (IVF)- D5 Water 500 ml at KVO

● Medications- Solumedrol 20mg intravenous BID

● Oxygen at 3liters per Nasal Cannula.

Nursing responsibilities related to Oxygen therapy

A. Before (10 Points)

1. What materials are you going to prepare before the procedure?

Before administering oxygen via nasal cannula, the materials I’m going to prepare are:

● Oxygen source (either oxygen tank or wall oxygen source)

● Oxygen Flow meter
● Humidifier and distilled water
● Nasal cannula
● Gauze (to place at ear beneath the tubing)

Page 1 of 4
 Bicol University
COLLEGE OF NURSING
Legazpi City

● “No smoking” sign

2. What are the preliminary steps to be performed?

In administering oxygen therapy, the preliminary steps to be performed are:

● History taking
● Assessment of client’s respiratory status
● Taking of oxygen saturation via pulse oximeter or arterial blood gas as ordered
● Assessment of presence of sputum and its characteristics
● Assessment of clinical signs and symptoms of respiratory problems
● Reviewing the doctor’s order for oxygen therapy
● Preparation of the materials needed
● Proper handwashing
● Verification of client
● Explanation of the procedure to the client
● Positioning the client to semi- or high Fowler’s position as tolerated
● Insertion of the flow meter into the oxygen source
● Attachment of oxygen tubing to the nozzle on flow meter
● Attachment of humidifier
● Attachment of oxygen tubing to the humidifier
● Turning on the oxygen at the prescribed rate and checking of its flow through the
tubing
● Application of the nasal cannula to the patient
3. What should be noted in the physician’s order?

For the oxygen therapy, the physician’s order should include the following:

● Patient’s complete name

● Patient’s date of birth
● Oxygen therapy requested
● Reason for ordering the oxygen therapy (diagnosis description, ICD-9 code, sign(s),
symptoms)
● Provider's name
● Provider's signature
4. What information must be given to the client?

The client must be given information which includes:

● Definition of oxygen therapy

● The procedures of the oxygen therapy
● The purpose of oxygen therapy
● The safety precautions associated with oxygen use
● Significance of breathing through nose

Page 2 of 4
 Bicol University
COLLEGE OF NURSING
Legazpi City

5. What assessment data must be collected?

For the assessment data, the following must be collected:

● Present health history

● Past health history
● Vital signs
● Respiratory rate, rhythm, and depth
● Shape of chest and symmetry
● Presence of sputum and its characteristics
● Skin and nail color, bruises and/or lacerations, scars
● Presented clinical signs and symptoms of a respiratory problem
● Areas of tenderness by palpation
● Breath sounds
● Diagnostic examination results such as chest x-ray, spirometry, pulse oximeter, and
arterial blood gas
6. What precautionary measures must be implemented?

The precautionary measures include:

● Post "No Smoking" signs in the room where the oxygen is kept.
● No smoking around the patient, within 10 feet of the oxygen equipment.
● No open flame (e.g. candles) within 10 feet of the oxygen equipment.
● Do not expose the oxygen equipment to electrical appliances (such as electric razors, hair
dryers, electric blankets, etc.)
● Keep the oxygen system away from aerosol cans or sprays, including air fresheners or hair
spray.
● Do not lubricate the oxygen equipment. The patient should use water-based products instead
of petroleum-based products on their face or chest.
● Keep the oxygen system in a secure place where it won't get knocked over.

B. During (5Points)

1. What should be assessed during the administration of oxygen?

During the administration of oxygen, the assessment includes:

● Proper functioning of the oxygen equipment

● Patient’s respiratory status
● Patient’s initial response to the oxygen

Page 3 of 4
 Bicol University
COLLEGE OF NURSING
Legazpi City

C. After (5Points)

1. What should be documented?

After the administration of oxygen, the following data should be documented:

● Type of oxygen device used

● Amount of oxygen administered
● Position placed
● Client’s response to the oxygen therapy

Prepared by:

Mark Zedrix A. Mediario

BSN Level III - Group 11

Page 4 of 4