SKILL

14-5 Administering Oxygen by Mask

When a patient requires a higher concentration of oxygen than a nasal cannula can
deliver (6 L or 44% oxygen concentration), an oxygen mask is used (See Table 14-1 in
Skill 14-4 for a comparison of different types of oxygen deliver systems). The mask is
fitted carefully to the patient’s face to avoid leakage of oxygen and 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 mask, the
partial rebreather mask, the nonrebreather mask, and the Venturi mask.

Equipment
 Flow meter connected to oxygen
supply
 Humidifier with sterile distilled
water, if necessary for the type of
mask prescribed
 Face masks, specified by
physician
 Gauze to pad elastic band
(optional)

Assessment
Assess patient’s oxygen saturation level before starting oxygen therapy to provide a baseline
for determining the effectiveness of oxygen 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.
 SKILL Administering Oxygen by Mask (continued)
14-5

NURSING Determine the related factors for the nursing diagnoses based on the patient’s current
status. Appropriate nursing diagnoses may include:
DIAGNOSIS
 Impaired Gas Exchange

 Ineffective Breathing Pattern

 Ineffective Airway Clearance

Other nursing diagnoses that may be appropriate include:

 Risk for Activity Intolerance

 Decreased Cardiac Output

 Excess Fluid Volume

OUTCOME The expected outcome is that the patient will exhibit an oxygen saturation level
IDENTIFICATION within acceptable parameters. Other outcomes that may be appropriate include the
AND PLANNING following: 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 RATINGS

1. Identify the patient. 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 Explanation relieves anxiety and facilitates
reason to the patient. Review safety cooperation. Oxygen supports combustion.
precautions necessary when oxygen is in
use. Place “No Smoking” signs in
appropriate areas.

3. Perform hand hygiene. Hand hygiene deters the spread of

microorganisms.

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

5. Position face mask over patient’s nose
and mouth. Adjust the elastic strap so that
the mask fits snugly but comfortably on the
face. Adjust the flow rate to the prescribed
rate.
A loose or poorly fitting mask will result in
oxygen loss and decreased therapeutic
value. Masks may cause a feeling of
suffocation, and the patient needs frequent
attention and reassurance.
SKILL
14-5 Administering Oxygen by Mask (continued)

IMPLEMENTATION

ACTION RATIONALE RATINGS

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

7. Reassess patient’s respiratory status, This helps 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.

8. Perform hand hygiene. Hand hygiene deters the spread of

microorganisms.

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

EVALUATION The expected outcome is met when the patient exhibits an oxygen
saturation level within acceptable parameters. In addition, the patient
demonstrates an absence of respiratory distress and accessory muscle use
and exhibits respiratory rate and depth with normal parameters.

DOCUMENTATION

Guidelines Document type of mask used, amount of oxygen used, oxygen saturation
level, lung sounds, and rate/pattern of respirations. Document your
assessment pre- and post intervention.

Sample Documentation
9/22/08 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 nonrebreather face mask applied at 12 L/min as
ordered. Patient’s skin is pink after O₂ applied. Oxygen saturation increased to 98% .
Respirations even and unlabored. Chest rises symmetrically. Respiratory rate 18 breaths per
minute. Lungs remain with decreased breath sounds throughout. Patient denies dyspnea. －
C. Bausler, RN
SKILL
14-5 Administering Oxygen by Mask (continued)

Unexpected Situations and  Patient was previously fine but now is cyanotic, and pulse oximeter
Associated Interventions reading <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.

Special Considerations

General Consideration  Different types of face masks are available for use.
 It’s important to ensure the mask fits snugly around the patient’s face. If
it’s 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 time the mask is removed to maintain
adequate oxygenation.