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Oxygen therapy O UT LINE Definition of the oxygen therapy Types of oxygen therapy purposes of using the oxygen therapy Administration of oxygen therapy.

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Presentation on theme: "Oxygen therapy O UT LINE Definition of the oxygen therapy Types of oxygen therapy purposes of using the oxygen therapy Administration of oxygen therapy."— Presentation transcript:

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2 Oxygen therapy

3 O UT LINE Definition of the oxygen therapy Types of oxygen therapy purposes of using the oxygen therapy Administration of oxygen therapy Complication of oxygen therapy

4 L EARNING 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

5 O XYGEN THERAPY Definition:  Oxygen is a colorless, odorless, tasteless gas that is essential for the body to function properly and to survive.

6 W HAT 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.

7 W HAT 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.

8 P URPOSE  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.

9 P URPOSE  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.

10 OXYGEN THERAPY IS USED TO TREAT  Example 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)

11 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.

12 M ETHODS OF D ISPENSING O XYGEN Piped in Cylinder Oxygen concentrator

13 S OURCES 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.

14 1- U SING 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.

15  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. U SING OXYGEN CYLINDERS :

16 2- W ALL – OUTLET OXYGEN : The oxygen is supplied from a central source through a pipeline. Only a flow meter and a humidifier are required.

17 P REPARATION 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.

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19 C AUTIONS F OR O XYGEN T HERAPY 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 fire Infection

20 Methods of oxygen administration:

21 C LASSIFICATION OF O XYGEN D ELIVERY S YSTEMS Low flow systems contribute partially to inspired gas client breathes do not provide constant FIO2 Ex: 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

22 M ETHODS OF OXYGEN ADMINISTRATION : 1- Nasal cannula

23 N ASAL 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%).

24 DisadvantagesAdvantagesPriority Nursing Interventions Amount Delivered F1o2 (Fraction Inspired Oxygen) Method  may cause irritation to the nasal and pharyngeal mucosa  if oxygen flow rates are above 6 liters/minute Variable FIO2  Client able to talk and eat with oxygen in place  Easily used in home setting  Check frequently that both prongs are in clients nares  Never deliver more than 2-3 L\min to client with chronic lung disease Low flow % 1 L\min=24% 2 L\min=28% 3 L\min=32% 4 L\min=36% 5 L\min=40% 6 L\min=44% Nasal Cannula

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26 F ACE MASK  The simple Oxygen mask  The partial rebreather mask:  The non rebreather mask:  The venturi mask:

27 T HE SIMPLE O XYGEN 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.

28 T HE SIMPLE O XYGEN 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).

29 DisadvantagesAdvantagesPriority Nursing Interventions Amount Delivered F1o2 (Fraction Inspired Oxygen) Method Tight seal required to deliver higher concentration Difficult to keep mask in position over nose and mouth Potential for skin breakdown (pressure, moisture) Wasting Uncomfortable for pt while eating or talking Expensive with nasal tube Can provide increased delivery of oxygen for short period of time Monitor client frequently to check placement of the mask. Support client if claustrophobia is concern Secure physician's order to replace mask with nasal cannula during meal time Low Flow 6-10 L\min 35%-60% Simple mask

30 T HE 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%.

31 T HE 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.

32 T HE 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

33 T HE 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.

34 DisadvantagesAdvantagesPriority Nursing Interventions Amount Delivered F1o2 (Fraction Inspired Oxygen) Method  Requires tight seal (eating and talking difficult, uncomfort able  Not as drying to mucous membrane s  Clinet can inhale room air through openings in mask if oxygens supply is briefly interrupted  Set flow rate so mask remains tow-thirds full during inspiration  Keep reservoir bag free of twists or kinks  Low Flow 6 L\min  75%-80% oxygen Partial Rebreather Mask

35 DisadvantagesAdvantagesPriority Nursing Interventions Amount Delivere d F1o2 Method  Impractical for long term Therapy Malfunction can cause CO2 buildup  suffocation  Expensive  Feeling of suffocation  Uncomfortable  Costly  Delivers the highest possible oxygen concentratio n  Suitable for pt breathing spontaneous with sever hypoxemia  Maintain flow rate so reservoir bag collapses only slightly during inspiration  Check that valves and rubber flaps are function properly (open during expiration )  Monitor SaO2 with pulse oximeter  Low Flow 6-15 L \min  80%- 100% Nonrebreather MASK

36 V ENTURI MASK  It is high flow concentration of oxygen.  Oxygen from %  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

37 T HE 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).

38 T HE VENTURI MASK The 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

39 DisadvantagesAdvantage s Priority Nursing Interventio ns Amount Delivered F1o2 Method  uncomfortable  Risk for skin irritation  produce respiratory depression in COPD patient with high oxygen concentration 50%  Delivers most precise oxygen concentrati on  Doesn’t dry mucous membrane s (humidity  Requires careful mointoring to verify F1O2 at flow rate ordered  Check that air intake valves are not blocked  Oxygen from %  of 4 to 15 L/min. Venturi Mask

40 T RACHEOSTOMY C OLLAR / M ASK  Inserted directed into trachea  Is indicated for chronic o2 therapy need  O2 flow rate 8 to 10L  Provides accurate FIO2  Provides good humidity.  Comfortable,more efficient  Less expensive

41 T- PIECE  Used on end of ET tube when weaning from ventilator  Provides accurate FIO2  Provides good humidity

42 S IDE EFFECT & COMPLICATION OF OXYGEN THERAPY  Oxygen toxicity  Retrolental fibroplasia  Absorption atelectasis

43 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.

44 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.

45 S IDE EFFECT & COMPLICATION OF OXYGEN THERAPY  Retrolental fibroplasia Blindness due to vasoconstriction & ischemia ( premature infants )

46 S IDE EFFECT & COMPLICATION OF OXYGEN THERAPY  Absorption atelectasis  100 % FLO2 breathing associated with decrease ventilation ( obstruction )  Hypoventilation ( increase 30 /M ) Effect ( lung collapse )

47 RationalSteps  provide a baseline data for future assessment  Oxygen maybe depress the hypoxia drive ( decrease respiratory rate, alliterate mental states *If Paco2 is decrease or normal ( PT not expression CO2 retention & can use oxygen without fear Assessment:  Check the physician order.  Assesses physical condition  Assess vital signs,  Assess level of consciousness  Assess the laboratory results, especially the ABG analyses,  Assess risk of CO2retention with oxygen administration Technique of oxygen administration A-Administering oxygen by nasal cannula:

48 A SSESSMENT . Identify the type of oxygen equipment and oxygen source in your facility

49 RationalSteps  To prevent infection. * Planning:  Wash hands.  Prepare equipment  Oxygen therapy  plastic nasal cannula  connection tube,  Simple face mask  The partial rebreather mask  The non rebreather mask  The venturi mask

50 RationalSteps  Humidification maybe not be ordered if the flow rate is <4 /l/min  Humidifier filled with distilled water.  Flow meter  No smoking signs

51 RationalSteps  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. *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.

52 RationalSteps  Low flow 1 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.  Allow 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.

53 RationalSteps  To provide optimal delivery of oxygen to patient..  Oxygen dries the mucous membrane and cause irritation  Adjust 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.

54 RationalSteps  Ensure pt receive flow sufficient to meet aspiratory demand & maintain accurate concentration oxygen  face mask  Produce the flow rate ( 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.

55 RationalSteps  To ensure a tight fit.  To reduce irritation and pressure and protect the skin.  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.

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

57 RationalSteps  to ensure correct air / oxygen mix  The partial rebreather mask  The non rebreather mask  The venturi mask  Attach 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

58 E VALUATION :  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.

59 D OCUMENTATION :  Date and time oxygen started.  Method of delivery.  Oxygen concentration and flow rate.  Patient observation.  Add oronasal care to the nursing care plan

60 O2 DELIVERY DEVICES C ONT. EQUIPMENT FLOW FIO2 SPECIAL NOTES ANESTHESIA BAG 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.

61 O2 DELIVERY DEVICES C ONT. EQUIPMENT FLOW FIO2 SPECIAL NOTES NASAL CANNULA 1/2 - 6 L/M *** 6 L/M MAX. SIMPLE O2 MASK L/M *** USE 5 L/M (WITHOUT BAG) MINIMUM RESERVOIR MASK L/M *** 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 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.

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