Oxygen Therapy

Fundamental of Nursing
Prepared by: A.L AMANI FADHIL ABBAS
BASIC SCIENCE
FIRST STAGE
Learning objective
Define oxygen therapy .
List the different sources of oxygen therapy.
 Discuss the type of oxygen therapy devices with
advantages and disadvantages of each device type.
 Explain some basic medical terminology (condition).
List the indication of oxygen therapy .
Demonstrate Complications of oxygen therapy.
 List Nursing assessment and consideration during
oxygen therapy.
Oxygen Therapy
‘’ Oxygen’’ is a colorless, odorless, tasteless gas that is
essential for the body to function properly and to survive.
‘’Oxygen therapy’’ is the administration of oxygen at a
concentration of pressure greater than that found in the
environmental atmosphere(room air) .The air that we
breathe contain approximately 21% oxygen .the heart relies
on oxygen to pump blood.
Oxygen therapy is a key treatment in respiratory care. The
goal of oxygen therapy is to treat or prevent hypoxemia by
preventing tissue hypoxia which may result in tissue injury
or even cell death.
Oxygen Therapy can be administered from different sources
at the hospital, including :
1. Wall outlet.
2. Oxygen tank.
3. Liquid oxygen system.
4. Oxygen concentrator.
 Basic Terminology
Anoxia No oxygen availability in tissues.
Hypoxia. Lack of oxygen availability in tissues or its refers to a condition where the
amount of oxygen available to the cells is not adequate to meet metabolic need.
Hypoxemia Is low level of oxygen in the blood. It starts in the arteries. Hypoxemia isn't
an illness or a condition. It's a sign of a problem tied to breathing or blood flow.
Hypercapnia is high carbon dioxide content in the blood or its is an increase in partial
pressure of carbon dioxide (PaCO2) above 45 mm Hg (normally 35-45).
 FiO2. fraction of inspired oxygen
Is the concentration of oxygen in the gas mixture. The gas mixture at room air has a fraction
of inspired oxygen of 21%, meaning that the concentration of oxygen at room air is 21%.
 Detection of oxygen level in the blood is done by Clinical evaluation using Pulse oximetry
(SpO2)and doing ABG (arterial blood gas )analysis to detect (SaO2 and Pao2).
Normal Pao2 is 80-100 mmHg
SaO2 is the oxygen saturation of arterial blood, while SpO2 is the oxygen saturation as
detected by the pulse oximeter. Normal Sao2 or SpO2 or values vary between 95% and
100%.
 Target saturation range of oxygen
In COPD and other conditions associated with chronic respiratory failure,
oxygen should be administered if the SpO2 is less than 88%, the target
SpO2 should range ( 88% to 92%).
 In other acute medical conditions, oxygen should be administered if the
SpO2 is less than 92%,and the target SpO2 should range (92% to 96%).
Oxygen Flow Meter
All oxygen sources are attached to a flow
meter that indicates the flow rate, usually in
liters of oxygen administered per minute,
which typically ranges between 1 and 15
liters per minute (LPM).
A humidifier bottle is also used to prevent
the oxygen from drying out the mucous
membranes lining the nose and mouth.
Pulse Oximetry
 Pulse Oximeter is a handheld clip device used to
measure one's oxygen saturation and heart rate.
SpO2 values below 95% (94.9%-90.1%) are
considered to be abnormal, and caution should
be taken at these values.
Patients with an SpO2 reading of less than 90%
are said to be hypoxemic.
Patients with an SpO2 reading of less than
85%would be severely hypoxemic.
These patients would most likely need an
external oxygen supply.
Acute VS sever Hypoxia signs
and symptoms
1. Restlessness
2. Disorientation, confusion
3. In-coordination, impaired
judgment
4. Hyperventilation (air
hunger -increase breathing
rate )
5. Circulatory changes in
acute hypoxia heart rate
increased while in sever
hypoxia heart rate will
slow down).
Indications of oxygen therapy
1. Documented hypoxemia
Adults, children, infants > 28 days,PaO2 < 60mm,SaO2 < 90%
Neonates – PaO2 < 50mm hg, SaO2 < 88%
2. Before and after suction.
3.Patients with decreased oxygen carrying capacity.
Anemia , sickle cell disease.
4.Acute conditions like Pneumonia , Asthma attack or Respiratory distress
syndrome RDS in neonate and Severe trauma, Acute myocardial infarction
(heart attack) , post anesthesia recovery .
4. Chronic conditions like COPD ,Heart failure ,Cystic Fibrosis and Sleep
Apnea. chronic bronchitis, emphysema, and chronic asthma).
Classification of Oxygen Delivery Systems
1.Low Flow systems contribute partially to inspired gas that the client
breathes(RR is less than 25 bpm and has regular breathing pattern)
Nasal catheters(cannula).
 Simple Masks.
Partial rebreathing mask
Masks with reservoir bag.

2. High Flow or Fixed performance devices.

Deliver specific and constant percent of oxygen independent of client’s
breathing (RR greater than 25 and has irregular breathing pattern )
Venturi mask
Tracheostomy Collar/ Mask
T-PIECE.
Oxygen Hood
Oxygen Tent
 Nasal cannula
It is 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%).
Amount delivered FIO2 Nursing priority action Advantages Disadvantages
24%-44%

1 L/min 24% 1-Check frequently that 1-Patient is able to talk May cause irritation and
2 L/min 28% both prongs are in clients and eat with oxygen in dryness to the nasal and
3 L/min 32% nares . place. pharyngeal mucosa .
4 L/min 36% 2-Never deliver more 2-in expensive
5 L/min 40% than 6 L/min because it 3- Affordable
6 L/min 44% cause nasal dryness and ,lightweight and Easily
bleeding . used in home setting.
Simple Oxygen mask
Amount delivered Nursing priority Advantages Disadvantages
FIO2 action
FLOWRATE L/min
A flow rate of 5 to 10 1-Continuously 1- Simple to use. 1- Can cause claustrophobia
L/min FIO2 35%- check if its 2- In expensive as well as skin breakdown .
60% correctly fit to 3-Its eliminates the 2- Poor fitting .
the face. danger of suffocation 3- Must remove to eat
present if a mask
with one-way valves
becomes
disconnected from
oxygen because it
has holes in the mask
Partial rebreathing mask
Amount Nursing priority action Advantages Disadvantages
delivered FIO2
FLOWRATE
L/min

10-15 L/min FIO2 up to 1--have reservoir .Higher delivery of 1- warm , poorly fitting .
80% bag That must FIO2 2-Insufficient flow rate may lead to
remain inflated rebreathing of CO2 leads to
during both suffocation hazard.
inspiration and
expiration. 3-Eye irritation
2-A high 4-Limited access to mouth for eating
Concentration of and drinking
oxygen Can be
Delivered.
3-fill the bag with O2 before
oxygen therapy.
Non – rebreathing mask
Amount delivered Nursing priority Advantages Disadvantages
FIO2 action
FLOWRATE L/min

10 -15 L/Min FIO2 1-Are similar in 1-This have one - 1- poorly fitting.
up to 100% design to partial way valve. 2-suffocation
rebreathing mask 2- high O2 happened if the
except They have Concentration oxygen source
Additional valves. 3- indicated for suddenly isolated
acute medical because its depend
emergencies. only on oxygen
source for
ventilation.
Venturi mask
 Is high flow oxygen delivery device.
Oxygen from 40 - 50% At liters flow of 4 to 15
L/min.
 The mask is constructed so that there is a
constant flow of room air blended with a fixed
concentration of oxygen
Advantages
1. Delivers most exact oxygen concentration.
2. Doesn’t dry mucous membranes.
 Disadvantages
1. Uncomfortable
2. Risk for skin irritation
3. Produce respiratory depression in COPD patient
with high oxygen concentration 50%
 Oxygen Hood
An oxygen hood 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
Hoods provide up to 80% to 90% oxygen, good
humidification, and controlled temperature.
They allow easy access to the child for other
care.
Oxygen Tent
An oxygen tent consists of a canopy (cover)is placed over the
head and shoulders, or over the entire body of a patient to
provide oxygen at a higher level than normal.
 Typically the tent is made of see-through plastic material.
It can envelop the patient’s bed with the end sections held in
place by a mattress to ensure that the tent is airtight.
 The enclosure often has a side opening with a zipper.
Tents for older children provide the same environment
advantages but allow less ready access to the patient and
usually provide only 21% to 50% oxygen.
AMBU BAG
Artificial Manual Breathing Unit (or) Bag Valve
Mask Ventilation is a hand-held device commonly
used to provide positive pressure ventilation to
patients who are not breathing or not breathing
adequately on their own
They are commonly used in various medical
settings, including ambulances, emergency
departments, and intensive care units.
Tracheostomy Collar/ Mask
 Inserted directed into trachea.
 Is indicated for chronic O2 therapy
need.
O2 flow rate 8 to 10L.
 Provides accurate FIO2 .
 Comfortable ,more efficient.
 T-PIECE
The decision of extubation is a critical time because
mortality is particularly high and to reduce the risk of
reintubation, according to the guideline In intensive
care unit (ICU), recommend to systematically perform
a spontaneous breathing trial (SBT) before extubation
in order to mimic the post extubation complications
. SBT is usually performed with a T-piece
disconnecting the patient from the ventilator or with
low levels of pressure-support ventilation
(PSV).Used on end of Endotracheal tube when
weaning from ventilator.
Provides accurate FIO2.
 Provides good humidity.
Complications of Oxygen Administration
1. Infection
2. Dryness of mucous membrane of respiratory tract.
3. Fire hazard.
4. Oxygen toxicity .
5. Oxygen induced hypoventilation .
6. Asphyxia.
7. Retinopathy of prematurity.
Nursing assessment and consideration during oxygen
therapy
1. Assess for signs of hypoxia
( Confusion ,Difficulty speaking, Tachycardia, Dyspnea, Pallor and Cyanosis).
 Increased rate and depth of respirations,
 Accessory muscle use,
SpO2 less than 92%
2. Verify oxygen delivery device, flow rate, humidification, target oxygen
saturation
3. Ensure proper fit and adjust for comfort in case of using Nasal cannula or
face mask).
4. Monitor pressure points for skin breakdown; provide skin care, padding as
needed
Nursing assessment and consideration during oxygen
therapy
5. Check tubing for twists, attached to device and oxygen source.
6. Monitor response to supplemental oxygen; report responding or worsening oxygenation
status (general condition of the patient and Oxygen saturation).
7. Check and report Vital signs.
8. Auscultate and report Lung sounds.
9. Assess skin for color changes.
10. Assess Level of consciousness (mentation).
11-Place The patient in Simi – Fowler Position.
Mentation is Mental functions are :
1-Abilities that enable the individual to be alert and focus on her /his environment.
2-Perceive and interpret sensory phenomena.
3-Feel and regulate emotions.
4-Perform higher level functions that enable him to organize and control her/his behavior and
action and to learn, reason, and synthesize information.
Nursing assessment and consideration during
oxygen therapy
12. Educate the patient about :
Purpose of oxygen therapy.
Oxygen set-up, pulse oximetry, how to wear the delivery device.
Offer emotional support and reassurance.
Wash nasal cannula in warm soapy water and replace it every two to four
weeks.
Supplemental oxygen is a medication; administer their oxygen at the
prescribed rate, not to discontinue O2 therapy suddenly.
Increasing their fluid intake can help reduce dryness of mucous membranes
Nursing assessment and consideration
during oxygen therapy
12. Safety measures
Keep the oxygen away from any heat source.
Avoid using equipment that could emit a
spark.
Avoid wearing synthetic clothing due to static
electricity.
Avoid use of flammable liquids.
No smoking.
Fire extinguisher readily available.