3Out lineDefinition of the oxygen therapyTypes of oxygen therapypurposes of using the oxygen therapyAdministration of oxygen therapyComplication of oxygen therapy
4Learning objectives: Define the oxygen therapy Discuss the type of c oxygen therapyList the purpose of using the oxygen therapyExplain the procedureDemonstrate the procedureList Complication of oxygen therapy
5Oxygen therapyDefinition:Oxygen is a colorless, odorless, tasteless gas that is essential for the body to function properly and to survive.
6What is meaning of O2 therapy Oxygen therapy is the administration of oxygen at a concentration of pressure greater than that found in the environmental atmosphereThe air that we breathe contain approximately 21% oxygenthe heart relies on oxygen to pump blood.
7What 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.
8PurposeThe 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.
9Oxygen therapy is a key treatment in respiratory care. PurposeOxygen 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.
10oxygen therapy is used to treat Example in case :-Documented hypoxemiaSevere respiratory distress (acute asthma or pneumonia)Severe traumaChronic obstructive pulmonary disease (COPD, including chronic bronchitis, emphysema, and chronic asthma)
11oxygen therapy is used to treat Pulmonary hypertensionAcute myocardial infarction (heart attack)Short-term therapy, such as post- anesthesia recoveryOxygen may also be used to treat chronic lung disease patients during exercise .
12Methods of Dispensing Oxygen Piped inCylinderOxygen concentrator
132- Wall outlets. 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.
141- Using oxygen cylinders: The oxygen cylinder is delivered witha 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.
15Using oxygen cylinders: 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.
162- Wall – outlet oxygen:The oxygen is supplied from a central source through a pipeline.Only a flow meter and a humidifier are required.
17PreparationA 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.
21Classification of Oxygen Delivery Systems Low flow systemscontribute partially to inspired gas client breathesdo not provide constant FIO2Ex: nasal cannula, simple mask , non-re breather mask , Partial rebreather maskHigh flow systemsdeliver specific and constant percent of oxygen independent of client’s breathingEx: Venturi mask,, trach collar, T-piece
22Methods of oxygen administration: 1- Nasal cannula
23Nasal 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%).
24F1o2 (Fraction Inspired Oxygen) DisadvantagesAdvantagesPriority NursingInterventionsAmount DeliveredF1o2 (Fraction Inspired Oxygen)Methodmay cause irritation to the nasal and pharyngeal mucosaif oxygen flow rates are above 6 liters/minute Variable FIO2Client able to talk and eat with oxygen in placeEasily used in home settingCheck frequently that both prongs are in clients naresNever deliver more than 2-3 L\min to client with chronic lung diseaseLow flow24-44 %1 L\min=24%2 L\min=28%3 L\min=32%4 L\min=36%5 L\min=40%6 L\min=44%Nasal Cannula
26Face mask The simple Oxygen mask The partial rebreather mask: The non rebreather mask:The venturi mask:
27The simple Oxygen maskSimple 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.
28The simple Oxygen maskIt 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).
29F1o2 (Fraction Inspired Oxygen) DisadvantagesAdvantagesPriority NursingInterventionsAmount DeliveredF1o2 (Fraction Inspired Oxygen)MethodTight seal required to deliver higher concentrationDifficult to keep mask in position over nose and mouthPotential for skin breakdown (pressure, moisture)WastingUncomfortable for pt while eating or talkingExpensive with nasal tubeCan provide increased delivery of oxygen for short period of timeMonitor client frequently to check placement of the mask.Support client if claustrophobia is concernSecure physician's order to replace mask with nasal cannula during meal timeLow Flow6-10 L\min35%-60%Simple mask
30The partial rebreather mask: The mask is have with a reservoir bag must romaine inflated during both inspiration & expirationIt collection of the first parts of the patients' exhaled air.It is used to deliver oxygen concentrations up to 80%.
31The 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.
32The non rebreather mask This mask provides the highest concentration ofoxygen (95-100%) at a flow rate6-15 L/min.It is similar to the partial rebreather maskexcept two one-way valves prevent conservation of exhaled air.The bag is an oxygen reservoir
33The non rebreather mask When the patient exhales air.the one-way valve closes and all of the expired air is deposited into theatmosphere, not the reservoir bag.In this way, the patient is not rebreathing any of the expired gas.
34F1o2 (Fraction Inspired Oxygen) DisadvantagesAdvantagesPriority NursingInterventionsAmount DeliveredF1o2 (Fraction Inspired Oxygen)MethodRequires tight seal (eating and talking difficult, uncomfortableNot as drying to mucous membranesClinet can inhale room air through openings in mask if oxygens supply is briefly interruptedSet flow rate so mask remains tow-thirds full during inspirationKeep reservoir bag free of twists or kinksLow Flow6 L\min75%-80% oxygenPartial Rebreather Mask
35rebreather MASK Non Impractical for long term Therapy DisadvantagesAdvantagesPriority NursingInterventionsAmount DeliveredF1o2MethodImpractical for long term TherapyMalfunction can cause CO2 buildupsuffocationExpensiveFeeling of suffocationUncomfortableCostlyDelivers the highest possible oxygen concentrationSuitable for pt breathing spontaneous with sever hypoxemiaMaintain flow rate so reservoir bag collapses only slightly during inspirationCheck that valves and rubber flaps are function properly (open during expiration )Monitor SaO2 with pulse oximeterLow Flow6-15 L \min80%-100%Nonrebreather MASK
36Venturi mask Oxygen from 40 - 50% At liters flow of 4 to 15 L/min. 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
37The venturi mask The venturi system, is designed with wide- bore tubing and various color - coded jet adapters.Each color code corresponds to a preciseoxygen concentration and a specific liter flow.The venturi system,Room air dilutes the oxygen entering the tubing to a certain concentrationThe amount of air drawn in is determined by the size of the orifice (jet adapter).
38The 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 withchronic obstructive pulmonary disease
39Venturi Mask Disadvantages Advantages Priority Nursing Interventions Amount DeliveredF1o2MethoduncomfortableRisk for skin irritationproduce respiratory depression in COPD patient with high oxygen concentration 50%Delivers most precise oxygen concentrationDoesn’t dry mucous membranes (humidityRequires careful mointoring to verify F1O2 at flow rate orderedCheck that air intake valves are not blockedOxygen from %of 4 to 15 L/min.Venturi Mask
40Tracheostomy Collar/ Mask Inserted directed into tracheaIs indicated for chronic o2therapy needO2 flow rate 8 to 10LProvides accurate FIO2Provides good humidity.Comfortable ,more efficientLess expensive
41T-piece Used on end of ET tube when weaning from ventilator Provides accurate FIO2Provides good humidity
43occurs due to inspiration of a high oxygen toxicityIt is a condition in which ventilator failureoccurs due to inspiration of a highconcentration of oxygen for aprolongedperiod of time.Oxygen concentration greater than 50% over 24 to 48 hours can cause pathological changes in the lungs.
44Signs 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.
45Side effect & complication of oxygen therapy Retrolental fibroplasiaBlindness due to vasoconstriction & ischemia ( premature infants )
47Rational Steps Technique of oxygen administration A-Administering oxygen by nasal cannula:RationalStepsprovide a baseline data for future assessmentOxygen 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 fearAssessment:Check the physician order.Assesses physical conditionAssess vital signs ,Assess level of consciousnessAssess the laboratory results, especially the ABG analyses,Assess risk of CO2retention with oxygen administration
48Assessment. Identify the type of oxygen equipment and oxygen source in your facility
49*Planning: Rational Steps To prevent infection. Wash hands. Prepare equipmentOxygen therapyplastic nasal cannulaconnection tube,Simple face maskThe partial rebreather maskThe non rebreather maskThe venturi mask
50RationalStepsHumidification maybe not be ordered if the flow rate is <4 /l/minHumidifier filled with distilled water .Flow meterNo smoking signs
51RationalStepsTo 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.
52Rational Steps Allow 3-5 L oxygen to flow through the tubing. 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.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.
53Rational Steps To provide optimal delivery of oxygen to patient.. Oxygen dries the mucous membrane and cause irritationAdjust 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.
54face mask Rational Steps Ensure pt receive flow sufficient to meet aspiratory demand & maintain accurate concentration oxygenface maskProduce 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.
55RationalStepsTo 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.
56RationalStepsThere is danger of inhaling powder if it isplaced 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.
57The partial rebreather mask The non rebreather mask The venturi mask RationalStepsto ensure correct air / oxygen mixThe partial rebreather maskThe non rebreather maskThe venturi maskAttach tubing to flow meterShow the mask to pt & explain procedureTurn on oxygen flowmeter & prescribed rate ( usually indicated on mask )Place mask over pt nose & mouth under chin
58Evaluation: 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 hemoglobinOxygen saturation within normal limits.
59Date and time oxygen started. Method of delivery. Documentation:Date and time oxygen started.Method of delivery.Oxygen concentration and flow rate.Patient observation.Add oronasal care to the nursing care plan
60O2 DELIVERY DEVICES Cont. EQUIPMENT FLOW FIO SPECIAL NOTESANESTHESIABAGL/M USE AT 12 L/M MIN.POTENTIAL OFBAROTRAUMAOR ASPHYXIATION*** SHOWS THAT FIO2 VARIES WITH DIFFERENTF, VT, INSPIRATORY FLOW RATES.
61O2 DELIVERY DEVICES Cont. EQUIPMENT FLOW FIO SPECIAL NOTESNASAL CANNULA 1/ L/M *** L/M MAX.SIMPLE O2 MASK L/M *** USE 5 L/M(WITHOUT BAG) MINIMUMRESERVOIR MASK L/M *** PAGE RT IF USED(MASK WITH BAG) (BAG TO NOTCOLLAPSE)VENTI MASK L/M , 26, 31, READ ENCLOSED6 L/M , .40, INSTRUCTIONSNEBULIZER L/M OR > , .30, MIST MUST BE.40, .50, VISIBLE1.0***ANESTHESIABAGL/M USE AT 12 L/M MIN.POTENTIAL OFBAROTRAUMAOR ASPHYXIATION*** SHOWS THAT FIO2 VARIES WITH DIFFERENTF, VT, INSPIRATORY FLOW RATES.