1. Oxygen Use and the CNA

2. Signs and Symptoms to Report Unusual skin color Unusual color of lips, mucous membranes, nail beds Cool, clammy skin Slow, rapid breathing Noisy breathing Dyspnea or SOB Gasping Rales Choking on secretions Changes in mental status Tachycardia

3. Patients at risk for Poor Oxygenation Cardiac disease Pulmonary disease Postop patient Sleep apnea Decreased LOC Neuromuscular diseases Morbid obesity Severe kyphoscoliosis

4. Cap Refill Gives a quick look into how well oxygen gets to body tissues We first check the color of the nail beds Press the nail for a few seconds-the skin underneath blanches Release the nail and evaluate how long it takes to return to normal color How long should this take? Can we check Cap Refill through nail polish?

5. Oxygen Therapy Some facilities have oxygen pumped into the room and others rely on portable devices for providing oxygen to residents. How and what amount of oxygen a resident receives is decided by the doctor Certain conditions such as COPD can cause a patient to become compromised when given too much 02. Always follow orders. Pulse Oximetry is used to measure the level of saturation of hgb with oxygen This detects changes in the patient’s oxygen levels before you see outward changes in skin color If patient is on oxygen, make sure you document how many L/min the patient is on

6. Oxygen Delivery Systems Oxygen may be delivered by nasal cannula which is a simple way of giving oxygen in which the tubing attaches to an oxygen source and has two prongs that fit in beginning passageway of the nose. For this to benefit the resident, the prongs must be kept in the nose. There are also different types of mask which can deliver a greater concentration of oxygen. The mask covers the mouth and nose

7. NASAL CANNULA They are easy to set up and are well tolerated by patients Usually used with orders for 1 - 6 liters per minute. A humidifier is used with liter flows > 4 LPM or for patient comfort. Higher flows can cause nosebleeds and headaches. Should use “Cannula Cushions” for sore ears.

8. SIMPLE MASK Flows of 5 - 12 LPM. Liter flow must be at least 5 LPM to ensure that CO 2 is being flushed out of the mask. Good for patients with blocked nasal passages and mouth breathers. Guard against aspiration. A humidifier is optional. The masks are difficult to tolerate with skin irritation and at meal times.

9. NON-REBREATHER MASK Delivers FiO 2 of 50 - 70%. This mask utilizes 3 one-way valves and a bag reservoir to supply the highest possible oxygen concentration of any of the masks. Flow can set to meet the patient’s maximum inspiratory needs and so the bag should not completely deflate on inspiration. A tight fit is necessary to deliver a high FiO 2.

10. REBREATHER OR PARTIAL REBREATHER MASK Delivers FiO 2 40 – 60% Can be achieved by removing valves from the mask. Allows for partial re- inhalation of the Carbon Dioxide that is expelled during respiration