Oxygen therapy - Skills module

What does ADPIE stand for?

• A = Assessment

• D = Diagnosis

• P = Planning

• Implementation

• E = Evaluation

Assessment phase of the nursing process?

During the assessment phase, the nurse collects and verifies data to formulate a database reflecting the client's problems and concerns.

Diagnosis phase of the nursing process?

During the diagnosis phase, the nurse analyzes and interprets data gathered from the nursing assessment to formulate a nursing diagnosis, which in this case is impaired gas exchange.

Planning phase of the nursing process?

During the planning phase, the nurse determines client outcomes, establishes priorities, and identifies nursing interventions.

Implementation phase of the nursing process?

During the implementation phase, the nurse carries out the identified nursing interventions.

Evaluation phase of the nursing process?

During the evaluation phase, the nurse determines whether the planned client outcomes have been met and revises the plan of care if indicated.

When is oxygen therapy indicated

When patients are at risk of developing hypoxia such as having low blood oxygen levels (hypoxemia)

• patients with cardiac conditions

• respiratory illness

• patients in pain or sedation following surgery

Hypoxia symptoms

Vary depending patient’s health & health history, age, current disease process but may include the following:

Symptoms of early stages of hypoxia

• restlessness

• anxiety,

• confusion

• increased heart rate,

• elevated blood pressure

• increased respiratory rate

• Dyspnea / shallow breathing

Symptoms of late stages of hypoxia

• decreased activity level

• decreased level of consciousness

• hypotension

• bradycardia

• metabolic acidosis

• cyanosis (bluish discoloration of the skin)

what are the symptoms in the chronic stage of hypoxia

• clubbing of fingers and toes

• peripheral adema

• right-sided heart failure

• oxygen saturation below 87%

• respiratory acidosis

can oxygen help resolve dyspnea?

dyspnea is most often associated with other factors such as muscular issues affecting breathing. These must be addressed before jumping onto oxygen therapy.

How often should water be replaced in an oxygen nebulizer?

follow facility protocol, but usually when water is low or at least every 24 hrs

sterile water is best

What is hyperbaric oxygen therapy?

delivery of 100% oxygen using a pressurized chamber that allows increased oxygen absorption in the body up to 20 times the normal concentration

when is hyperbaric oxygen therapy usually indicated?

It is usually indicated for conditions like

• carbon monoxide poisoning

• decompression sickness,

• severe tissue infection,

• acute ischemia.

• cerebral arterial gas embolus

• radiation tissue damage

• decompression sickness

• osteoradionecrosis

• necrotizing infections

• crush injuries

• complex wounds

Hyperbaric oxygen therapy promotes enhanced healing and recovery in these situations.

What assessment findings would indicate oxygen therapy is effective?

• pulse oximetry

• arterial blood gas analysis

• pulmonary function test

• ECG tracings

• physical examination findings

• functional status
  
  MAY NOT be too effective when treating COPD exercise tolerance
  may help exercise duration and performance when involving cystic fibrosis

Signs of oxygen toxicity

Affects the central nervous system (CNS) and pulmonary system.

• Pallor (paleness)

• anxiety

• sweating

• nausea

• vomiting

• seizures

• muscle twitching

• vertigo

• tinnitus

• hallucinations

• visual changes

• respiratory changes

• decreased consciousness

what would indicate the use of humidification in oxygen therapy?

• flow rate equal to or more that 4 L/minute
  (replace sterile waster every 24 hrs)

equipment for oxygen therapy

• oxygen output/source/outlet (on the wall)

• flow meter (attaches to oxygen source to control flow)

• extension tubing

• oxygen delivery device

how would you position the ball inside the oxygen flow meter when setting flow

align the middle of the ball with the corresponding line for the desired amount of oxygen

What goes into account when choosing an oxygen delivery device?

• reason for the need of oxygen therapy

• flow rate prescribed

• length of treatment

what is FiO₂

fraction of inspired oxygen→ what the patient breathes in
oxygen concentration (%) per litter

• 1 L of oxygen (flow rate) = 24% oxygen concentration (FiO₂ )

• to calculate FiO₂ you multiply the flow rate in liters by 4 and add 20
  - example: 6 L x 4 + 20 = 44% FiO₂ =]
  
  

This is under normal circumstance. patient’s breathing depth and rate must also be considered, as they can affect the actual FiO₂ delivered to the patient.

Nasal Cannula oxygen range of flow rate

1- 6 L

• most often used

• usually 7- 14 feet long

• has two small prongs that fit into the nostrils

• variable sizes for various age groups

When is nasal cannula usually used

when treating patients with minor/non critical breathing problems or those not tolerating a mask

doesn’t require humidification unless flow rate exceeds 4 L

Simple face mask

• holes allow for 75% of inspired air to come from outside the mask

• used for moderate flow rate in a short period of time

• NOT be used with rates lower than 5 L due to carbon dioxide build-up.

• consider humidification
  
  

simple face mask range of oxygen flow rate

5-10 L of oxygen per minute

nonrebreather mask

Mask fitted with one-way inhalation and exhalation valves so that al exhaled gas is vented out and inhaled gas comes only from a reservoir connected to the mask

• used to deliver high flow rates & high oxygen concentration

• typically used in emergencies

• has vents on each side covered by flaps to prevent breathing in room air

• reservoir bag is inflated with pure oxygen (nearly 100%)

• do not allow bag to deflate. risks patient breathing in carbon dioxide

Non-breather face mask flow rate

10-15 L
maintaining reservoir bag 2/3 full

(80-95% FiO₂)

Venturi Mask

• used for the critically ill

• most commonly used for COPD patients

• MOST ACCURATE FORM OF OXYGEN DELIVERY

• require specific concentrations of oxygen

• has holes on side of mask to allow exhaled air to escape

• CO2 build-up is minimal

• interferes with eating (nasal cannula can be used temporarily to allow patients to eat )

Venturi mask flow rate range

4-15 L of oxygen per minute,

delivering precise concentrations of oxygen.

Face tent

• alternative for claustrophobic patients who cannot tolerate a standard mask.

• often used after nasal and oral surgery

• difficult to control precise FiO₂ levels.

flow rate of oxygen for a face tent

at least 10 L of oxygen per min

Oxygen hood

Canopy that provides control of temp, humidity, and oxygen concentration

• for pediatric patients (usually)

• treat airway inflammation, infection and croup

• ensure enough open space around neck to allow carbon dioxide to escape

range of oxygen flow rate for Oxygen hood

10-15 L / min

Manual resuscitation bag

• used to provide high concentration of oxygen through oxygen port

• use prior to a procedure (suctioning, intubating)

• during respiratory or cardiac arrest, or when having trouble breathing

• inflates from ambient air/oxygen source only

range of oxygen flow rate for manual resuscitation bag

10-15 L per min

tracheostomy mask (or collar)

• fits into the tracheostomy opening to deliver oxygen directly

• neck straps secure mask in place

• requires continuous humidification because it bypasses upper respiratory tract

T-tube (t-piece)

t-shaped adapter used to provide air or supplemental oxygen to an endotracheal or tracheostomy tube.

oxygen flow rate for a tracheostomy mask (collar)

& t-piece

10 L per min

Mechanical ventilation

Use of a ventilator to assist or replace spontaneous breathing by delivering positive-pressure breaths to the lungs. (negative pressure included but uncommon)

noninvasive ventilation

used to maintain positive airway pressure and to improve alveolar ventilation without the need of an artificial airway. the two types are

• CPAP - one consistent pressure

• BiPAP - 2 different pressures: higher during inhalation & lower during exhalation

CPAP

positive airway pressure device used often to treat sleep apnea preventing upper airway from collapsing

• same pressure for both inspirations and expirations

• water pressure 5-20 cm of water

BiPAP

provides two levels of pressure

• higher pressure during inspiration

• lower pressure during expiration

• increase in the amount of air at the end of a normal expiration (FRC-functional residual capacity)

• reduce airway closure and improved oxygenation

• helps maintain airway/alveolar pressure

Compressed oxygen system

• sometimes used in a home

• supplied in nonliquid gas cylinder stored under high pressure measured in lbs per square inch (psi)

bulk liquid oxygen system

• usually used in a hospital

• stored outside the building at precise temperature

• delivered as gas through wall outlets in patient rooms

Oxygen cylinders use

• Cylinder key - used for opening and closing (or tightening neck)

• regulator

• pressure gauge (part of regulator) - indicates amount of oxygen left in tank(psi). red = empty

• flow meter (part of regulator) - used to control flow rate (L per min) -lefty loosey (opens) —> righty tighty (closes)

• oxygen delivery device -

available in different sizes and pressure capacities. Sizes come in form of letters and E is the most common for home use

safe use of oxygen tank

• keep away from fire/heat source or potential for sparks

• caution while using faulty electrical equipment (radios & electric razors)

• no use of electric or friction toys with kids

• display oxygen in use signs on doors

• notify family memebers

• keep tanks upright and secured with chain/appropriate holder

• avoid tank falls or falls with tank lol

• alway turn off tank after use

• keep an eye on levels to ensure adequate amount remaining

• keep tank in well ventilated area

• in area free of clutter

• NO SMOKING near

  
  

hypercapnia

a condition characterized by elevated levels of arterial carbon dioxide (CO₂) in the bloodstream, often resulting from inadequate ventilation. Symptoms may include headache, confusion, and shortness of breath.

hypoxemia

decreased levels of arterial oxygen saturation

-heart rate increases and arterial oxygen saturation falls below 94%

COPD oxygen therapy

• NEVER GIVE HIGH OXYGEN - risk of respiratory depression and increased carbon dioxide retention.

• placing patient in semi-fowler or high-fowler position helps facilitate lung expansion

• keep SPO2 between 90-93% on the lower flow rate possible

• high risk of hypoxemia, hypercapnia, and

• turning, repositioning, coughing, and deep breathing will promote ventilation

what to do first of oxygen therapy does’t seem to be improving patient

check to make sure equipment is functioning properly, correct oxygen delivery device, and make sure flow rate is set correctly.

What to assess for while providing oxygen therapy

• vitals including oxygen saturation

• skin color

• level of consciousness,

• assess skin of skin breakdown or irritation of nose, ears, and under chin

• consider padding pressure area to avoid skin problems

when is oxygen required at home

when patients cannot maintain oxygen saturation 88% or grater

• COPD (emphysema or chronic bronchitis)

COPD

It is a chronic lung disease that causes persistent airflow obstruction, making it difficult to move air out of the lungs.

two main types are chronic bronchitis and emphysema.

emphysema (a type of COPD)

In emphysema, the walls between alveoli are destroyed & disappear, causing neighboring alveoli to merge into larger, abnormal air spaces.

• Alveolar wall destruction → larger air spaces → less surface area for gas exchange (walls) → air trapping

• Patient has difficulty getting air out

Chronic Bronchitis (a COPD condition)

A type of COPD characterized by a chronic productive cough for at least three months in two consecutive years. It involves inflammation of the bronchial tubes, leading to increased mucus production and airway obstruction.

Chronic bronchitis: excess mucus + airway inflammation → airways become narrowed/obstructed → difficult to move air out.

three types of oxygen therapy delivery systems for home use

• compressed gas cylinders or tanks - 15 L/min (inexpensive)

• liquid oxygen systems - 6 L/min (expensive) - need refill by patient

• oxygen concentrators - 4-5 L/min (least expensive)

oxygen concentrators

• takes room air and removes nitrogen, water, vapor, and hydrocarbons out of room air causing oxygen to concentrate.

• concentration of oxygen decreases as flow rate increases (going too fast to concentrate)

• require electricity outlet - plan for backup incase of outage

• alarm goes off until the desired inside pressure is reached