Oxygen TherapyFundamentals of

nursingInstructor: R. Hanock

Reading assignment: Fundamentals textbook (Burton)pages: 614-627, 636-638 (skills 28-3, 28-4 & 28-5)

Objectives: O2 Therapy

• At the completion of this unit: The student will be able to: 1)Describe nursing interventions & routines that facilitate

safe oxygen administration2)Describe the various equipment items & methods of O2

delivery utilized to facilitate improved oxygenation. 3)State the S&S and underlying factors related to COPD,

hypoxemia, & oxygen toxicity.4)Explain assessment and documentation principles relating

to the care of patients receiving O2 therapy.

Anatomy Overview

Upper airway: nose, mouth, pharynx, & upper trachea

LungsLeft lung - two lobesRight lung - three lobes

> bronchi divide into bronchioles> bronchioles terminate at the alveoli

Oxygen TherapyOxygen is a medication and requires a physician

order. Apply the 5 rights to medication administration

Facilities often have protocols in place of MD orders. (I.e.: weaning protocols)

Nursing responsibility: Always ensure that O2 is set to the prescribed rate.

The universal color for O2 receptacles & equipment is _______________________

Oxygen Administration

•Supplement oxygen in inspired air•Delivered by nasal cannula, mask, tent, croupette, or catheter•Requires humidification, flow rate prescribed by

physician

Ambu-Bag used for resuscitationProvides ventilation in emergency

situations

Oxygen Administration

•Flow rates: 1-6 L/minute

1 L/min = 24%, 3L/min = 32%, 6L/min=44%

•PTs with COPD given only 1-2 L/minute to prevent respiratory depression

Position Lung Expansion Increasedsurface area for gas exchange

Improved gas exchange (ventilation)

Artificial Airways

•Nasopharyngeal (P.626, FIG 28-5)•Oropharyngeal •Endotracheal tubes (p.626 FIG 28-5)•Tracheostomy (P.627 FIG •28-8)

Pulse oximetry

* Measuring oxygen saturation of hemoglobin

•Monitors PTs at risk for hypoxemia•Physicians order or nurses discretion•http://www.youtube.com/watch?v=Cj_M-vWGbWQ

Pulse Oximetry Devices:measure the O2 saturationlevels of arterial blood by use of light waves. (skill 17-8, p. 371)

Airway ObstructionAirway Obstruction

•Common causes of airway obstructions

1)Choking: airway occlusion

2)Disease processes (commonly neurological deficits)

3)Respiratory secretions

Aspiration precautions

• Keep upright during and after meals• Avoid thin liquids• Crush medications

or use liquid forms• Keep suction set up

at bed side

• Place food in unaffected side of mouth (CVA clients) • Tuck chin to chest

when swallowing

Nubulizer Treatments

•Hand held nebulizer•Nebulizer is a medication delivery system: air compressor, medication cup, mask or hand-held mouth piece•Vapor (mist) is inhaled into airways direct affects less systemic affects•Review p.636, skill 28-4

Metered-Dose Inhaler/Multi-Dose Inhaler (MDI)

May be used with or without a spacer, requires assessment Measured doses of medicationDeliver dose during deep inhalationMedications dispersed in mistCompliance problems: complex task for some

Incentive spirometer

Teaching your patient about incentive spirometry

p.620: Patient Teaching Connection

Incentive Spirometer: Components

Piston Type Sphere Type

Nursing Instruction: Lift the spheres or piston as high as you can and hold them up for as long as you can with the deepest and longest inhalation that you are capable of. Perform 10 deep breathes every hour while you are awake and are not fatigued.

Equipment: Delivery Systems

Ps 623-625, table 28-4Nasal cannulaMasks• Simple face mask• Partial rebreather• Nonrebreather• Venturi mask• Face tent

Nasal Cannula: Low O2 Flow Delivery

Simple Face Mask: Delivers 40 to 60% O2 concentrations

Partial-Rebreather and Non-Rebreather MasksDifference is with the ports & valves

Reservoir bagPartial rebreather: CO2 is Exhaled into reservoir bag and Side ports (valves/vents) close during Exhalation CO2 is then Inhaled.

Non-rebreather: the Reservoir valves close and sideVents open during exhalation. CO2 is not available during Inhalation.

Venti-Mask: Delivers 24-80% O2Dial to change O2 concentration delivery

Tracheostomy with direct attachmentCollars are frequently used

Tracheostomy shortensThe airway less workTo breathe and Expectorate secretions

Direct attachment usedWhen on ventilator.

T-Piece Attached to Tracheostomy

Oxygen & Humidity Tents

- For infants & young children• Cool saturated air to keep respiratory tract well hydrated•Used for croup, pneumonia, or other upper respiratory diseases

Face TentDoes not deliver precise O2 concentrations

Patient Care Concerns•Psychological

•Safety •Fire Hazards•Pressure Hazards•Malfunctioning Equipment

Equipment

•Flow meter•Regulator•Pressure gauge•Humidifier•Sterile water

Pin index safety system

Most small O2 transport cylinders utilize the pin system to ensure proper placement of the O2 regulator.

Oxygen Regulators

•Bourdon Gauge Brass Steel Aluminum

Oxygen Regulators

•Grab n GO Brass

Tank Construction Steel Aluminum

Humidification of Oxygen

•Moderate & high levels of O2 are drying and irritating to the mucous membranes of the airways. •A humidification device must be

attached to the flow meter to humidify O2.

Oxygen Cylinder Storage

Storage:• Stationary Holders

Transport:• Rolling Stands• Bed stands

All cylinders must be stored securely!All cylinders must be stored securely!

Magnetic Fields

• Steel Cylinders and regulators may become projectiles when near a strong magnetic field.

Exercise extreme caution when near a Magnetic field

DOs and DON'Ts with Oxygen Equipment

• Don't allow smoking around oxygen. • Do maintain oxygen equipment as

the supplier & JCAHO instruct. Work closely with the respiratory therapy department. • Don't use equipment which is visibly

dirty, in poor repair, or damaged. • Do use plugs, caps and plastic bags

to protect "off duty" equipment from dust and dirt.

Oxygen Therapy Safety Precautions•Oxygen tanks contain oxygen under pressure•Oxygen supports combustion

Potential Physiological Problems

> Loss of stimulus to breath for those with Chronic Obstructive Pulmonary Disease (COPD)

1 – 2 L/Minute only > Oxygen is drying to

respiratory membranes> Lung tissue damage occurs

from continued use of high concentrations of O2.

Hypoxemia

• Impaired gas exchange•Resp. Insufficiency: ↓ oxygen level in blood caused by resp system abnormalities•Results in inability to meet cellular oxygen needs (hypoxia) &/or inability to remove excess carbon dioxide (hypercapnia).

Hypoxemia

•Onset can be rapid or gradual while early signs are without difficulty breathing i.e.: dyspnea, labored respirations, SOB

•Health threat: prolonged hypoxemia & hypercapnia starves tissues of O2 & causes acidosis tissue necrosis tissue death

Early S&S of HYPOXEMIA

1. Confusion, restlessness, irritability, anxiety

2.Confusion – change in mental status - (The first sign, occurs before other symptoms)

3.Tachypnea (rapid breathing) will become labored if prolonged (compensatory mechanism)

4. SOB: moving to later stage, becoming too fatigued to continue compensating.

Later S&S HYPOXEMIA

5. Cyanosis6. Retractions – inward muscle movement of intercostal spaces; neck & abdomen muscle involvement7. Acid-base balance disturbance8. ↓ oxygen saturation

Oxygen Toxicity

•O2 Toxicity may develop when O2 concentrations of > 50% are administered for > than 48 to 72 hrs. •Prolonged use of high O2 concentrations

reduces surfactant production & causes lung tissue damage

a) alveolar collapse b) reduced lung elasticity • Early sign of O2 toxicity = dry cough

Procedures for O2 admin

•Assessment, Check physician orders, & consult with respiratory therapy• - Resp assessment: rate, depth, sat, lung sounds, subjective data•Auscultate - compare areas, side to side

•Planning• Implementation•Evaluation

Documentation

•Data from respiratory assessment•Oxygen flow rate & method of delivery• Amount prn oxygen used• Time & location of blood gas sampling• Location of oximetry probe & range of saturation•Description of sputum expectorated• Coughing and deep breathing exercises• Time & evaluation of respiratory treatments

Documentation• Date/TimeNursing DX: Impaired gas exchange: Dyspnea on

exertion• S: “Walking makes me short of breath”.• O: Respirations 34 & shallow after 30 min rest

period. (continue with data collection)• A: Dyspnea unrelieved by rest.• P: Administer O2 3L/min via nasal cannula per

protocol. Dr. Wilson notified. Reassess in 30 min.

Documentation: Narrative

•Date/Time•Complained of mild dyspnea on ambulation. Respirations 34 & shallow after 30 min rest. O2 at 3L/min. started via nasal cannula per standing order. (include all data from resp assessment) Dr. Wilson notified.

Nancy Nurse LPN

Closure: O2 Administration

Critical Thinking: why did I make the background of this presentation green?

1)Review questions: chap. 28, p. 645-6 questions 1-6. 2) Video activity3) Lab activity review4) Review activities work-sheet