Oxygen therapy

OUT LINE

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

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

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.

WHAT IS MEANING OF O2 THERAPY

If not enough oxygen is circulating in the blood, it’s difficult for the tissues of the heart to keep pumping.

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.

If this process is inadequate, oxygen levels in the blood decrease, and the patient may need supplemental oxygen.

PURPOSE

Oxygen therapy is a key treatment in respiratory care.

The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury.

OXYGEN THERAPY IS USED TO TREATExample in case :- Documented hypoxemia Severe respiratory distress (acute asthma or pneumonia)

Severe trauma Chronic obstructive pulmonary disease (COPD, including chronic bronchitis, emphysema, and chronic asthma)

OXYGEN THERAPY IS USED TO TREAT

Pulmonary hypertension Acute myocardial infarction (heart attack)

Short-term therapy, such as post-anesthesia recovery

Oxygen may also be used to treat chronic lung disease patients during exercise .

METHODS OF DISPENSING OXYGEN

Piped inCylinderOxygen concentrator

SOURCES OF OXYGEN:

1- Cylinder. 2- Wall outlets.

Oxygen is moistened by passing it through a humidification system to prevent the mucous membranes of the respiratory tree from becoming dry.

1- USING OXYGEN CYLINDERS:

The oxygen cylinder is delivered with a protective cap to prevent accidental

force against the cylinder outlet.

To release oxygen safety and at a desirable rate, a regulator is used. It consists of two parts.

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.

USING OXYGEN CYLINDERS:

2 -WALL – OUTLET OXYGEN:

The oxygen is supplied from a central source through a pipeline.

Only a flow meter and a humidifier are required.

PREPARATION

A physician's order is required for oxygen therapy, except in emergency use.

Clinical observations. Oxygen supplemental is determined by inadequate oxygen saturation.

indicated in Artial Blood Gas measurements,(ABGs ) .

Pulse Oximetry.

CAUTIONS FOR OXYGEN THERAPY

Oxygen toxicity – can occur with FIO2 > 50% longer than 48 hrs

Suppression of ventilation – will lead to increased CO2 and carbon dioxide narcosis

Danger of fireInfection

CLASSIFICATION OF OXYGEN DELIVERY SYSTEMS

Low flow systems contribute partially to inspired gas

client breathesdo not provide constant FIO2Ex: nasal cannula, simple mask , non-re

breather mask , Partial rebreather mask High flow systems

deliver specific and constant percent of oxygen independent of client’s breathing

Ex: Venturi mask,, trach collar, T-piece

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

AdvantagesDisadvantages

Nasal CannulaLow flow

24-44%

1 L\min=24%

2 L\min=28%

3 L\min=32%

4 L\min=36%

5 L\min=40%

6 L\min=44%

Check frequently that both prongs are in clients nares

Never deliver more than 2-3 L\min to client with chronic lung disease

Client able to talk and eat with oxygen in place

Easily used in home setting

may cause irritation to the nasal and pharyngeal mucosa if oxygen flow rates are above 6 liters/minute Variable FIO2

FACE MASKThe simple Oxygen maskThe partial rebreather mask:The non rebreather mask:The venturi mask:

THE SIMPLE OXYGEN MASK Simple mask is made

of clear, flexible , plastic or rubber that can be molded to fit the face.

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.

THE SIMPLE OXYGEN MASK

It delivers 35% to 60% oxygen .A flow rate of 6 to 10 liters per

minute. It has vents on its sides which allow

room air to leak in at many places, thereby diluting the source oxygen.

Often it is used when an increased delivery of oxygen is needed for short periods

(i.e., less than 12 hours).

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

THE NON REBREATHER MASK When the patient

exhales air. the one-way valve

closes and all of the expired air is deposited into the

atmosphere, not the reservoir bag.

In this way, the patient is not rebreathing any of the expired gas.

VENTURI MASK It is high flow concentration of oxygen.

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

THE VENTURI MASK is designed with wide- bore tubing and

various color - coded jet adapters. Each color code corresponds to a precise oxygen concentration and a specific liter

flow.

The venturi system, 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 MASKThe narrower the jet adapter, the greater the air dilution, and the

lower the concentration of oxygen.

It is used primarily for patients with chronic obstructive pulmonary disease

TRACHEOSTOMY COLLAR/ MASK

Inserted directed into trachea Is indicated for chronic o2 therapy need O2 flow rate 8 to 10LProvides accurate FIO2Provides good humidity.Comfortable ,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 toxicityRetrolental fibroplasia Absorption atelectasis

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.

Oxygen concentration greater than 50% over 24 to 48 hours can cause pathological changes in the lungs.

Signs and symptoms of oxygen toxicity: •Non-productive cough .

•Nausea and vomiting. •Substernal chest pain.

•Fatigue. •Nasal stuffiness.

•Headache. •Sore throat.

•Hypoventilation. .Nasal congestion.

.Dyspnea.. Inspiration 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 )

Technique of oxygen administrationA-Administering oxygen by nasal cannula:

ASSESSMENT

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

StepsRational

Humidifier filled with distilled water .Flow meter No smoking signs

Humidification maybe not be ordered if the flow rate is <4 /l/min

StepsRational*Implementation:

Identify the patient.

Explain procedure to the patient.Assist the patient to a semi-fowler's position if possible.

Attach the oxygen supply tube with humidification to the cannula , face mask.

To be sure you are performing the procedure for the correct patient.To gain his cooperation.

This position permits easier chest expansion and hence easier breathing.To prevent dehydration of mucous membrane.

StepsRationalAllow 3-5 L oxygen to flow through the tubing.

Place the prongs in the patient's nostrils and adjust it comfortably.

Use gauze pads both behind the head or the ears and under the chin and tighten to comfort.

Low flow1 L\min=24%

2 L\min=28%

3 L\min=32%

4 L\min=36%

5 L\min=40%

6 L\min=44%

To facilitate oxygen administration and comfort the patient.

To reduce irritation and pressure and protect the skin.

StepsRationalAdjust the flow rate to the ordered level.

Encourage patient to breath through his nose with his mouth closed.

Assess the patient nose and mouth and provide oronasal care at least every 8 hours.

To provide optimal delivery of oxygen to patient..

Oxygen dries the mucous membrane and cause irritation

StepsRationalface mask

Produce the flow rate ( 10 -12 l/min ) Attach the oxygen supply tube to the mask .Regulate the oxygen flow.Position the mask over the patient's nose and mouth. And fit it securely, shaping the metal band on the mask to the bridge of the nose.

Ensure pt receive flow sufficient to meet aspiratory demand & maintain accurate concentration oxygen

StepsRational Adjust the elastic band around the patient's head and tighten.

Use gauze pads both behind the head or the ears. Adjust the flow rate to the ordered level.

To ensure a tight fit.

To reduce irritation and pressure and protect the skin.

StepsRational

Remove the mask and dry the skin every 2-3 hours if the oxygen is running continuously. Don't powder around the mask.

Wash your hands.

There is danger of inhaling powder if it is placed on the mask.

StepsRationalThe partial rebreather maskThe non rebreather maskThe venturi maskAttach 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

to ensure correct air / oxygen mix

EVALUATION:Breathing pattern regular and at normal rate.

pink color in nail beds, lips, conjunctiva of eyes.

No confusion, disorientation, difficulty with cognition.

Arterial oxygen concentration or hemoglobin

Oxygen saturation within normal limits.

DOCUMENTATION:

Date and time oxygen started.Method of delivery.Oxygen concentration and flow rate.

Patient observation.Add oronasal care to the nursing care plan

O2 DELIVERY DEVICES CONT.

EQUIPMENT FLOW FIO2 SPECIAL NOTES

ANESTHESIA BAG

12 -15 L/M 1.0 USE AT 12 L/M MIN. POTENTIAL OF BAROTRAUMA OR ASPHYXIATION*** SHOWS THAT FIO2 VARIES WITH DIFFERENT

F, VT, INSPIRATORY FLOW RATES.

O2 DELIVERY DEVICES CONT.

EQUIPMENT FLOW FIO2 SPECIAL NOTES

NASAL CANNULA 1/2 - 6 L/M .24 - 44*** 6 L/M MAX.

SIMPLE O2 MASK 6 - 10 L/M .35 - 55*** USE 5 L/M (WITHOUT BAG) MINIMUM

RESERVOIR MASK 10-15 L/M .60 -80*** PAGE RT IF USED (MASK WITH BAG) (BAG TO NOT COLLAPSE)VENTI MASK 3 L/M .24, 26, 31, READ ENCLOSED 6 L/M .35, .40, .50 INSTRUCTIONS

NEBULIZER 8 L/M OR > .28, .30, .35 MIST MUST BE .40, .50, 70 VISIBLE 1.0***ANESTHESIA BAG

12 -15 L/M 1.0 USE AT 12 L/M MIN. POTENTIAL OF BAROTRAUMA OR ASPHYXIATION*** SHOWS THAT FIO2 VARIES WITH DIFFERENT

F, VT, INSPIRATORY FLOW RATES.