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Precautions for oxygen administration Oxygen, which constitutes 21% of normal air, is a tasteless, odorless, and colorless gas

. It supports combustion. To prevent fires and injuries, take the following precautions: • • Avoid open flames in the patient’s room. Place “no smoking” signs in conspicuous places in the patient’s room or 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, such as electric bell cords, razors, radios, and suctioning equipment, is in good working order and emits no sparks. Avoid wearing and using synthetic fabrics that build up static electricity. Avoid using oils in the area. Oil can ignite spontaneously in the presence of oxygen.

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Oxygen delivery systems Oxygen can be administered by many different delivery systems: nasal canula, nasal catheter, transtracheal catheter, simple mask, partial rebreather mask, nonrebreather mask, venture mask, and tent. Oxygen delivery System Method Nursing Intervention Nasal cannula Amount Delivered FiO Low flow 1 L/min = 2 L/min = 3 L/min = 4 L/min = 5 L/min = 6 L/min = Priority

24 % 28% 32% 36% 40% 44%

Check frequently that both prongs are in patient’s nares. Never deliver more than 2-3 L/min to patient with chronic lung disease.

Simple mask

Low flow 6-10 L/min = 35%-60% (5 L/min is minimum setting)

Monitor patient frequently to check placement of the mask.

Set flow rate so the mask remains twothirds full during inspiration. Requires careful monitoring to verify FiO2 at flow rate ordered. Secure physician’s order to replace mask with nasal cannula during meal time.Partial rebreather mask Low Flow 6-15 L/min = 70%-90% Support patient if claustrophobia is a concern. including the administering device and the liter flow rate (L/min) or the percentage of oxygen. Check that valves and rubber flaps are functioning properly (open during expiration and closed during inhalation). . Keep reservoir bag free of twists or kinks. Check that air intake valves are not blocked. Face Mask. check: (a) the order for oxygen. Monitor SaO2 with pulse oximeter. Maintain flow rate so reservoir bag collapse only slightly during inspiration. or Face Tent Before administering oxygen. Nonrebreather mask Low Flow 6-15 L/min = 60%-100% Venturi mask High Flow 4-10 L/min = 24%-55% Administering Oxygen by CAnnula.

hypertension. bradypnea. Face Tent • To provide high humidity • To provide oxygen when a mask is poorly tolerated. • Presence of clinical signs of hypoxemia: Tachycardia and tachypnea are often early signs. and decreased pulmonary ventilation. PaCO2 is normally 35 to 45 mm Hg). • To provide a high flow of O2 when attached to Venturi system Assessment • Skin and mucous membrane color: Note whether cyanosis is present. suprasternal. dyspnea. • Breathing patterns: Note depth of respiration and presence of tachypnea. Note: If the client has not had arterial blood gases ordered. headache. Determine . kyphosis). lethargy. Purposes Cannula • To deliver a relatively low concentration of oxygen when only minimal O2 support is required. or orthopnea. • Presence of clinical signs of oxygen toxicity: tracheal irritation and cough. • Lung sounds audible by auscultating the chest and by ear. oxygen saturation should be checked using a noninvasive oximeter.g.. tremor. • Chest wall configuration (e. and (c) whether the client has COPD. Confusion is a later sign of severe oxyen deprivation. substernal. Face Mask To provide moderate O2 support and higher concentration of oxygen and/or humidity than is provided by cannula.(b) the levels of oxygen (PaO2) and Carbon dioxide (PaCO2) in the client’s arterial blood (PaO2 is normally 80 to 100 mm Hg. supraclavicular. • Presence of clinical signs of hypercarbia (hypercapnia): restlessness. • Chest movements: Note whether there are any intercostals. or tracheal retractions during inspiration or expiration. • To allow uninterrupted delivery of oxygen wile the client ingests food or fluids.

Oxygen saturation levels. Low flows of oxygen (2 L/min) stimulate breathing for such persons by maintaining slight hypoxemia. arterial blood gas of oxygen (PaO2) and carbon dioxide (PaO2) are measured periodically to monitor hypoxemia. reapplying the oxygen delivery device may be performed by the UAP. Results of diagnostic studies such as chest x-ray. Planning Consult with a respiratory therapist as needed in the beginning and during care of clients receiving ordered oxygen therapy. rhythm. and respiratory rate. Pulmonary function test. In many agencies. Abnormal findings must be validated and interpreted by the nurse. However people with COPD may have a chronically high carbon dioxide level and their stimulus to breathe is hypoxemia. especially pulse rate and quality. and complete blood count. if available. and depth. hematocrit. Whether the client has COPD. and many aspects of the client’s response to oxygen therapy are observed during usual care and may be recorded by persons other than the nurse. Equipment Cannula • Oxygen supply with a flow meter and adapter • Humidifier with distilled water or tap water according to agency protocol • Nasal cannula and tubing • Tape • Padding for the elastic band Face mask • Oxygen supply with a flow meter and adapter • Humidifier with distilled water or tap water according to agency protocol • Prescribed face mask of the appropriate size • Padding for the elastic band Face Tent • Oxygen supply with a flow meter and adapter . A high carbon dioxide level in the blood is the normal stimulus to breathe. However. Delegation Initiating the administration of oxygen is considered similar to administering a medication and is not delegated to unlicensed assistive personnel (UAP). if available.• • • • • • Vital signs. The nurse is also responsible for ensuring that the correct delivery method is being used. the therapist establishes the initial equipment and client teaching. During continuous oxygen administration. Hemoglobin.

• Perform a respirator assessment to develop baseline data if not already available. and the connections should be airtight. Discuss how the effects of the oxygen therapy will be used in planning further care or treatments. Provide for client privacy. or tent. • Explain the oxygen is not dangerous when safety precautions are observed. 2. (This can be done before coming to the bedside). • Attach the flow meter to the wall outlet or tank. mask. 2. and how he or she can cooperate. Turn on the oxygen at the prescribed rate and ensure proper functioning. Cannula . why is I necessary. There should be no kinks in the tubing. if appropriate. There should be bubbles in the humidifier as theoxygen flows through. Prepare the client and support people. Determine the need for oxygen therapy. fill the humidifier bottle. and verify the other for the therapy.• • Humidifier with distilled water or tap wate according to agency protocol Face tent of the appropriate size Implementation Preparation 1. Prior to performing the procedure. • If needed. • Check that the oxygen is flowing freely through the tubing. You should feel the oxygen at the outlets of the cannula. Apply the appropriate oxygen delivery device. • Set the oxygen at the flow rate ordered. Rationale: This position permit easier chest expansion and hence easier breathing. • Attach the humidifier bottle to the base of the flow meter. Explain to the client what you are going to do. Set u the oxygen equipment and the humidifier. 4. 6. Performance 1. 5. • Assist the client to semi-Fowler’s position if possible. The flow meter should be in the off position. Perform hand hygiene and observe appropriate infection control procedures. introduce self and verify the client’s identity using the agency protocol. 3. • Attach the prescribed oxygen tubing and delivery device to the humidifier. Inform the client and support people about the safety precautions connected with oxygen use.

Assess the top of the client’s ears for any signs of irritation from the cannula strap. If the cannula will not stay in place. 7. and cyanosis. If present. dyspnea. color. Ratioale: The mask should mold to the face. Secure the elastic band around the client’s head so that the mask is comfortable but snug. • • • Assess the client’s vitalsigns. Assess the client in 15 to 30 minutes. and provide support while the client adjusts to the device. and ease of respirations. Nasal Cannula • Assess the clients nares for encrustations and irritation. and apply it from the nose downward. restlessness. so that very little oxygen escapes into the eyes or around the cheeks and chin. Review oxygen saturation or arterial blood gas results if they are available. • Face mask or Tent . paddingwith a gauze pad may help relieve the discomfort. Padding will prevent irritation from the mask. and regularly thereafter. with the outlet prongs fitting into the nares and the elastic band around the head.• • • Face • • • Put the cannula over the client’s face. level of anxiety. confusion. Apply a watersoluble lubricant as required to soothe the mucous membranes. Assess the client regularly. Some models have a strap to adjust under the chin. depending on the client’s condition. Pad the tubing and band over the ears and cheeckbones as needed. tachycardia. Rationle: Face tent • Place the tent over the client’s face. tape it at the sides of the face. Fit the mask to the contours of the client’s face. and secure the ties around the head. mask Guide the mask toward the client’s face. • Pad the band behind the ears and over bony prominences. Assess the client regularly for clinical signs of hypoxia.

• Inspect the facial skin frequently for dampness or chaftin.. 9. • Be sure that water is not collecting in dependent loops of the tubing. Relate findings to previous data if available (e. Document findings in the client record using forms or checklist supplemented by narrative notes when appropriate. and dry and treat it as needed. • Check the liter flow and the level of water in the humidifier in 30 minutes and whenever providing care to the client. Inspect the equipment on a regular basis.g. Evaluation • Perform follow up based findings that deviated from expected or normal for the client. 8. check oxygen saturation to evaluate adequate oxygenation). Report significant deviations from normal to the primary care provider. • . • Make sure that safety precautions are being followed.