Prepared By:

EMILY G. GUNDAYAO, RNADELFA ANGELITA DE

LEON, RN

ADMINISTERING OXYGEN THERAPY

Administering Oxygen TherapyOUTLINE:

Aim and objective of Oxygen Therapy Human Respiration Pathophysiology Definition Benefits of Oxygen Therapy Indications and contraindications Safety Precaution Methods of Administration for adults and Pedia Potential complications while administering Oxygen Nursing care

AIM AND OBJECTIVES OF OXYGEN THERAPY

AIM To ensure that patients

in need of oxygen therapy are provided the correct measures for treatment and comfort

OBJECTIVES To give clear guidance on the clinical indications for the use of oxygen therapy in pallative care setting To list the equipments needed for each method of administration.

HUMAN RESPIRATION

Is an odorless, tasteless, colorless, transparent gas that is slightly heavier than air. Oxygen is essential for cell metabolism, and in return, tissue oxygenation is essential for all normal physiological functions.

OXYGEN THERAPYis the administration of oxygen as a medical

intervention, which can be for a variety of purposes in both chronic and acute patient care.

it is used to treat or prevent symptoms of hypoxia and or hypoxemia.

BENIFITS OF OXYGEN THERAPY

Widely used in emergency medicine, both in hospital and by emergency medical services or advanced first aiders.

Indications: For cardio pulmonary emergencies with shortness of breath and chest pain, cardiac or respiratory arrest. For severe trauma

OXYGEN

OXYGEN THERAPY CONTRA INDICATION

Oxygen treatment is contraindicated in all patients with unfavourable ventilation response to oxygen treatment. In case of non-effective O2 treatment, mechanical ventilation must be turned to as well as in all cases with patients in respiratory coma.

OXYGEN THERAPY (A patient has a higher risk of complications but might still be able to receive treatment.

Asthma – It could result in a pneumothorax.High Fever –It could lower the threshold for

seizures; temperature should be lowered before attempting therapy

Optic Neuritis – Rare cases of worsening vision and blindness have occurred

Pregnancy –It is unknown if any stress is caused to the fetus.

Emphysema:

It is a type of COPD involving damage of the air sacs (alveoli) with carbon dioxide retention.

With high levels of CO2 in their bodies so become immune to it and respiration is triggered by low levels of oxygen

Therefore if you give a high concentration of oxygen, you are removing their trigger to breath.

Leading to respiratory depression or even arrest (stop breathing completely) known as hypoxic drive.

Effect of oxygen on COPD is to cause increased carbon dioxide retention, which may cause drowsiness, headaches, and in severe cases lack of respiration, which may lead to death

COPD versus healthy lungManagement of COPD

to assess and monitor the disease, reduce the risk factors, manage stable COPD, prevent and treat acute exacerbations and manage comorbidity.

The only measures that have been shown to reduce mortality is smoking cessation and supplemental oxygen.

Hyperventilation/Overbreathing Increase of air in the lungs above the normal amount

Abnormally prolonged and deep breathing, usually associated with acute anxiety or emotional tension

This results in reducing the carbon dioxide (CO2) level of the body that provides the necessary stimulus for breathing. It can cause dizziness and may even lead to unconsciousness.

Immediate TreatmentBreathing into a paper bag is not

recommended (CO2 levels in the blood will rise too much)Relaxation techniques (Standard treatment) Breathing slowly and purposefully = by

breathing through only one nostril (by holding the other nostril closed with

the fingers) then focus on breathing as well as reduce the amount of air entering the lungs.

Oxygen Therapy Safety Precautions:

Place cautionary signs reading “No Smoking: Oxygen in use” on the clients door.

Make sure that electric devices (such as razors, hearing aids, radios, televisions, and hearing pads) are in good working order to prevent the occurrence of short-circuit sparks.

Oxygen Therapy Safety Precautions: Con’t.

Avoid the use of flammable materials such as oils, greases, alcohol, ether, and acetone(e.g. nail polish remover), near clients receiving oxygen.

Make known the location of the fire extinguishers, and make sure personnel are trained in their use.

I. Nasal Cannula:

METHODS OF OXYGEN ADMINISTRATION

FOR ADULTS

Is a tube that has two prongs to go in the nose passages (nostrils)

Nasal prongs delivers low flow of oxygen concentration of 25% to 33% at 1-3 L/min.

Oxygen source Plastic nasal cannula with

connecting tubing (disposable)Humidifier filled with sterile

waterFlowmeterNo smoking sign

EQUIPMENTS:

1. Show the nasal prong to the patient and explain the procedure.

2. Make sure the humidifier is filled to the 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.

5. Place the tip of nasal prong in the patient’s nose and adjust the strap.

PROCEDURE:

Nasal cannula- is low flow system, oxygen concentration will vary, depending on the patient’s respiratory rate and tidal volume. Approximate concentrations delivered are:

1L= 24%-25% 3L= 30%-33%

2L= 27%-29%

Room Air = 21% + 4 % in each L/min of O2 concentration

Example: 21% + 4% (1L) = 25%

21% + 8% (2L) = 29%

21% + 12% (3L)= 33%

mask that delivers moderate oxygen flow to nose and mouth.

Delivers oxygen concentrations of 40%-60% at 4L-6L/min.

FACE MASK

EQUIPMENTS:

Oxygen sourceHumidifier bottle with

distilled waterSimple 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

III. Non Rebreathing Mask

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.

PARTIAL REBREATHER MASK has an inflatable bag that

stores 100 % oxygena) 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.

TYPES OF FACE MASK

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 flowmeter3. Set and adjust the flowmeter to 6- 10 L/min 4. Place mask on patients face and adjust the

straps5. Stay with the patient to make the patients

comfortable and observe reactions6. Remove mask periodically

V. Venturi Mask

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.

VENTURI MASK type of disposable mask used to deliver a controlled oxygen concentration to a patient. The flow of 100% oxygen through the venturi draws in a controlled amount of room air (21% oxygen).

Commonly available masks deliver 24, 28, 31, 35 or 40% oxygen.

PROCEDURE: For Venturi mask1. 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

Delivers high concentration of oxygen to patient with insufficient inspiratory effort.

Delivers O2 concentration

of 15L/min at 100% with reservoir.

VI. Bag-Valve Mask (Ambu-bag)

Equipment/Supplies Hand held Ambu bag. Cuffed face maskOxygen source, Oxygen tubing. Gloves

VI. Bag-Valve Mask (Ambu-bag)

Purpose : Manually ventilate

client when off ventilator and unable to breath independently.

Promote oxygenation until able to breathe independently.

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.

Is used to administer oxygen to patient

with ET or tracheostomy tube who is breathing spontaneously.

A device for connecting two inputs to one output or vice versa

VII. T- PIECE ( BRIGGS) adapter

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

3. Attach the large bore tubing from the T-tube to the humidifier outlet.

4. Adjust the flow rate as ordered

5. Drain the tubing frequently by emptying condensate into a separate receptacle, not into the humidifier

Is a method of respiratory ventilation used primarily in the treatment of sleep apnea

Commonly used for critically ill patient with Respiratory Failure, CHF and COPD who are admitted in ICU, CCU or other specialized respiratory unit

VIII. CONTINOUS POSITIVE AIRWAY PRESSURE (CPAP)

1. Show the mask to the patient and explain the procedure.

2. Insert NG tube if ordered3. Attach NG tube adapter4. 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 possible

PROCEDURE: For CPAP

Accomplished by way of a small (8 French) catheter inserted between the second and third tracheal cartilage

Oxygen delivery is more efficient because all oxygen enters the lungs.

Delivers oxygen concentrations of 60% - 100% at 4L-6L/min.

IX. Transtracheal Catheter

Administering Oxygen By Transtracheal Catheter

OXYGEN THERAPY FOR CHILDREN AND INFANTS

Children with respiratory problems may receive oxygen therapy via nasal cannula, face mask, face tent, oxygen hood and Closed Incubator may also be used for infants and young children.

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).

Pediatric Assessment and Management

INITIAL ASSESSMENT

Begins before you touch the patient

Form a general impression.

Determine a chief complaint.

The Pediatric Assessment Triangle can help.

Pediatric Assessment TriangleAppearance

AwakeAwareUpright

Work of breathingRetractionsNoises

Skin circulation

General Principles Regarding Oxygen Delivery

The choice of system will depend upon the clinical status of the patient and the desired dose of oxygen

Oxygen should be humidified, whenever possible, to prevent dried secretions from obstructing smaller airways.

The effectiveness of oxygen delivery should be monitored with pulse oximetry.

Young children in respiratory distress may become frightened or agitated when oxygen is administered, causing their clinical conditions to deteriorate. Therefore, they should remain in a position of comfort whenever possible

HOW IS OXYGEN DELIVERED? NASAL CANNULA A thin, soft, plastic tube

and has soft prongs that gently fit into your baby’s nose.

Oxygen flows through the tube. The baby must be able to breathe without assistance in order to use this type of oxygen therapy.

OXYGEN BY MASK Choose an appropriate size of mask

that covers the mouth and nose of the patient.

Rationale: Extra space under the mask and around face may decrease effectiveness of the therapy.

Do not use the mask for comatose infants or children

Rationale: Such children are most likely to vomit. The risk of aspiration may be increased with mask therapy because of obstruction of the flow of vomitus.

HOW IS OXYGEN DELIVERED? - is used for babies

who can breathe on their own but still need extra oxygen.

- A hood is a plastic dome or box with warm, moist oxygen inside. The hood is placed over the baby's head.

OXYGEN HOOD

OXYGEN HOOD Continously monitor the oxygen concentration, temperature, and humidity inside the hood.

Rationale: Oxygen should be warmed to prevent a neonatal response to cold stress, including oxygen deprivation and reduction of blood glucose levels.

OXYGEN THERAPY FOR CHILDREN

FACE TENT are available in adult size

only a flow of 8- 10 L/min

should be used to flush the system and provide a stable oxygen concentration

Face TentIt 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.

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

1. 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.

PROCEDURE : O2 Therapy for Children

POST PROCEDURE  Monitor the effect of therapy with pulse

oximetry and/or blood gas analysis.   Assess the patient for tolerance and

appropriateness of therapy  All “continuous” and “prn” oxygen therapy must

be verified for proper set up and function.

Change equipment as specified in the SFH Changing of Equipment Policy.   

POTENTIAL COMPLICATIONSImpairment of respiratory drive in people with

COPD(those who retain carbon dioxide)Discomfort secondary to drying of mucous

membranesEye irritationMask can act as barrier against feeding and

communicationCreation 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 equipment.

NURSING CARE Ensure the mask and elastic are not causing pressure marks,

especially on the nose or behind the ears. If using nasal prong, inspect inside of the nose daily for evidence of pressure on the mucosa.

If the patient is able to transfer to and from the bed to the chair/commode check that the oxygen tubing is long enough.

Offer advice and help with the use of nasal prong for eating or drinking.

THANK YOU!!!