About Oxygen Therapy

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					Oxygen therapy is the administration of oxygen as a therapeutic modality. Oxygen therapy
benefits the patient by increasing the supply of oxygen to the lungs and thereby increasing the
availability of oxygen to the body tissues.

Appropriate levels of oxygen are vital to support cell respiration. High blood and tissue levels of
oxygen can be helpful or damaging, depending on circumstances. Hyperbaric oxygen therapy is
the use of high levels of oxygen for treatment of specific diseases. High levels of oxygen given
to infants causes blindness by promoting overgrowth of new blood vessels in the eye
obstructing sight. This is Retinopathy of prematurity (ROP). Administration of high levels of
oxygen in patients with severe emphysema and high blood carbon dioxide reduces respiratory
drive, which can precipitate respiratory failure and death.

Oxygen first aid specifically refers to the use of oxygen in a first aid setting. Oxygen will assist
patients with myocardial infarction and hypoxia (low blood oxygen levels). Care needs to be
exercised in patients with chronic obstructive pulmonary disease, especially in those known to
retain carbon dioxide (type II respiratory failure) who lose their respiratory drive and accumulate
carbon dioxide if administered oxygen in moderate concentration. For this reason, some
jurisdictions require medical approval for all emergency oxygen administration.

Related devices

   1. A pressure regulator is used to control the high pressure of oxygen delivered from a
      cylinder to a low pressure controllable by the flowmeter.
   2. A flowmeter is used to control and indicate the flow of oxygen. Typiclal flow range is 0-
      15 lpm.
   3. A nebulizer can be used deliver nebulizable drugs such as albuterol or epinephrine into
      the airways by creating a vapor-mist from the liquid form of the drug. Nebulizers are also
      commonly used with room air in the home with an electric air pump.




Supplying Oxygen Therapy

Oxygen is a medication and requires a physician’s order for dosage and route. Often agencies
have protocols with standing orders for oxygen administration in an emergency. Oxygen is
supplied in several different ways:

      Wall outlets connected to a large central tank of oxygen are usually provided in healthcare
       facilities.
   Liquid Oxygen Units are often used for home oxygen therapy. Liquid oxygen is contained in
    thermally insulating tanks. The liquid has to boil changing into a gas for breathing. Large tanks
    are used by hospitals. Small tanks can be used domestically. Liquid oxygen tanks are refilled by
    liquid oxygen suppliers.




   Compressed O2 in portable tanks may also be available. Cylinders contain compressed gaseous
    oxygen. Small cylinders are used for first aid and for home oxygen patients when mobility is
    required. Cylinders are refilled by a gas supplier.




   Oxygen Concentrator removes nitrogen from room air and concentrates O2. It requires a battery
    pack or electrical outlet for power. Oxygen concentrations can deliver flow up to 4 liters per
    minute (L/min) to create an FIO2 of approximately 36 %. Concentrations are higher at lower flow
    rates (e.g. an FIO2 of 95 % at 1 L/min). These devices eliminate the need for buying oxygen
    cylinders, relieving client’s anxiety about running out of oxygen. However they are expensive,
    noisy, and not portable; moreover, the client must still have backup oxygen in case of power
    failure. Oxygen concentrators are electrically powered devices which remove nitrogen from air.
    They are most commonly used in a domestic situation, because they do not need refilling.
    However, a number of manufacturers have introduced portable oxygen concentrators. These
    have replaced the need to use liquid or gas cylinders for mobility for many patients. Portable
    Oxygen Concentrators allow patients to freely travel without the need of gas or liquid. The FAA
    has approved portable oxygen concentrators for the use on many commercial airlines. Most
    major airlines allow the three major portable oxygen concentrators; it is necessary to check in
    advance if a particular brand or model is permitted on a particular airline. These can typically use
    AC, DC, or battery power. Some portable concentrators have only pulse or demand flow
    capabilities, while continuous flow portables are available. Pulse or demand flow is similar to the
    way an oxygen conserving device delivers oxygen from liquid oxygen or a gas cylinder only
    during inhalation, but on a concentrator, the oxygen made in between pulses is stored for the next
    pulse. Where a conserving device can make a liquid or gas container last longer, pulse or
    demand settings on oxygen concentrators can make a certain flow appear as a higher effective
    flow, or reduce power consumption and/or extend battery life.
An oxygen flow meter must be connected to the oxygen source to control the flow rate of oxygen from its
source to the patient. Flow meters are set in liters per minute. Various devices are used to deliver oxygen
to a patient. They differ in amount of oxygen they can deliver and the degree to which they enclose the
patient.

Transtracheal Oxygen Delivery
        A tracheostomy is a direct surgical opening into the trachea through the neck. Inhaled air
bypasses upper airway, which normally warms and moistens air before it reaches the lower
airway. Oxygen may be delivered through the tracheostomy via color or an adapter. A
transtracheal catheter is a catheter placed into the tracheostomy to deliver O2 directly into the
trachea. Because oxygen cannot be humidified this device, it is rarely used.




Oxygen Hazards
The following risks are associated with oxygen therapy:
    Oxygen toxicity develops when O2 concentrations of more than 50 % are administered
        for longer than 48 to 72 hours. Prolonged use of high O2 concentration reduces
        surfactant production, which leads to alveolar collapse and reduced lung elasticity.
    Oxygen supports combustion, although it does not burn, high concentrations of oxygen
        will turn a small spark of fire into a large fire. Fire prevention precautions must be used
        near oxygen delivery systems.

Evaluating Adequacy of Oxygenation
          SaO2                   Arterial PO2                                Comment
                                                                   Normal arterial values in
95-100%                          80-100 mmHg
                                                                   healthy people.
                                                                   PO2>60 mmHg is required
                                                                   to sustain life and activity.
90%                              60 mmHg
                                                                   This level is NOT normal in
                                                                   healthy people.
                                                                   Normal venous values; a
75%                              40mmHg                            LETHAL arterial value in
                                                                   ANYONE.



Administering Oxygen by Cannula, Face Mask, or Face Tent
Critical Aspects:
Attach the flow meter to the wall oxygen source.
Assemble and apply the oxygen equipment according to the device prescribed (nasal cannula,
face mask, or face tent)
Turn on the oxygen flow using the flow meter, and adjust it according to the prescribed flow rate.
Make sure that the oxygen equipment is set up correctly and functioning properly before you
leave the patient’s bedside.

Equipment:
    Oxygen Source
    Flow meter
    Nasal Cannula, Oxygen Mask, or Face Tent
    Prefilled humidification device
    Padding

Delegation
You should assess the patient, then initiate oxygen therapy as needed,. You can delegate
reapplication of oxygen therapy to appropriately trained assistive personnel when necessary.

Assessment
Assess the patient’s comprehension of oxygen therapy. Understanding allays anxiety and
promotes cooperation.
Assess the patient’s respiratory status, including respiratory rate, depth and rhythm. Breath
sounds, color and pulse oximetry results. To determine the need for and effectiveness of
oxygen therapy.
Assess nares (if a nasal cannula is being used) and ears for skin breakdown.

Procedural Steps
   1. Attach the flow meter to the wall oxygen source. If you are using a portable oxygen tank,
      attach the flow meter to the tank if it is not already connected. The flow meter regulates
      the amount of oxygen delivered.
   2. Assemble the oxygen equipment. Assembling the oxygen equipment readies the
      equipment for oxygen administration.

   Procedure Variation A
   Nasal Cannula

   3. Attach the humidifier to the flow meter. (Humidification is necessary only for flow rates >
      3 L/min.) If you are not using a humidifier, attach the adaptor to the flow meter.
      Humidification prevents the drying of the nasal membranes.
   4. Attach the nasal cannula to the humidifier or the adapter.
   5. Place the nasal prongs in the patient’s nares and then place the tubing around each ear.
      Properly positioned the device for successful oxygen delivery.
   6. Use the slide adjustment device to tighten the cannula on place under the patient’s chin.
      The nasal cannula must fit securely to ensure accurate oxygen delivery.
   7. Turn on the oxygen using the flow meter and adjust it according to the prescribed flow
      rate. Ensures that the oxygen is delivered at the prescribed rate. Oxygen delivered at an
      incorrect rate can cause patient injury.
   8. Make sure that oxygen equipment is set up correctly and functioning properly before you
      leave the patient’s bedside.
   Procedure Variation B
   Face Mask

   9. Attach the prefilled humidifier to the flow meter. The humidification device must be
       attached to the flow meter to ensure delivery of humidified oxygen, which prevents the
       drying of airways that occurs with high oxygen flow rates.
   10. Attach the oxygen tubing connected to the mask to the humidifier. Prepares the tubing
       for oxygen delivery.
   11. Gently place the facemask on the patient’s face applying from the bridge of the nose to
       under the chin. Fits the mask snugly to the patient’s face preventing oxygen from
       escaping around the edges of the mask.
   12. Secure the elastic band around the back of the patient’s head. Make sure the mask fits
       snugly but comfortably. The mask must fit snugly so that oxygen cannot escape around
       the edges of the mask. The mask must also fit comfortably because a fit that is too tight
       may cause skin breakdown.
   13. Turn on the oxygen using the flow meter and adjust it according to the prescribed flow
       rate. Ensures that oxygen is delivered at the prescribed rate. Oxygen delivered at an
       incorrect rate can cause patient injury.
   14. Make sure that the oxygen equipment is set up correctly and functioning properly before
       you leave the patient’s bedside.

   Procedure Variation C
   Face Tent

   15. Attach the prefilled humidifier to the flow meter. Ensures delivery of humidified oxygen
       which prevents the drying of airways that occurs with high oxygen flow rates.
   16. Attach the oxygen tubing to the face tent. Ensures adequate oxygen delivery.
   17. Attach the oxygen tubing to the humidifier. Prepares the tubing for oxygen delivery.
   18. Gently place the face tent in the front of the patient’s face making sure that it fits under
       the chin. Ensures a proper fit.
   19. Secure the elastic band around the back of the patient’s head. The elastic band must go
       around the back of the patient’s head to keep the face mask in place.
   20. Turn on the oxygen using the flow meter and adjust it according to the prescribed flow
       rate. Ensures that oxygen is delivered at the prescribed rate. Oxygen delivered at an
       incorrect rate can cause patient injury.
   21. Make sure that the oxygen makes sure that the oxygen equipment is set up correctly
       and functioning properly before you leave the patient’s bedside.

Evaluation:
    Auscultate breath sounds every 2 to 4 hours as indicated.
    Monitor pulse oximetry or arterial blood gas results. Evaluate skin areas that come in
      contact with oxygen delivery system for signs of skin breakdown.



Patient Teaching
    Demonstrate oxygen administration to the patient and caregiver. If the patient will be
       continuing oxygen therapy at home.
    Explain the importance of immediately reporting shortness of breath of any difficulty
       breathing.
Home Care
   Explain to the family and caregiver where to obtain oxygen equipment and what services
     are available. Make sure they choose a supplier who has 24 hours emergency services.
   Instruct the patient and caregiver about oxygen therapy and its use as well as safety
     measures that they must institute.
   Teach the patient and caregiver to clean the nasal cannula or face mask with soap and
     warm water when it becomes soiled.
   Provide the patient and caregiver with contact information of health care personnel who
     can be reached for advice and emergencies.
   In the home, liquid oxygen and oxygen concentrator are more commonly used than
     portable oxygen tanks. Liquid oxygen may be kept in small portable containers; an
     oxygen concentrator removes nitrogen from room air and concentrates O 2. it requires a
     battery pack or electrical outlet for power. Oxygen concentrators can deliver flow up to 4
     to 4 L/min to create an FIO2 of approximately 36%.

Oxygen Delivery Systems

Low-Flow Devices: Low-flow systems deliver oxygen at flows that are less than the patient's
inspiratory flowrate (ie, the delivered oxygen is diluted with room air) and, thus, the oxygen concentration
inhaled may be low or high, depending on the specific device and the patient's inspiratory flowrate.

High-Flow Devices: High-flow systems deliver a prescribed gas mixture -- either high or low FDO2 at
flowrates that exceed patient demand.Air-entrainment masks, also known as Venturi masks, can
accurately deliver predetermined oxygen concentration to the trachea up to 40%. Jet-mixing masks rated
at 35% or higher usually however do not deliver flowrates adequate to meet the inspiratory flowrates of
adults in respiratory distress. Aerosol masks, tracheostomy collars, T-tube adapters, and face tents can
be used with high-flow supplemental oxygen systems. A continuous aerosol generator or large-volume
reservoir humidifier can humidify the gas flow. Some aerosol generators however, cannot provide
adequate flows at high oxygen concentrations.




                                                                                             Nursing
       Delivery Method                      FIO2                 Discussion
                                                                                          Responsibilities
                                  1L/min=24%            -relatively              -check frequently that
Nasal Cannula: is a thin tube     2L/min=28%            comfortable.             the prongs are in the
with two small nozzles that       3L/min=32%            -patients can eat,       patient’s nose.
protrude into the patients        4L/min=36%            talk, and cough with     -assess for dryness of
nostrils.                         5L/min=40%            a nasal cannula in       the nasal mucosa.
                                  6L/min=44%            place.                   -humidify flow at rates
                                                        -works best if the       above 3L/min (flow at
                                  ☻ It can only         patient breathes         rates above 3L/min are
                                  provide oxygen at     through his nose.        drying)
                                  low flow rates, 1-6
                                  litres per minute
                                  (LPM), delivering a
                                  concentration of
                                  24-40%. Flow
                                  rates greater than
                                  4 liters per minute
                                  should also be
                                  used with a
                                  humidifcation
                                  system.
Simple Face Mask: a clear,        5-10L/min=40-         -requires flow rates     -place face mask
flexible mask that covers the     60%                   greater than 5L/min      securely over the
nose and mouth and delivers                             to prevent               mouth and nose.
oxygen into the mask.                                   accumulation and         -elastic straps fit
                                                        rebreathing of           around the head to
                                                        exhaled CO2 from         hold the mask in place.
                                                        within the mask.         Place the straps well
                                                        -masks are not           above the ears to
                                                        easily tolerated         prevent skin irritation
                                                        because they fir         and breakdown.
                                                        tightly and keep heat    -place gauze or other
                                                        from radiating from      soft material beneath
                                                        the face, making         the straps to prevent
                                                        patients feel hot.       irritation.
                                                        -talking is muffled by   -check the skin around
                                                        the mask, and it         the mask frequently.
☻used for non-life-threatening                          must be removed for      -check the skin over
conditions but which may                                the patient to eat or    the ears where the
progress in time, such as chest                         drink.                   mask strap rubs.
pain (possible heart attacks),
dizziness, and minor
hemorrhages.

Partial rebreather mask: uses     6-15L/min=50-         -allows higher FIO2      -maintain the flow at a
the reservoir bag to capture      90%                   levels to be delivered   high enough rate to
some exhaled gas for                                    because O2 is            prevent the reservoir
rebreathing.                                            collected in the         bag from collapsing
                                  ☻It is considered     reservoir bag for        during inhalation.
                                  a low-flow system     inhalation.
                                                        -exhalation ports
                                                        allow most exhaled
                                                        air to escape.
                                                   -several types are
                                                   available.
                                                   -can deliver an FIO2
                                                   above 50% at flow
                                                   rates of 6-15L/min.
                                                   -patient rebreathes
                                                   some exhaled air
                                                   along with O2.



Nonrebreather mask: similar        6-15L/min=70-   -contains only O2,      -maintain the flow at a
to the partial rebreathing         100%            which allows higher     rate high enough to
mask except it has a series                        FIO2 delivery. An       prevent the reservoir
of one-way valves. One                             FIO2 of 60-100% can     from collapsing during
                                                   be delivered at flow    inhalation.
valve is placed between the
                                                   rates of 6-15L/min.
bag and the mask to prevent                        -This mask is the
exhaled air from returning to                      only external device
the bag.                                           capable of delivering
                                                   an FIO2 of 100%.




                                   24-50%          -the cone-shaped        -the adapter indicates
                                                   adapter at the base     the required oxygen
                                                   of the mask allows a    flow rate needed to
Venturi Mask: a cone-shaped                        precise FIO2 to be      deliver the desired
adapter that serves as a mixing                    delivered. This is      FIO2. ensure that the
valve to control the amount of                     very useful for         flow is set at the rate
O2 and room air that flows                         patients with chronic   specified to deliver the
through the mask.                                  lung disease.           FIO2 desired.
                                                   -exhalation ports
                                                   keep CO2 buildup to
                                                   a minimum.




Face Tent: a large, open           8-12L/min=30-   -less reliable than a   -check the skin over
plastic mask that fits under the   55%             face mask for           the ears where the
chin. It is open at the top and is                     delivering precise      mask strap rubs.
held in place with an elastic                          FIO2 levels.
band around the head.                                  -does allow
                                                       moderate-to high-
                                                       density aerosol
                                                       delivery for
                                                       humidification.




Tracheostomy collar: a small,        4-10L/min=24-     -it is possible to      -watch for water
cup-shaped device that fits          100%              deliver both high       accumulation in the
over the tracheostomy opening                          FIO2 and high           tubing.
and is held in place with elastic                      humidity with a
straps around the neck.                                tracheostomy collar.
                                                       -large-bore tubing is
                                                       used to deliver
                                                       humidification to the
                                                       trachea; however,
                                                       water frequently
                                                       condenses inside the
                                                       tubing and can be
                                                       accidentally drained
                                                       into the
                                                       tracheostomy.
                                                       Usually, a water trap
                                                       of some sort of
                                                       placed in the tubing
                                                       to prevent this
                                                       problem.
T-Piece: A T-shaped plastic          4-10L/min=24-     -Oxygen humidity        -Take care that the
piece; the bottom of the T fits      100               are delivered into      oxygen delivery tubing
directly and tightly onto the                          one end of the T and    does not pull on the T-
tracheostomy tube.                                     exhaled through the     piece, which can
                                                       other end.              dislodge the
                                                                               tracheostomy tube and
                                                                               create an airway
                                                                               emergency.




                                      University Of San Carlos
                                        College Of Nursing
Oxygen Therapy and Adminitration




             Submitted to:
        Ms. Ramas, Phoebe Marie, R.N.




            Submitted by:
          Quijano, Albee Charis A.
          Racaza, Helen marie V.

              BSN 4A Group 33
          CCMC Female Medicale Ward




                SY 2008-2009

				
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