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GTJ 205/4: FON III

NursingYear 2
OXYGENATION

Objectives

Define oxygen therapy

Explain the aim of oxygen therapy
Explain indication of oxygen therapy
Describe the causes of the respiratory dysfunction
Identify clinical manifestation of respiratory dysfunction
Explain factors which effect respiratory dysfunction
Explain oxygen toxicity
Name the oxygen sources
Identify items for administering oxygen
Explain methods for administering oxygen
Explain nursing responsibilities during oxygen therapy
Demonstrate the methods for administering oxygen
Appreciate the importance of correct and safe methods
of administrating oxygen therapy for client

Introduction
Insipiration
Expiration
Ventilation
Respiration
Hypoxemia
Hypoxia
Promoting Oxygenation
- Positioning (Fowler, Orthopneic)
- Breathing Techniques (Deep B, Pursed Lip B,Diaphragmatic B
- Oxygen Therapy (Cannula, Mask, Hood, Tent, etc.)

Oxygen Therapy

Supplement of oxygen in a higher

concentration than the atmosphere to

prevent or reduce hypoxia .

insufficient
oxygen to meet
the metabolic
demand of
tissue and cells

Goals
To give supplement oxygen effectively to the client
Helps a client to breath effectively prevent or

minimize the cardiopulmonary work load angina

client
Prevent complication:

Hypoxemia

Hypoxia

Indications
Documented hypoxemia
Suspected hypoxemia
Suspected hypoxia

Causes Of Respiratory Disorder

Pathology in respiratory system:
obstructive - Chronic Obstructive Pulmonary

Disease (COPD) respiratory acidosis

hypoxemia - hypoxia
restrictive - asthma
Heart disease:
angina pectoris/ unstable angina

Metabolism disorder:
acidosis due to infection

Clinical Manifestation: RDS

ACUTE CHANGES
Anxiety
Rapid pulse rate
Breathing rapid and
deep
Reduce in air entry
Dyspnea
Use of accessory
muscles of respiration
Cardiac dysrhythmias
LOC

INSIDIOUS CHANGES
Pallor
Fatigue
Unable to concentrate
Dizziness
Behavior changes
Cyanosis
Clubbing
Abnormal lung sound

Terminology Used: Respiratory System

Eupnea - normal respiration 14-20/min in adult

Tachypnea - rapid shallow breathing

Bradypnea - slow breathing secondary to diabetic coma,

drug induced, and increase intracrainal pressure

Dyspnea - difficulty in breathing
Orthopnea - difficulty in breathing while asleep
Hyperventilation/hyperpnea - rapid deep breathing

Cheyne-Stoke Breathing - deep breathing alternate with

apnea
Apnea - no breathing

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Factors Which Effect Respiratory Functions: Development

(Evan-Smith, 2005)

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Contfactors Which Effect Respiratory Functions:

Environment

high altitude - low PaO2 - Respiration rate,

pulse rate
air pollution - difficulty in breathing, cough,
(watery eye, headache)
Life style:
exercise, athlete - breathing rate - slower
habit : smoker, alcohol, drugs abuse
food: obese - difficulty in breathing

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Contfactors Which Effect Respiratory Functions

Health status:

cardiopulmonary disorder: reduce cardiac

output, poor contractility of cardiac muscle

anemia - increase heart rate
Drug - narcotic: reduce heart rate,

suppressed respiratory center - medulla

oblongata

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Oxygen Toxicity
The effects of oxygen toxicity may be classified by the organs

affected, producing three principal forms:

Central nervous system, characterised by convulsions
followed by unconsciousness, occurring under hyperbaric
conditions;
Pulmonary (lungs), characterised by difficulty in breathing

and pain within the chest, occurring when breathing elevated

pressures of oxygen for extended periods;
Ocular (retinopathic conditions), characterised by alterations

to the eyes, occurring when breathing elevated pressures of

oxygen for extended periods.

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Oxygen Toxicity

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Oxygen Sources
Wall outlet
Portable tanks
Liquid oxygen unit store at 24oC

deliver via gas outlets on the wall

Oxygen concentrator room air
and stores for patient use

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Items For Oxygen Therapy

Oxygen Source:

- Cylinder
- Wall Outlet
Flow meter
Humidifier
Oxygen connecting tubing
Mask/ Nasal Cannula / Nasal Prong

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Method Of Administration Oxygen

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Nasal Prongs

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Nasal Prongs

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Face tent

Simple Mask

Tracheostomy mask

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Partial & Non Rebreather Mask

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Differences PRM & NRM

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Partial Rebreathing Mask (PRM)

Patient inhales a mixture of

atmospheric air, oxygen from its

source, and oxygen combined within
the reservoir bag
A way of recycling oxygen and venting
all the CO2 during expiration from the
mask
During expiration 1/3 of exhaled air
enters into reservoir bag (O2 high
level from the upper airways)
Reservoir bag is filled it force the
remainder exhaled air through small
ports in the PRM.

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Non Rebreating Mask (NRM)

All the exhaled air leaves the mask
The one way valves allow only O2

from its source as well as the

oxygen in the reservoir bag to be
inhaled
Air from atmosphere and exhaled
air do not enter the reservoir bag
Critically ill patients and top listed
for mechanical ventilation.
FIO2 of 90-100% can be achieved.

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Venturi Mask

Oxygen concentration can be controlled

administration
4 - 6 L/min = 24, 26, 28%
6 - 8 L/min = 30, 35, 40%
10L/min = 50%

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Nebulizers Combination Mask

Aerosol nebulizer

therapy with mask

medication chamber

- bronchodilator,
steroid - asthma

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Nursing Responsibilities During Oxygen Therapy: Pre

Medication need prescription unless in an

emergency
Place a NO SMOKING sign - explain why
Review medical records: chronic lung
disease especially Chronic Obstructive
Pulmonary disease (COPD)
Oxygen cylinders secured stored upright,
chained or appropriate holders

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Nursing Responsibilities During Oxygen Therapy

Monitor vital sign
Check oxygen flow rate as prescribe
Keep client comfortable -

clean and wipe client face

Assist with mouth toilet or gargle or give sips of

water
Monitor pressure area & intervention to relieve
pressure
Nasal prong - check frequently - both prongs in
nares, oxygen 2-3L/min especially - chronic lung
disease

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Nursing Responsibilities During Oxygen Therapy

Mask: placement of mask, claustrophobia -

support, replace with nasal prong during meals

Partial Rebreather Mask (PRM):
bag remain 2/3 full - inspiration, reservoir bag - not
kink/twisted
Non Rebreather Mask (NRM):
maintain flow rate reservoir bag collapses slightly
during inspiration, check valves & rubber flaps
functioning
Venturi Mask:
careful monitoring: verify FiO2 at flow rate
prescribe, air intake valve not blocked

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Nursing Responsibilities During Oxygen Therapy

Check arterial blood gas
Monitor vital signs
Record and report

NOTE:
Make sure the reservoir are fill with
oxygen before starting in a nonrebreathing/partial rebreathing mask

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Brain Storm Nursing Diagnosis

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Assessment: Patient & Equipment

Prescription
Patient general condition
Respiratory status
Conscious level : able to understand and obey command
Nasal anatomy state : patent, growth or polyps, trauma ect

Comfort
Identify equipment:

needed
suitability
adequate and
safe

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Cont Assessment: Enviroment

Environment
Working space comfortable and safe
Away from fire source

Enough room to move

clean
Adequate lighting
Bed height comfortable
Nurse:
Assistance needed

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Planning
Equipment:
Nasal Prong nasal/mask
Oxygen set
Humidfier
Sterile water
Flowmeter
Oxygen

Oxygen cylinder wrenches (if needed)

Tray with:
Cotton bud
Water in a galipot
Face tissue

Receiver
Caution sign : NO SMOKING

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List Of Composite Skills

Insertion of oxygen flow meter

Attach oxygen tubing technique

Administering oxygen supply via nasal prong

Administering oxygen supply via face mask

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Insertion Of Oxygen Flow Meter

Hold flow meter upright/vertically
Push in the plastic O ring /circle on the wall with your

thumb
Insert the flow meter into the female adaptor until you hear
click

regulator

Female
adaptor
Plastic O
ring/circle

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Attach Oxygen Tubing Technique

Insert the flow meter to the oxygen outlet

or oxygen supply
Fill the puritan bottle (humidification) with
distilled water (if necessary)
Attached the humidifier bottle to the flow
meter
Attach the oxygen tubing to the oxygen
outlet from the humidifier bottle

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Setting Oxygen Flow Rate

Eye level
Read at eye level:
center of the float

Adjusting oxygen flow rate

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Administering Oxygen Supply Via Nasal Prongs

Clean the patient nostril with the cotton bud

soak in a clean water (if necessary)

Adjust oxygen flow as prescribe
Insert the nasal prong into both nostril with
the curve turn downwards
Bring both tube over to the back of the ear
and toward the chin
Adjust the tubing under the chin to ensure
comfort

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Steps: Administering oxygen via nasal prongs

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Lecture Demo: Oxygen with nasal prongs

Supplies & Equipment

Flowmeter
Oxygen source
Nasal cannula & tubing
Humidifier & sterile water
Oxygen
Gloves
Steps
1.Check physician order
2.Wash hand & put on gloves
3.Explain the procedure to the client
4.Prepare The oxygen equipment Flowmeter, humidifier with sterile water
5. Adjust the flowmeter & check oxygen is flowing out of the prong
6. Clean the nostril patient
7.Put prongs into the client nostrils
8.Encourage client breath through the nose rather than the mouth
9.Assess the client comfort level
10.Place the No Smoking sign .

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Administering Oxygen Supply Via Face Mask

Clean the patient face

Adjust oxygen flow as prescribe

Place the face mask over the patient nose and

mouth
Secure the rubber string over the patient head
Adjust the mask to ensure comfort
Encourage client breath through the nose rather
than the mouth
Assess the client comfort level

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Steps: Administering oxygen via mask

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Lecture-Demo: Oxygen with simple mask

Supplies & Equipment

Flow meter
Oxygen source
Oxygen mask
Humidifier & sterile water
Oxygen
Gloves
Steps
1.Check physician order
2.Wash hand & put on gloves
3.Explain the procedure to the client
4.Prepare The oxygen equipment Flow meter, humidifier with sterile water
5. Adjust the flow meter & check oxygen is flowing out of the mask
6. Clean the patient face
7. Place the face mask over the patient nose and mouth
8.Secure the rubber string over the patient head
9.Adjust the mask to ensure comfort
10.Encourage client breath through the nose rather than the mouth
11.Assess the client comfort level
12.Place the No Smoking sign .

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Evaluation
Administering oxygen via:

a. venturi mask,
b. dail on venturi mask,
c. nonrebreather,
d. partial rebreather,
e. simple mask
Client comfort
Accurate oxygen supply:
Arterial blood gas result
Oxygen saturation
Vital sign
Skin colour
No complication

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Documentation
Respiratory assessment finding:

Flow rate
Method of delivery
Respond to treatment:
Effectiveness
Changes in doctors orders
Side effects
Abnormalities:

Report any abnormalities

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Summary
Indications for oxygen therapy
Types of oxygen delivery
Responsibilities before, during and after

oxygen therapy.