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Oxygen therapy

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Definition of the oxygen therapy Types of oxygen therapy purposes of using the oxygen therapy Administration of oxygen therapy Complication of oxygen therapy

LEARNING OBJECTIVES:       Define the oxygen therapy Discuss the type of c oxygen therapy List the purpose of using the oxygen therapy Explain the procedure Demonstrate the procedure List Complication of oxygen therapy .

tasteless gas that is essential for the body to function properly and to survive.OXYGEN THERAPY Definition:  Oxygen is a colorless. . odorless.

.WHAT IS MEANING OF O2 THERAPY  Oxygen therapy is the administration of oxygen at a concentration of pressure greater than that found in the environmental atmosphere  The air that we breathe contain approximately 21% oxygen  the heart relies on oxygen to pump blood.

. it’s difficult for the tissues of the heart to keep pumping.WHAT IS MEANING OF O2 THERAPY  If not enough oxygen is circulating in the blood.  Supplemental oxygen is used to treat medical conditions in which the tissues of the body do not have enough oxygen.

PURPOSE The body is constantly taking in oxygen and releasing carbon dioxide. and the patient may need supplemental oxygen. .  If this process is inadequate. oxygen levels in the blood decrease.

The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury. .PURPOSE Oxygen therapy is a key treatment in respiratory care.

OXYGEN THERAPY IS USED TO TREAT  Example in case : Documented hypoxemia  Severe respiratory distress (acute asthma or pneumonia)  Severe trauma  Chronic obstructive pulmonary disease (COPD. and chronic asthma) . emphysema. including chronic bronchitis.

.OXYGEN THERAPY IS USED TO TREAT  Pulmonary hypertension  Acute myocardial infarction (heart attack)  Short-term therapy. such as postanesthesia recovery  Oxygen may also be used to treat chronic lung disease patients during exercise .

METHODS OF DISPENSING OXYGEN Piped in Cylinder Oxygen concentrator .

Wall outlets. 2.SOURCES OF OXYGEN: Cylinder. .  1-  Oxygen is moistened by passing it through a humidification system to prevent the mucous membranes of the respiratory tree from becoming dry.

 To release oxygen safety and at a desirable rate.1- USING OXYGEN CYLINDERS:  The oxygen cylinder is delivered with a protective cap to prevent accidental force against the cylinder outlet. a regulator is used. It consists of two parts. .

.USING OXYGEN CYLINDERS:  A reduction gauge that reduces the pressure to a working level and shows the amount of oxygen in the tank. a flow meter that regulates the control of oxygen in liters per minutes.

2. Only a flow meter and a humidifier are required.  .WALL – OUTLET OXYGEN:  The oxygen is supplied from a central source through a pipeline.

(ABGs ) .  Oxygen supplemental is determined by inadequate oxygen saturation.  Clinical observations.PREPARATION A physician's order is required for oxygen therapy. .  indicated in Artial Blood Gas measurements. except in emergency use.  Pulse Oximetry.

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CAUTIONS FOR OXYGEN THERAPY toxicity – can occur with FIO2 > 50% longer than 48 hrs  Suppression of ventilation – will lead to increased CO2 and carbon dioxide narcosis  Danger of fire  Infection  Oxygen .

Methods of oxygen administration: .

Partial rebreather mask  High flow systems  deliver specific and constant percent of oxygen independent of client’s breathing  Ex: Venturi mask. trach collar. simple mask . T-piece . non-re breather mask ..CLASSIFICATION OF OXYGEN DELIVERY SYSTEMS  Low flow systems  contribute partially to inspired gas client breathes  do not provide constant FIO2  Ex: nasal cannula.

METHODS OF OXYGEN ADMINISTRATION:
1- Nasal cannula 

NASAL CANNULA (PRONGS):
It is a disposable.  plastic devise with two protruding prongs for insertion into the nostrils, connected to an oxygen source.

 Used

for low-medium concentrations of Oxygen (24-44%).

Method

Amount Delivered F1o2 (Fraction Inspired Oxygen)

Priority Nursing Interventions

Advantages

Disadvantages

Nasal Cannula

Check frequently Low flow that both 24-44 % prongs are in 1 L\min=24% clients nares 2 L\min=28% 3 L\min=32% Never 4 L\min=36% deliver more 5 L\min=40% than 2-3 L\min 6 L\min=44% to client with chronic lung disease

 Client able to talk and eat with oxygen in place

may cause irritation to the nasal and pharyngeal mucosa

Easily used if oxygen flow rates are in home above 6 setting liters/minute Variable FIO2

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FACE MASK  The simple Oxygen mask  The partial rebreather mask:  The non rebreather mask:  The venturi mask: .

plastic or rubber that can be molded to fit the face. flexible .  .THE SIMPLE OXYGEN MASK Simple mask is made of clear.  It is held to the head with elastic bands.  Some have a metal clip that can be bent over the bridge of the nose for a comfortable fit.

thereby diluting the source oxygen..  Often it is used when an increased delivery of oxygen is needed for short periods  (i.  A flow rate of 6 to 10 liters per minute.e.  It has vents on its sides which allow room air to leak in at many places. . less than 12 hours).THE  It SIMPLE OXYGEN MASK delivers 35% to 60% oxygen .

Method Amount Delivered F1o2 (Fraction Inspired Oxygen) Priority Nursing Interventions Advantages Disadvantages Simple mask Low Flow 6-10 L\min 35%-60% Monitor client frequently to check placement of the mask. moisture) Wasting Uncomfortable for pt while eating or talking Expensive with nasal tube . Support client if claustrophobia is concern Secure physician's order to replace mask with nasal cannula during meal time Can provide increased delivery of oxygen for short period of time Tight seal required to deliver higher concentration Difficult to keep mask in position over nose and mouth Potential for skin breakdown (pressure.

 .THE PARTIAL REBREATHER MASK: The mask is have with a reservoir bag must romaine inflated during both inspiration & expiration  It collection of the first parts of the patients' exhaled air.  It is used to deliver oxygen concentrations up to 80%.

THE PARTIAL REBREATHER MASK The oxygen flow rate must be maintained at a minimum of 6 L/min to ensure that the patient does not rebreathe large amounts of exhaled air.  .  The remaining exhaled air exits through vents.

THE NON REBREATHER MASK  This mask provides the highest concentration of  oxygen (95-100%) at a flow rate6-15 L/min.  It is similar to the partial rebreather mask  except two one-way valves prevent conservation of exhaled air.  The bag is an oxygen reservoir .

not the reservoir bag.  . the patient is not rebreathing any of the expired gas.  the one-way valve closes and all of the expired air is deposited into the  atmosphere.  In this way.THE NON REBREATHER MASK When the patient exhales air.

uncomfort able Not as drying to mucous membrane s .Method Amount Delivered F1o2 (Fraction Inspired Oxygen) Priority Nursing Advantages Disadvantages Interventions Partial Rebreather Mask Low Flow Set flow rate so 6 L\min mask remains 75%-80% tow-thirds oxygen full during inspiration Keep reservoir bag free of twists or kinks Clinet can inhale room air through openings in mask if oxygens supply is briefly interrupted Requires tight seal (eating and talking difficult.

Method Amount Delivere d F1o2 Priority Nursing Interventions Advantages Disadvantages rebreather MASK Low Flow 6-15 L \min Maintain flow rate so reservoir bag collapses only slightly during inspiration 80%100% Check that valves and rubber flaps are function properly (open during expiration ) Monitor SaO2 with pulse oximeter Delivers the highest possible oxygen concentration Suitable for pt breathing spontaneous with sever hypoxemia Impractical for long term Therapy Malfunction can cause CO2 buildup suffocation Expensive Feeling of suffocation Uncomfortable Costly Non .

 Oxygen from 40 .50%  At liters flow of 4 to 15 L/min.  The mask is so constructed that there is a constant flow of room air blended with a fixed concentration of oxygen  .VENTURI MASK It is high flow concentration of oxygen.

bore tubing and various color .  Room air dilutes the oxygen entering the tubing to a certain concentration  The amount of air drawn in is determined by the size of the orifice (jet adapter). The venturi system.  Each color code corresponds to a precise  oxygen concentration and a specific liter flow.coded jet adapters. .THE VENTURI MASK  is designed with wide.

 the greater the air dilution.The narrower the jet adapter.  It THE VENTURI MASK is used primarily for patients with chronic obstructive pulmonary disease . and the lower the concentration of oxygen.

Method Amount Delivered F1o2 Oxygen from 40-50% Priority Nursing Interventio ns Advantage s Disadvantages Venturi Mask Requires careful mointoring to verify of 4 to 15 F1O2 at L/min. flow rate ordered Check that air intake valves are not blocked Delivers most precise oxygen concentrati on Doesn’t dry mucous membrane s (humidity uncomfortable Risk for skin irritation produce respiratory depression in COPD patient with high oxygen concentration 50% .

 Comfortable .TRACHEOSTOMY COLLAR/ MASK  Inserted directed into trachea  Is indicated for chronic o2 therapy need  O2 flow rate 8 to 10L  Provides accurate FIO2  Provides good humidity.more efficient  Less expensive .

T-PIECE  Used on end of ET tube when weaning from ventilator  Provides accurate FIO2  Provides good humidity .

SIDE EFFECT & COMPLICATION OF OXYGEN THERAPY  Oxygen toxicity  Retrolental fibroplasia  Absorption atelectasis .

 Oxygen concentration greater than 50% over 24 to 48 hours can cause pathological changes in the lungs. .OXYGEN TOXICITY It is a condition in which ventilator failure  occurs due to inspiration of a high concentration of oxygen for aprolonged period of time.

Signs and symptoms of oxygen toxicity: • Non-productive cough. . Inspiration pain. . • Headache. Dyspnea. . • Nausea and vomiting. • Hypoventilation. • Fatigue. . • Nasal stuffiness. • Sore throat. Nasal congestion. • Substernal chest pain.

SIDE EFFECT & COMPLICATION OF OXYGEN THERAPY  Retrolental fibroplasia Blindness due to vasoconstriction & ischemia ( premature infants ) .

SIDE EFFECT & COMPLICATION OF OXYGEN THERAPY  Absorption atelectasis  100 % FLO2 breathing associated with decrease ventilation ( obstruction )  Hypoventilation ( increase 30 /M ) Effect ( lung collapse ) .

Rational provide a baseline data for future assessment Oxygen maybe depress the hypoxia drive ( decrease respiratory rate .Technique of oxygen administration A-Administering oxygen by nasal cannula: Steps •Assessment:      Check the physician order. Assesses physical condition Assess vital signs . especially the ABG analyses. Assess level of consciousness Assess the laboratory results. alliterate mental states  Assess risk of CO2retention with oxygen administration *If Paco2 is decrease or normal ( PT not expression CO2 retention & can use oxygen without fear .

ASSESSMENT  . Identify the type of oxygen equipment and oxygen source in your facility .

*Planning: Wash hands. Simple face mask The partial rebreather mask The non rebreather mask The venturi mask . Prepare equipment Oxygen therapy plastic nasal cannula connection tube.Steps Rational To prevent infection.

Steps Humidifier filled with distilled water . Flow meter No smoking signs Rational Humidification maybe not be ordered if the flow rate is <4 /l/min .

Explain procedure to the patient. To gain his cooperation. Rational To be sure you are performing the procedure for the correct patient. Attach the oxygen supply To prevent dehydration of tube with humidification to mucous membrane. Assist the patient to a semi. face mask.Steps *Implementation: Identify the patient. .This position permits fowler's position if possible. the cannula . easier chest expansion and hence easier breathing.

Rational Low flow 1 L\min=24% 2 L\min=28% 3 L\min=32% 4 L\min=36% 5 L\min=40% 6 L\min=44% Place the prongs in the patient's nostrils and adjust it comfortably. . To facilitate oxygen administration and comfort the patient. To reduce irritation and pressure and protect the skin. Use gauze pads both behind the head or the ears and under the chin and tighten to comfort.Steps Allow 3-5 L oxygen to flow through the tubing.

Steps Adjust the flow rate to the ordered level. irritation . Assess the patient nose and Oxygen dries the mucous mouth and provide oronasal care membrane and cause at least every 8 hours.. Rational To provide optimal delivery of oxygen to patient. Encourage patient to breath through his nose with his mouth closed.

Steps Rational Ensure pt receive flow sufficient to meet aspiratory demand & maintain accurate concentration oxygen face mask Produce the flow rate ( 10 12 l/min ) Attach the oxygen supply tube to the mask . shaping the metal band on the mask to the bridge of the nose. . Position the mask over the patient's nose and mouth. Regulate the oxygen flow. And fit it securely.

To reduce irritation and pressure and protect the skin. Adjust the flow rate to the ordered level. Rational To ensure a tight fit. .Steps  Adjust the elastic band around the patient's head and tighten. Use gauze pads both behind the head or the ears.

is running continuously. . Wash your hands.  Don't powder around the mask.Steps Rational Remove the mask There is danger of and dry the skin every inhaling powder if it is 2-3 hours if the oxygen placed on the mask.

Steps The partial rebreather mask The non rebreather mask The venturi mask Attach tubing to flow meter  Show the mask to pt & explain procedure  Turn on oxygen flowmeter & prescribed rate ( usually indicated on mask )  Place mask over pt nose & mouth under chin Rational to ensure correct air / oxygen mix .

 No confusion. . difficulty with cognition. lips. disorientation.  pink color in nail beds. conjunctiva of eyes.EVALUATION:  Breathing pattern regular and at normal rate.  Arterial oxygen concentration or hemoglobin  Oxygen saturation within normal limits.

DOCUMENTATION: Date and time oxygen started. Add oronasal care to the nursing care plan . Oxygen concentration and flow rate. Patient observation. Method of delivery.

EQUIPMENT FLOW FIO2 SPECIAL NOTES 12 -15 L/M 1. VT. INSPIRATORY FLOW RATES. USE AT 12 L/M MIN.0 ANESTHESIA BAG *** SHOWS THAT FIO2 VARIES WITH DIFFERENT F. POTENTIAL OF BAROTRAUMA OR ASPHYXIATION .O2 DELIVERY DEVICES CONT.

.35 .60 -80*** SPECIAL NOTES 6 L/M MAX. INSPIRATORY FLOW RATES. 70 1.35. . 26. .55*** .28. USE 5 L/M MINIMUM PAGE RT IF USED (BAG TO NOT COLLAPSE) READ ENCLOSED INSTRUCTIONS MIST MUST BE VISIBLE USE AT 12 L/M MIN.40. 31.44*** .0*** 1. .24.50 . POTENTIAL OF BAROTRAUMA OR ASPHYXIATION VENTI MASK NEBULIZER 3 L/M 6 L/M 8 L/M OR > .50.10 L/M 10-15 L/M FIO2 .35 .0 12 -15 L/M ANESTHESIA BAG *** SHOWS THAT FIO2 VARIES WITH DIFFERENT F.40.24 . VT. . . .O2 DELIVERY DEVICES CONT.6 L/M 6 .30. EQUIPMENT NASAL CANNULA SIMPLE O2 MASK (WITHOUT BAG) RESERVOIR MASK (MASK WITH BAG) FLOW 1/2 .