OXYGENATION

Ms. Abulencia & Ms. Mariano | Jan. 28 | Prelim

Introduction
● Oxygen
○ Very vital for us; it gives us energy
○ Form of survival
○ Very essential for respiration

● Respiratory System
○ Extracts oxygen from the air
● Importance of Clean Air
○ Respiration: We eliminate the carbon
○ Don’t smoke and avoid pollutions
dioxide that the cells produce after we
○ Clean Air Act
use oxygen
○ Clean environment = good breathing
○ Automatic and involuntary process in
process
which when air comes through the nose,
it enters through the little hair that will
moisten it (gives some a little heat) and Oxygen Hood & Oxygen Tent
will keep the dirt away from our lungs ● The process of oxygen hood and oxygen tent
(obstructs the dust or any particles). are the same. It only varies on the features.
○ When someone jogs or runs, breathing
comes in a difficult way especially when ● Oxygen Hood
he’s not used to exercising. Somehow ○ is a plastic dome or box with warmed
heavy and part in breathing because and humidified oxygen inside
they lack oxygen. ○ used for babies who can breathe on
○ Cars: fuel :: Humans: oxygen their own but still need extra oxygen
○ When you breathe in the air, it passes
through the nostril, cilia nose hair,
pharynx, larynx, and trachea.
○ Trachea: windpipe that filters
(strains/sinasala) the air that is being
inhaled.
○ Trachea will branch into 2 which are the
bronchi. ○
○ Cilia: tiny hair that moves back and
forth, moving the mucus inside
○ Mucus: very sticky substance that
collects the germs and other particles
that might harm the lungs
○ Right lung has 3 lobes while the left
lung has only 2 lobes to give space for
the heart.
○ Lobes are now filled with small and
spongy sacs called the alveoli wherein ○
the exchange of O2 and CO2 happens. ○ The nurse improvised; only in the PH
○ Diaphragm: beneath the lungs; dome
shape; will constrict when you breathe in
and expand when you breathe out;
separates the chest cavity from the
abdominal cavity

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 ● Oxygen Tent
○ consists of a canopy placed over the
head and shoulders, or over the entire
body of a patient to provide oxygen at a
higher level than normal.
○ some devices cover only a part of the
face
○
Oxygen Administration Using an Oxygen Hood
● Oxygen Hood
○ clear plastic compartment that fits
around the neonate’s head
○ provides warm and humidified O2
(moisture in the air)
○ allows the neonate to receive a desired
FiO2
○ FiO2
■ the fraction of inspired oxygen
at room temperature
■ the concentration of oxygen that
the person inhales
■ normal FiO2 : 21%
○ surrounds the head and neck of the
infant and leaves the rest of the body
available for care
■ there’s a space from the neck
down in order not to suffocate
the baby
■ the edges should not be sharp
in order not to produce any
harm to the baby
■ it should have a cover and
protection to avoid having
scratches and lesion
● Oxygen Saturation
○ Preterm (less than 36 weeks)
■ 90-94%
○ Term or post-term infant
■ considered as an adult already
■ 90-99%
● Overview
○ Oxygen administration is ordered for
patients with respiratory or illnesses
those who have musculoskeletal or
neurologic problems that interfere with
proper oxygenation causing hypoxia.
➼ Hypoxia
• inadequate oxygen supply at the
tissue level
• is a condition in which the body or
a region of the body is deprived of
adequate oxygen supply at the
tissue level.
• may be classified as either:
a. Generalized
- affecting the whole body
b. Local
- affecting a region of the body
• Signs of Hypoxia: confusion,
restlessness, & shortness of breath
● Oxygen Hoods
○ are generally used to deliver oxygen to
infants.
○ They supply an oxygen concentration
that is almost 100%.
○ The oxygen hood is placed over the
infant's head and shoulders.
○ The hoods are made of hard plastic or
vinyl with a metal frame.
○ Oxygen saturation (O2 sat.) is important
■ oxygen level keeps it at a
normal range and it is very
much needed in the cell of the
body (function &
life-threatening)
■ Blood oxygen level is an
indicator also whether or not the
oxygen is being well distributed
in the lungs, more so in the cells
of the lungs. “Kailangan na ba
niya ng oxygen? How much of
the oxygen are we to give?
Pano pag nasa 80 or 90 lang
yung O2 sat? Do we consider
that as something critical na or
hindi?” It serves as our basis.
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● Indications
○ Used for babies who can breathe on
their own but still need extra oxygen
○ Some signs of abnormal breathing tells
us that there is asphyxiation
(cyanosis)
■ Over breastfeed baby and
without burp: oxygenation hood
can help even just after a few
minutes
■ Respiratory distress
■ Apnea attacks (sometimes
happens)
● Equipment
○ Oxygen source
○ Oxygen hood
○ Oxygen analyzer
○ Humidification device
● Parts of Wall Outlet Oxygen
● Assessment
1. Assess patient’s lung sounds
○ ● Common Abnormal Lung Sounds
○ It’s commonly used today but the
traditional one (oxygen tank) can still be
seen in government institutions. May
danger sign sa paggamit ng oxygen
tank.
○ Flow meter: device wherein you control
the rate of oxygen being delivered to the
patient in liters per minute
○ Flow adjuster: tell you how much of the
silver ball will go up
○ Oxygen output: wherein you attach the
connector
○ Humidifying cup: fill up with distilled or
mineral water. Tap water is not allowed
since it contains minerals and other
harmful things that the baby might
absorb
■ Water: will prevent the nose,
mouth, throat from becoming
dry so it should be filled up with
water. No need to fill it in full, 3/4
or 1/2 will do.
○ Pressure gauge: pressure of the gas; if
meron bang laman yung gas.
○ Screw cap
○ Pressure reducing valve
○ Safety valve
○ Oxygen-in pipe
○
- Many respiratory conditions may cause
the patient's oxygen demand to
increase.
○ Rales: rattling & bubbling
sounds; can be seen in patients
with pneumonia, has infections
in the lungs, atelectasis (a
partial or complete collapsed
lungs)
○ Rhonchi: resemble in snoring
sound; can be seen in COPD
patients (has history with
smoking)
○ Stridor: somehow the same
with wheezing like sound; can
be seen with allergies & swelling
○ Wheezing: like whistles,
common in the PH; especially in
patients with asthma
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2. Assess the oxygen saturation level
- The physician will usually order a
baseline for the pulse oximeter.
■ Oximetry Sensors: used/can be
seen in newborns/infants
■ Sensors of pulse oximeter can
be placed in:
■
■ Complete Radiant Warmer:
■
■ Normally seen in the area, even
in government institutions
■ Heater: if baby need
phototherapy
■ Control unit: Dito nakainput
lahat; has thermometer, pulse
oximeter
■ Side panels
■ Bed with mattress
■ Mount
■ Used when:
● there’s a distress in the
baby
● If need to monitor dahil
di maganda ang
APGAR score
■ Nurses are responsible in
monitoring the vital signs
3. Assess skin color
- A pale or cyanotic patient may not be
receiving enough oxygen.
- Be observant. If you’re assigned to the
babies/infant, take note of everything
that you notice.
4. Assess patient for any signs of
respiratory distress such as:
● Nasal flaring: can be seen in
widened nostrils
● Grunting: mumbles, murmur,
ungol
● Retractions: when you breathe,
kita/halata/nagsisink yung ribs
● Oxygen depleted patients often
exhibit these signs.
● Nursing Diagnosis
1. Impaired gas exchange
● Happens when there’s an
excess or deficit of oxygenation
● CO2 being eliminated in the
alveoli
● Shallow respiration, irregular
respiration, dyspnea, orthopnea,
irritable, restless, cyanotic can
be seen/observed
2. Ineffective breathing pattern
● Inspiration and expiration are
already damaged in breathing
the ventilation that he needs
● Has severe respiratory problem
3. Ineffective airway clearance
● There are obstructions or
secretions that are needed to
remove to make a clear airway
● Sometimes positioning is also
important in neonate
● Dito papasok yung suctioning
● Planning
○ Patient will exhibit an oxygen saturation
level within acceptable parameters.
○ Patient will not experience dyspnea.
○ Patient will demonstrate effortless
respirations in the normal range for age
groups without evidence of nasal flaring
or use of accessory muscles
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● Implementation
1. Identify the patient using at least two
methods.
- check ID tags/wristband; ask
mother/guardian about the baby’s name
& birthdate
➼ Rationale: Confirms patients identify by
checking patients ID and asking their name.
Positive identification of the patient is
essential to ensure the intervention is
administered to the correct patient.
2. Explain what you are going to do and
the reason to the patient and parents /
guardians. Review safety precautions
necessary when oxygen is in use.
➼ Rationale: Explain the procedure will
relieve anxiety and facilitates cooperation.
Safety means oxygen supports combustion.
3. Perform hand hygiene.
- Before touching another baby, wash
hands.
➼ Rationale: To prevent cross infection
because it deters the spread of
microorganisms.
4. Calibrate the oxygen analyzer according
to the manufacturer's directions.
➼ Rationale: This ensures accurate
readings and appropriate adjustments to
therapy.
■ Safety Precautions with Oxygen
● Post oxygen signs on the door/over
bed and follow facility policy.
(Smoking is not allowed specially
when oxygen is in used because
oxygen supports combustion, making
it prone to fire hazard)
●
● Check with the nurse before using
electrical equipment such as razors,
fans, radios, televisions.
(Due to electrical hazards; they may
create spark and serious fire)
● Never use flammable liquids such as
nail polish remover.
● Be sure that the oxygen cylinder is
secure on base and chained to a
carrier or wall.
●
● Immediately report smoking/smoking
material when oxygen is in use.
● Use only cotton blankets - not wool or
synthetic.
● If tank is empty report to nurse
■ Oxygen Analyzer
●
● Used to ensure accuracy of the
oxygen.
● Measures the content of the oxygen.
5. Place the hood on the crib. Connect the
humidifier to the oxygen source in the
wall. Connect the oxygen tubing to the
hood. Adjust the flow rate as ordered by
the physician. Check that oxygen is
flowing into the hood.
- The flow rate is recommended and
ordered only by the physician. All the
time, we must follow the doctor’s order
but there are times that we can question
their order.
➼ Rationale: Oxygen forced through a water
reservoir is humidified before it is delivered
to the patient thus preventing dehydration of
the mucus membranes.
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6. Turn the analyzer on. Place an oxygen
analyzer probe in the hood.
- Before you start, check first everything -
flow meter, pressure gauge, humidified
cup.
➼ Rationale: The analyzer will give an
accurate reading of the concentration of
oxygen in the hood / in bed.
*for suctioning yung nasa right side
7. Adjust oxygen flow as necessary based
on sensor readings. Once oxygen levels
reach the prescribed amount, place the
hood over the patient's head. The hood
should not rub against the infant’s neck,
chin, or shoulder.
- Make sure that there is no irritation in
the infant’s head. There’s a space
between the hood and infant’s skin.
➼ Rationale: Patient will receive oxygen
once placed under the hood. Pressure and
irritation could result in alterations in the
infant’s skin integrity.
8. If using the soft vinyl hood, roll small
blankets or towels and place around the
edges where the hood meets the crib to
keep oxygen concentration at desired
level. Do not block the hole in the top of
the hood if present. If using a vinyl
hood, the vent hole covering may need
to be removed.
➼ Rationale: The blankets help keep the
edges of the hood sealed and prevent
oxygen from escaping. This hole allows for
the escape of carbon dioxide, blocking it
may cause a buildup of carbon dioxide in the
hood.
9. Instruct family members not to raise
edges of the hood.
- There are times that the parents are
nangingialam ng flow rate so keep
instructing them not to. You could also
check what's really happening with the
baby.
➼ Rationale: Every time the hood is raised
oxygen is released.
10. Reassess patient’s respiratory status
including respiratory rate, effort, oxygen
saturation and lung sounds. Note any
signs of respiratory distress like
tachycardia, nasal flaring, grunting,
retractions or dyspnea.
➼ Rationale: This assesses the
effectiveness of oxygen therapy.
11. Perform hand hygiene.
➼ Rationale: Hand hygiene deters the
spread of microorganism.
12. Frequently check bedding and patients
head for moisture.
- There are times that moisture is created
and the patient’s bed becomes wet. You
have to change it.
➼ Rationale: The humidification delivered in
an oxygen hood makes cloth moist, which
would be uncomfortable for the patient.
13. Monitor the patient’s body temperature
at regular intervals.
➼ Rationale: Hyperthermia can result from
administering cool oxygen
● Question: Are there any instances that the
nurse can immediately decide on the oxygen
level of the baby? How much oxygen can we
give to them? What level can we start?
○ Emergency situation calls for an
immediate decision, so you can decide.
But do not give too much oxygen. Start
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 with 2-3 liters/minute for the mother but
start with the lowest for the baby. When
the doctor arrives, the deciding factor is
now will be at the hand of the doctor -
whether to increase the O2 level or not.
● Evaluation
○ Is the patient able to tolerate the oxygen
device?
○ Is the oxygen flow at the level as
ordered?
○ Is an oxygen sign posted?
○ Does the patient understand the
instructions regarding safety during
oxygen administration?
○ Is breathing less labored with oxygen
administration?
○ Is oxygen saturation improving?
● Documentation
○ Document amount of oxygen applied,
respiratory rate, oxygen saturation level
and your assessment pre and post
intervention.
■ Natolerate ba ng baby, what is
the RR at this time? O2 stat?
Time; document.
Oxygen Administration Using an Oxygen Tent
● The Boy in the Plastic Bubble
○ oxygen demand to increase.
○ Movie with a good example of an
oxygen tent. It tells us that the boy is
born with immune deficiencies, if he is
not in his bubble/tent, he experiences
breathing problems.
● Overview
○ Oxygen tents are often used in children
who will not leave a face mask or nasal
cannula in place.
○ The oxygen tent gives the patient
freedom to move in the bed or crib
while humidified oxygen is being
delivered, however it is difficult to keep
the tent closed since the child may want
contact with his / her parents.
■ The size of the tent
varies/depends on the patient’s
size (Tugma lang sa size niya).
It could be bigger or smaller.
○ It is difficult to maintain a consistent
level of oxygen and to deliver oxygen at
a higher rate than 30% to 50%.
○ Frequent assessment of the child's
pajamas and bedding is necessary
because the humidification quickly
creates moisture, leading to damp
clothing and linens and possible
hypothermia
● Equipment
○ Oxygen source
○ Oxygen tent
○ Humidifier compatible with tent
○ Oxygen analyzer
○ Small blankets for blanket rolls
● Indications
○ Provide more oxygen to their lungs and
to their tissues.
○ Treatment for the amount of oxygen in
the blood, decreases load in the heart
and facilitates breathing.
○ Ease symptoms like cough and dried up
secretions that occur in respiratory
conditions.
○ Persons with viral / bacterial meningitis
develops breathing difficulty
● Assessment
○ *Same with oxygen hood*
○ + 1. Secretions may cause the patient's
● Nursing Diagnosis & Planning
○ *Same with oxygen hood*
● Implementation
○ *Steps 1-4 & 10-12 Same with oxygen
hood*
5. Place the tent over the crib. Connect the
humidifier to the oxygen source in the wall
and connect the tent tubing to the humidifier.
Adjust the flow rate as ordered by the
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 physician. Check the oxygen is flowing into
the tent.
➼ Rationale: Oxygen forced through a water
reservoir is humidified before it is delivered
to the patient thus preventing dehydration of
the mucus membranes.
6. Turn the analyzer on. Place an oxygen
analyzer probe in a tent out of the patient's
reach.
➼ *Same rationale*
7. Adjust oxygen flow as necessary based
on sensor readings. Once oxygen levels
reach the prescribed amount, place the
patient in the tent.
➼ *Same rationale*
8. Roll small blankets like jelly roll and tuck
tent edges under the blanket rolls as
necessary.
➼ The blankets help keep the edges of the
tent sealed and prevent oxygen from
escaping.
9. Encourage patient and family members to
keep the tent flap closed.
➼ Every time the hood is raised, oxygen is
released.
● Evaluation & Documentation
○ *Same with oxygen hood*
● Questions
○ How to feed the baby? If the baby is
inside the hood and tent and it’s time for
feeding, there’s no problem with it. They
can put off for a while the oxygen and
can get the baby and feed them
specially for breastfeeding. For a child,
they might tantrum if hungry. The
feeding won’t last for an hour so we can
stop the oxygen. Sometimes, the
mothers feed them inside the tent (kaso
baka maging malikot at makalat).
○ When is the oxygen hood indicated?
Used for babies who can breathe on
their own but still need extra oxygen. It
is usually 2 liters per minute.
○ For patients with oxygen support, the
lesser the number of liters per minute,
the more independent the patient is (in
terms of breathing on his own). So
assess first.
○ Epiglottis: part of the respiratory
system that controls the air and food in
the esophagus. Shifts the air to the
lungs while foods to the stomach.
○ Pagnagdedeliver ng oxygen, nagshishift
yung epiglottis para hindi pupunta sa
tiyan yung hangin which results to
kabag. Pagkumakain naman yung bata,
magshishift yung epiglottis para
magclose yung tunnel papunta sa lungs.
However, if yung patient mo may signs
ng respiratory distress (hinihingal
kunyari pero nakakahinga parin) at
nagsabay ka ng deliver ng oxygen at
pagkain, may possibilities na malito
yung epiglottis so the patient may
aspirate. Thus, you really have to check
first before you feed the client. The
parents don’t know this.
○ Paghindi maganda yung breathing ng
bata kahit he is breathing on his own,
pagnakita mo na yung RR, abdominal
breathing, rhythm, chest ay di maganda,
you really have to be careful.
○ Sometimes, when the patient is on
respiratory distress, specially yung mga
hindi nakakahinga, hindi
nakakapagcough out ng mga secretions
like newborns/infants, minsan
nakanothing per orem sila until RR is
less than 40%. Use critical thinking as
they are fragile.
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Administering Oxygen by Nasal Cannula
● Reason why we administer oxygen
○ The oxygen is a gas that the cells in our
body need to work properly. If the
oxygen did not work properly, then the
patient’s body wouldn’t work properly as
well.
○ The air we breathe normally contains
21% of oxygen (both for pedia and even
adults) so we can receive up to 100% of
oxygen.
● Overview
○ 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.
➼ Rationale: Less oxygen organs may
be injured and harmful and too much
oxygen can cause injury
○ A nasal cannula is used to deliver from
1 L/minute to 6 L/minute of oxygen.
● Parts of Wall Outlet Oxygen
○ Flow meter - an instrument used to
measure the linear or the nonlinear
mass or volume (ex. 2 liters, 4 liters)
○ If the silver ball increase it means there
is an oxygen already flowing in flow
meter
○ Pressure gauge - reads the pressure of
the cylinder content (dito makikita kung
may laman pa yung tank)
○ Regulator - simply regulates the flow
from the oxygen cylinder
○ Pressure adjuster - a divide which
control the liquid or the gases by
reducing a high input pressure to control
lower output pressure
● Equipment
○ Flow meter connected to oxygen supply
○ Humidifier with sterile, distilled water
(optional for low-flow system)
○ Nasal cannula and tubing
● Different types and sizes of nasal cannula
1. Adult
2. Pediatric
3. Infant
● Gauze to pad tubing over ears
(optional) - why do we need gauze?
The gauze would place on the earlobe that could
lessen or prevent the irritation of the baby
because of their sensitive skin
● PPE, as indicated
● Assessment
1. Assess the patient’s oxygen saturation level
before starting oxygen therapy to provide a
baseline for evaluating the effectiveness of
oxygen therapy.
2. Assess the patient’s respiratory status, including
respiratory rate, effort, and lung sounds.
Normal respiratory rate
● infant/newborn (0-12months) - 30-60 bpm
● toddler (1-3 years) - 24-40 bpm
● preschooler (3-5 years) - 22-34 bpm
● school aged child (5-12 years) 18-30 bpm
3. Note any signs of respiratory
distress, such as tachypnea, nasal
flaring, use of accessory muscles, or dyspnea.
● Nursing Diagnosis
1. Determine the related factors for the nursing
diagnosis based on the patient’s current status.
Appropriate nursing diagnoses may include:
Impaired Gas Exchange
➼ Rationale: the movement of gas from the area
with a high concentration
- because there is deficit oxygenation (ex.
Carbohydrates is 60% and the oxygen is only
40%)
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Ineffective Airway Clearance
➼ Rationale: there is the possibility that there is an
obstruction narrowing of airway clearance
Symptoms : fatigue and low energy
Ineffective Breathing Pattern
➼ Rationale: the signs are accessory muscle use,
labored breathing, first lip breathing, color change
2.Other nursing diagnoses that
may be appropriate include:
Risk for Activity Intolerance
➼ Rationale: less oxygen
Excess Fluid Volume
➼ Rationale: there is too much volume in lungs
Decreased Cardiac Output
➼ Rationale: at risk of developing a health status
characterized by an insufficient quantity of blood
pumped by the heart to meet physical metabolic
demands.
● Outcome Identification and Planning
● The expected outcome is that the
patient 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.
● Implementation
1. Bring necessary equipment to
the bedside stand or overbed
table.
● Why do you need to bring everything to your
bedside when you go to the patient?
➼ Rationale: to serve time and energy
2. Perform hand hygiene and
put on PPE, if indicated.
3. Identify the patient
➼ Rationale: 2 identifiers id tags, name of the
baby, birthday and the year
4. Close curtains around bed
and close the door to the
room, if possible
5. Explain what you are going to do
and the reason for doing it to the
patient. Review safety precautions
necessary when oxygen is in use.
Place “No Smoking” signs in
appropriate areas
➼ Rationale: the oxygen cause fire
6. Connect nasal cannula to oxygen
setup with humidification, if one is
in use. Adjust flow rate as ordered.
Check that oxygen is flowing out of
prongs
7. Place prongs in patient’s nostrils.
Place tubing over and behind each
ear with adjuster comfortably
under chin. The tubing may be
placed around the patient’s head,
with the adjuster at the back or
base of the head. Place gauze pads
at ear beneath the tubing, as
necessary
➼ Rationale: to prevent irritation of the pressure
8. Adjust the fit of the cannula, as
necessary Tubing should be snug
but not tight against the skin.
9. Encourage patients to breathe
through the nose, with the mouth
closed
10. Reassess 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
11. Remove PPE, if used. Perform
hand hygiene.
12. Put on clean gloves. Remove
and clean the cannula and assess
nares at least every 8 hours, or
according to agency
recommendations. Check nares for
evidence of irritation or bleeding.
➼ Rationale: to avoid irritation and wound
● 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 muscle use and
demonstrates respiratory rate and
depth within normal ranges.
● Documentation
● Document your assessment
before and after intervention.
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● Document the amount of
oxygen applied, the patient’s
respiratory rate, oxygen
saturation, and lung sounds.
● Unexpected Situations and Associated
Interventions
○ Check to see that the oxygen tubing is
still connected to the flow meter and the
flow meter is still on the previous setting.
➼ Rationale: To check if the tubing is not
tangled or twisted. Sometimes the mother or
the baby accidentally puts their body weight
on the tubing that may stop the flow. Also
check if the flow meter is functioning. Using
an oxygen tank may disconnect the tubing
and stop the flow than a flow meter
embedded in the wall.
○ 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 the 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. (Check every 3 mins or 5
mins.)
○ When dozing, patient begins to breathe
through the mouth: Temporarily place
the nasal cannula near the mouth. If this
does not raise the pulse oximeter
reading, you may need to obtain an
order to switch the patient to a mask
while sleeping.
➼ Rationale: Face mask is the ideal mask
for the babies that are sleeping because it
prevents irritation on the nose.
● Home Care Considerations
○ Oxygen administration may
need to be continued in the
home setting. (w/ the use of
nasal cannula)
○ Portable oxygen concentrators
are used most frequently.
○ Caregivers/mothers 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 during
oxygen therapy.
○ 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.
➼ Rationale: To prevent sparks
during therapy.
○ Avoid using oils in the area. Oil
can ignite spontaneously in the
presence of oxygen.
➼ Rationale: Oil is hot and may
ignite in the presence of oxygen.
“Kapag naka nasal cannula pwede
ba kumain ng naka ganon o
kailangan tanggalin pa?” You can
still eat while wearing nasal cannula
because it does not affect the
passageway of the mouth.
Administering Oxygen by Mask
Same principle with the three devices: oxygen tent, hood
and nasal cannula.
● Overview
○ 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 facemask
(consists of ventilators, soft metal or
stopper, garter to lock the mask to the
patient’s face).
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There are other types of oxygen mask:
1. Partial Rebreather Mask
- Allows some air to be recycled instead
of completely preventing you from
rebreathing air. When 100% oxygen
flows, the oxygen will go through your
mouth and to the bag. The bag
constricts when you inhale and expands
when you exhale (mix of inspired and
expired gas).
- Uses a 2 way valve that provides a
very high concentration of oxygen
without the risk of suffocation.
2. Non Rebreather Mask
- Similar to a partial rebreather mask but uses a 1 way
valve for the inhaled ox.
- Special medication device that is used to provide
oxygen in emergencies. It helps people who can still
breathe but need a lot of oxygen just like the tent and the
hood (extra oxygen siya).
- Used to treat several conditions.
- It has ventilators on each side in which when you
exhale oxygen, the exhaled air will pass through those
ventilators.
3. Venturi Mask/ Air Entrainment Mask
- An ordinary
mask that has
an extension
with a colorful
end/device that
gives a fixed
oxygen
percentage a
patient needs
and there is no need to adjust.
- A controlled oxygen therapy.
- The colorful devices that are placed in the extension
which indicate a specific oxygen percentage. Ex. 20%
oxygen- orange.
- High flow device that delivers a fixed oxygen
concentration of 24%-50%.
- The device is appropriate for the patient who has a
hypoxic drive to breathe but also needs supplemental
oxygen like for COPD patients.
“Partial rebreather, non rebreather and the nasal
cannula. 100% oxygen na po ba yan hindi na siya
pwede machange and in the venturi mask pwede siya
machange?” Yes, you can give 100% in the partial and
non rebreather mask but specifically like in the COPD
patients, and the Doctor orders a specific oxygen
concentration to avoid over oxygenation and damage in
the alveoli.
● 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 the patient's oxygen saturation
level before starting oxygen therapy to
provide a baseline for determining the
effectiveness of therapy.
➼ Rationale: To know the effectiveness and how
much oxygen saturation you must give to the
patient.
○ Assess the 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
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 ○ Ineffective Breathing Pattern
Other nursing diagnoses that may be
appropriate include:
○ Risk for Activity Intolerance
○ Excess Fluid Volume
○ Decreased Cardiac Output

● Outcome Identification and Planning

○ The expected outcome is that the
patient exhibits an oxygen saturation
level within acceptable parameters.
○ Other outcomes that may be appropriate
include the following: the patient will ○ Position face mask over the patient’s
remain free of signs and symptoms of nose and mouth. Adjust the elastic strap
respiratory distress; and respiratory so that the mask fits snugly but
status, including respiratory rate and comfortably on the face. Adjust the flow
depth, will be in the normal range for the rate to the prescribed rate.
patient’s age.

● Implementation
○ Bring necessary equipment to the
bedside stand or overbed table.
➼ Rationale: Conserves energy and time.
○ Perform hand hygiene and put on PPE,
if indicated.
○ Identify the patient. (by using two
identifiers)
○ Close curtains around bed and close the ○ If the patient reports irritation or redness
door to the room, if possible. is noted, use gauze pads under the
➼ Rationale: To provide client privacy. elastic strap at pressure points to
○ Explain what you are going to do and reduce irritation to ears and scalp.
the reason for doing it to the patient. ■ Skin of the baby is still sensitive.
Review safety precautions necessary ○ Reassess patient’s respiratory status,
when oxygen is in use. Place “No including respiratory rate, effort, and
Smoking” signs in appropriate areas. lung sounds. Note any signs of
○ Attach face mask to oxygen source (with respiratory distress, such as tachypnea,
humidification, if appropriate, for the nasal flaring, use of accessory muscles,
specific mask). Start the flow of oxygen or dyspnea.
at the specified rate. For a mask with a ○ Remove PPE, if used. Perform hand
reservoir, be sure to allow oxygen to fill hygiene.
the bag first before proceeding to the ○ Remove the mask and dry the skin
next step. every 2 to 3 hours if the oxygen is
running continuously. Do not use
powder around the mask.
➼ Rationale: Dry the skin to avoid moist. The
patient may also inhale if there is a powder
around the mask and causes lung problems.

● Evaluation
○ The expected outcome is met when the
patient exhibits an oxygen saturation
level within acceptable parameters.

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 ○ In addition, the patient demonstrates an
absence of respiratory distress and use
of accessory muscle and exhibits
respiratory rate and depth within normal
parameters.
● Documentation
○ Document type of mask used, amount of
oxygen used, oxygen saturation level,
lung sounds and rate/pattern of
respirations.
○ Document your assessment before and
after intervention.
● Unexpected Situations and Associated
Interventions
○ Patient was previously fine 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 for 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.
➼ Rationale: To prevent any bleeding or fresh
wound.
mask is removed to maintain adequate
oxygenation.
“Hindi po ba maraming procedure yung gagawin if
papalit palit from nasal cannula to oxygen mask?”
That’s the disadvantage of mask, papalit palit. Mamaya
naka nasal cannula na siya throughout 8 hrs tas ayun
pala dapat oxygen mask dapat. Medyo hassle ang mask
kasi papalit palit.
“Possible po ba makaramdam ng discomfort yung
patient while wearing face mask? For example po
umiiyak ang baby ano ang gagawin ng nurse?” There is
a possibility na iirita yung mga baby. The nurse will now
ask the doctor for recommendation of nasal mask, but
then dun sa nasal mask more concentration yung
oxygen. If tinurn out or nilagay sa nasal cannula, tatagal
yung therapy and confinement of the patient. Kailangan
makuha ng patient yung adequate oxygen concentration.
“May situation po ba na from nonrebreather mask
magsswitch sa nasal cannula or sa tent or hood?”
Shifting of oxygen concentration only, not the device
itself. Assess the patient after switching masks if there is
respiratory distress happening to the patient. If having
respiratory distress, then let the mask stay on the patient
at higher concentration of oxygen.

● Special Considerations
○ Different types of face masks are
available for use that depend on the
patient’s condition.
○ It’s important to ensure the mask fits
snugly around the patient’s face. If it is
loose, it will not effectively deliver the
right amount of oxygen.
○ The mask must be removed for the
patient to eat, drink, and take
medications. Obtain an order for oxygen
via nasal cannula for use during meal
times and limit the amount of times the

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