OSCE REVIEW - BSN  HYPERVENTILATION/ OVERBREATHING

Increase air in the lungs above the normal. Usually

O2 ADMINISTRATION associated with acute anxiety or emotional tension. It
 RESPIRATION MOVEMENT can cause dizziness and may even lead to
1. Oxygen rich air from environment unconsciousness.
2. Nasal cavities
3. Pharynx  IMMEDIATE TREATMENT
4. Trachea Breathing in paper bag is not recommended instead
5. Bronchi breath with only one nostril while the other is closed
6. Bronchioles thru finger then focus breathing to reduce the amount
7. Alveoli of air that enters the lungs.
8. 02 an carbon dioxide exchange in alveoli
9. Bronchioles  METHODS OF OXYGEN ADMINISTRATION
10. Bronchi FOR ADULTS
11. Trachea
12. Pharynx 1) Nasal Cannula (FOR ADULT)
13. Nasal cavities ✔ Is a tube that has two prongs to go in the
14. Carbon dioxide rich air in the environment. nose passages (nostrils)
✔ Nasal prongs delivers low flow of oxygen
 Oxygen concentration of 25% to 33% at 1-3
Odorless, tasteless, colorless, transparent gas that L/min.
is slightly heavier than air.
EQUIPMENTS
It is essential for cell metabolism, and in return, tissue ✔ Oxygen source
oxygenation is essential for all normal physiologic ✔ Plastic nasal cannula with connecting
functions. tubing (disposable)
✔ Humidifier filled with sterile water
Used to treat or prevent symptoms of hypoxia and ✔ Flowmeter
hypoxemia ✔ No smoking sign

 INDICATIONS
 CARDIOPULMONARY EMERGENCIES
 SOB
 CHEST PAIN
 CARDIAC OR RESPI ARREST
PROCEDURE:
 SEVERE TRAUMA
1. Show the nasal prong to the patient and explain the
 USED BY HOSPITALS AND FIRST AIDERS
procedure.

 CONTRAINDICATIONS 2. Make sure the humidifier is filled to the

 All patients with unfavorable ventilation to
oxygen treatment
 Mechanical ventilation must be turned on in all
cases with patients in respi coma.
appropriate mark.
3. Attach the connecting tube from the nasal prong to
the humidifier outlet.
4. Set the flow rate at the prescribed liters per minute.

 PT. TO RECEIVE TREATMENT 5. Place the tip of nasal prong in the patient’s nose
 ASTHMA-it could result in a pneumothorax and adjust the strap.
 HIGH FEVER-to lower seizures; and lowering temp.
 OPTIC NEUTRITIS- rare cases of worsening Nasal cannula- is low flow system, oxygen
vision and blindness concentration will vary, depending on the patient’s
 PREGNANCY- if any stress is caused to the fetus. respiratory rate and tidal volume. Approximate
COMPLICATIONS concentrations delivered are:
1L= 24%-25% 3L= 30%-33%
 EMPHYSEMA
2L= 27%-29%
Type of COPD involving damage of the air sacs
(alveoli) with carbon dioxide retention. Therefore If Room Air = 21% + 4 % in each L/min of O2
you give a high concentration of O2, you are removing concentration
the trigger to breath that leads to respi depression or Example: 21% + 4% (1L) = 25%
even arrest. 21% + 8% (2L) = 29%
Effect of O2 on COPD is to cause increased CO2
retention, which may cause drowsiness, headaches, and 21% + 12% (3L)= 33%
in severe cases lack of respi which may lead to death.
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OSCE REVIEW - BSN
O2 ADMINISTRATION
2) FACE MASK (FOR ADULT)
⮚ mask that delivers moderate oxygen flow to
nose and mouth.
⮚ Delivers oxygen concentrations of 40%-60%
at 4L-6L/min.
EQUIPMENTS:
✔ Oxygen source
✔ Humidifier bottle with distilled water
✔ Simple face mask with tubing(disposable)
✔ Flowmeter
PROCEDURE
1. Show the mask to the patient and explain
the procedure.
2. Make sure that the humidifier is filled to
the appropriate mark
3 Attach the tubing from the mask to the
humidifier outlet
4 Set the desired oxygen concentration
as prescribed.
5 Apply the mask to the patient’s face and
adjust the straps so the mask fits securely
3) Non Rebreathing Mask (FOR ADULT)
Has an inflatable bag to store 100% oxygen and
one way valve between the bag and mask to
prevent exhaled air from entering the bag.
- one way valves covering one or both the
exhalation ports to prevent entry of room air on
inspiration
Delivers oxygen concentrations of 60%-100% at
6L-10L/min.
4) PARTIAL REBREATHER MASK (FOR ADULT)
✔ has an inflatable bag that stores 100
% oxygen
a) On inspiration, the patient
inhales from the mask and bag; on
expiration, the bag refills with
oxygen and expired gases exit
through perforations on both side
of the mask and some enters the
bag
b) High concentrations of
oxygen 50% to 75% can be
delivered.
PROCEDURE: For Non Rebreathing Mask
And Partial Rebreathing Mask
1. Show the mask to the patient and explain the
procedure
2. Attach the tubing to the flowmeter
3. Set and adjust the flowmeter to 6- 10 L/min
4. Place mask on patients face and adjust the straps
5. Stay with the patient to make the patients
comfortable
and observe reactions
6. Remove mask periodically
5) Venturi Mask (FOR ADULT)
Mask with device that mixes air
and oxygen to deliver constant
oxygen concentration.
Mask that delivers oxygen
concentration of 24% - 40% at
4 – 8 L/min.
PROCEDURE: For Venturi mask
1. Show the venturi mask to the patient
and explain the procedure.
2. Connect the mask to the oxygen
flowmeter
3. Set the prescribed rate (usually
indicated on the mask
4. Place the mask over the patient’s nose
and mouth then under the chin. Adjust
the elastic strap
5. Determine the patient’s comfort with
oxygen use
6) Bag-Valve Mask (Ambubag) (FOR ADULT)
Delivers high concentration of
oxygen to patient with insufficient
inspiratory effort.
Delivers O2 concentration
of 15L/min at 100% with reservoir.
PROCEDURE: For Manual
Resuscitation Bag
1. Wash hands. Refer to the Hand Washing
procedure.
2. Explain procedure to client.
3. Connect to oxygen by attaching one end of tubing
to flow
meter adapter and one end to the Ambu bag. Turn
the flowmeter to “ flush” position.
4. Place mask over nose and mouth - use dominant
hand to
ventilate by compressing the bag oxygenation until
able to
breathe independently.
5. Observe chest rise and fall to determine
effectiveness of
compressions.
6. Observe client color, comfort level.
OSCE REVIEW - BSN Pediatric Assessment Triangle

O2 ADMINISTRATION ⚫ Appearance
⚫ Awake
7) T - PIECE ( BRIGGS) adapter (FOR ADULT) ⚫ Aware
Is used to administer oxygen to patient ⚫ Upright
with ET or tracheostomy tube who is ⚫ Work of breathing
⚫ Retractions
breathing spontaneously.
⚫ Noises
A device for connecting two inputs to
⚫ Skin circulation
one output or vice versa

PROCEDURE: For T-piece (Briggs) adapter

1. Show the T-tube to patient and explain
the procedure
2. Make sure the humidifier is filled to the
appropriate mark TYPES OF DELIVERY OF O2
3. Attach the large bore tubing from the T-tube to  NASAL CANNULA
the humidifier outlet. ✔ A thin, soft, plastic tube and has soft
4. Adjust the flow rate as ordered prongs that gently fit into your baby’s
5. Drain the tubing frequently by emptying nose.
condensate into a separate receptacle, not into the ✔ Oxygen flows through the tube. The baby
humidifier must be able to breathe without assistance
in order to use this type of
8) CONTINOUS POSITIVE AIRWAY PRESSURE oxygen therapy.
(CPAP) (FOR ADULT)
Is a method of respiratory ventilation used primarily  OXYGEN HOOD
in the treatment of sleep apnea
Commonly used for critically ill patient with - is used for babies who can breathe on their own
Respiratory Failure, CHF and COPD who are admitted but still need extra oxygen.
in ICU, CCU or other specialized respiratory unit
- A hood is a plastic dome or box with warm,
moist oxygen inside. The hood is placed over
PROCEDURE: For CPAP
the baby's head.
1. Show the mask to the patient and explain the
procedure.
2. Insert NG tube if ordered
3. Attach NG tube adapter
4. Set the desired oxygen concentration.
5. Place the mask on the patient’s face and adjust
the strap.
6. Organize care to remove the mask as infrequently as ✔ Continously monitor the oxygen concentration,
possible temperature, and humidity inside the hood.
Rationale: Oxygen should be warmed to prevent a
9) Transtracheal Catheter (FOR ADULT) neonatal response to cold stress, including oxygen
Accomplished by way of a small (8 French) deprivation and reduction of blood glucose levels.
catheter inserted between the second and third
 FACE TENT
tracheal cartilage Oxygen delivery is more
✔ are available in adult size only
efficient because all
✔ a flow of 8- 10 L/min should be
oxygen enters the lungs Delivers oxygen
used to flush the system and provide a
concentrations of 60% - 100%
stable oxygen concentration
at 4L-6L/min.

Oxygen Concentration in Infants

✔ High levels of oxygen given to infants causes
blindness by promoting overgrowth of new blood
vessels in the eye obstructing sight. This is called
retinopathy of prematurity (ROP).
⚫ It can replace oxygen masks when masks are
poorly tolerated by clients.
⚫ Soft and lightweight face tent designed for
patients with facial skin burn or trauma.
Latex-free elastic head strap for better fit and less
skin irritation.

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OSCE REVIEW - BSN

O2 ADMINISTRATION

 CLOSED INCUBATOR OR
ISOLETTES

✔ The incubator is used to provide

a controlled environment for the
neonate.
✔ When a baby is relatively stable but
still premature or requiring intravenous
fluids or other special attention, he or she
is cared for in an "incubator."
✔ The incubator keeps the baby warm
with moistened air in a clean environment,
and helps to protect the baby from noise,
drafts, infection
✔ Keep sleeves of incubator closed
- to prevent loss of oxygen

PROCEDURE
Explain the procedure to the child and
allow the child to feel the equipment and
the oxygen flowing through the tube and
mask
2. Maintain a clear airway by suctioning, if
necessary.
3. Provide source of humidification
4. Observe the child’s response to oxygen
5. Terminate oxygen therapy gradually
6. Continually monitor the child’s response during
weaning.
7. Observe for restlessness, increased pulse
rate, respiratory distress, and cyanosis.

POTENTIAL COMPLICATIONS
⚫ Impairment of respiratory drive in people
with COPD(those who retain carbon dioxide)
⚫ Discomfort secondary to drying of mucous
membranes
⚫ Eye irritation
⚫ Mask can act as barrier against feeding
and communication
⚫ Creation of a fire hazard (smoking in same
room must be banned)
⚫ Restriction of activities.

NURSING CARE
⚫ Before commencing oxygen therapy ensure
that it is prescribed and that the patient
understands why he/she requires it.
Reassurance and information can relieve the
distress significantly.
⚫ Reassure the patient and sit him/her
up comfortably supported by pillows
before explaining how to use the
equipm