Lec 10: Oxygen therapy

what is the order of a resp assessment

• inspection

• auscultation

• palpation

• percussion

wheezing def

• high pitched musical note

• from air traveling through narrow passage on inspiration

• common in asthma

Cough def/purpose

• to clear bronchi of irritant

• productive, non productive

• ask pt about quality of cough

dyspnea def

• subjective

• difficulty breathing

• due to underlying pulmonary or heart disease

• sign of hypoxia

Risk factors for potential oxygenation issues include

• smoking

• substance exposure and/or abuse=causes malnutrition=anemia

• pain

• fatigue

Risk factors for oxygenation issues in the older adult

• atherosclerotic plaques

• osteoporosis

Oxygen therapy def/purpose/characteristics

• used to relieve or prevent tissue hypoxemia

• is often used in conjunction with other interventions

• requires a prescribers order

• treated like a medication- so all rights and checks apply

• once initiated, pt needs to be continuously assessed

• complications can arise and safety measures followed

what are the diff ways oxygen can be administered

• nasal cannula

• simple face mask

• mask with reservoir bag

• face tent=if mask not tolerable

• oxygen hood=usually for children

• oxygen tent=children, ten must be filled 1st

nasal cannula

• most common

• The easiest tolerated

• easily dislodged, can cause dryness, can cause blockage if deviated septum

• can talk/eat with it

• best for low flow oxygenation, 1-6 LPM (high flow 6-15) or 24-44% Fio2

nasal cannula oxygen concentrations

• 1L/min=24% fio2

• 2L/min=28% fio2

• 3L/min=32%

• 4L/min=36%

• etc

administration guidelines for nasal cannula

• check patency of nostrils with penlight, put prongs in nostrils

• position canula tubing behind ears and under chin, secure under chin with clip

Simple face mask

• medium to high flow oxygen

• 6-10L/min or 40-60% fio2, never less

• not for long term use,, uncomfortable

• must remove for eating

• best used post surgery/recovery

administration guidelines for simple mask

• ensure mask is tight fitting

• place mask over pts nose, mouth, and chin, then mold metal to bridge of nose

• minimum flow rate is 6L or co2 will build up

Mask with reservoir bag

• higher flow oxygen flow, 10-15LPM

• bag must be inflated 2/3rds during inspiration

• best for emergencies

Do you always need an order for oxygen?

yes but if o2 sat is less than or equal to 90% or if no pulse oximeter available and pt has signs of hypoxia, you are allowed but must require to contact provider for an order

Oxygen orders examples

Darth Vader

 ULI# 123456789

 DOB: 01/01/50

 November 17, 2025

 Administer oxygen at 2L/min via nasal canula continuously

 Dr. Athena Grant

DarthVader

 ULI# 123456789

 DOB: 01/01/50

 November 17, 2025

 Administer oxygen to maintain a saturation above 90% via nasal canula continuously

 Dr. Athena Grant

AHS oxygen therapy titration tool pic

diff oxygen devices and flow rates pic

do medication checks/rights apply to oxygen

yes, its a medication

Conditions that can lead to alterations in oxygenation

• hypoxia (normal sat is ≥92%)=can occur with others on list

• pneumonia

• airway obstruction (complete or partial)

• COPD

• asthma

Oxygen Toxicity def/cause

when too high a concentration of oxygen (> 50-60%) is administered for an extended period (longer than 24 hours).

• causes an overproduction of free radicals, if not tx, free radicals can damage/kill cells

s&s of oxygen toxicity

• substernal pain

• paresthesia

• dyspnea

• restlessness

• fatigue

• malaise

• progressive respiratory difficulty

• refractory hypoxia

• atelectasis

• infiltrates

strategies for Prevention of Oxygen Toxicity

• lowest amount of oxygen is used to obtain the necessary PaO2 level

• if possible decrease or monitor the amount of time on higher oxygen levels

• tx the underlying cause or why the o2 is needed

• monitor often for s&s and report immediately

Safety reminders in Oxygen Therapy

• oxygen is highly combustible

• inform everyone that oxygen is in the area ex verbal reminder, put signage in room, no smoking

• remove items that cause spark

• o2 tank should be stored upright and secured with a chain or in a holder

• ensure all electrical equipment is functioning or correctly grounded

• ensure you are up to date on fire safety and procedures

• pt/family education on o2 safety

• ensure adequate portable oxygen supply should pt leave the unit

comfort and hygiene measures related to oxygen therapy

• assess for areas of redness, dryness and skin breakdown (where equipment is in contact with skin) every 4 hrs

• use water based nasal ointment

• cleanse the skin that is contact with any oxygen equipment

• good care of the nares, lips and oral mucosa

list Interventions to promote airway clearance

• positioning=pt upright, semi/high fowler

• deep breathing & coughing=opens up alveoli, increased gas exchange

• incentive spirometer

• hydration

• chest physio

• postural drainage

diff types of Deep Breathing & Coughing

• diaphragmatic breathing=strengthens diaphragm

• pursed lip breathing=prolongs exhalation stage, prevents airway collapse, increases airway pressure during expiration=reduces amount of air trapped

• huff coughing=lean forward cough twice, huff on exhale, forces air out and increases airway expansion

Incentive spirometer

• for post op pts

• increases pt intake of air, needs pt teaching

• suck in mouthpiece

• flow oriented has >1 ball, keep balls up long as possible

• helps gas exchange, loosens excretions

how often should a pt use an incentive spirometer

4 times every hr, taking 10 breaths each time

• practice coughing after

why is hydration important

as a person becomes dehydrated, their airway secretions become thicker

• thicker=harder to breathe

• use a humidifier in room

Chest Physiotherapy (changing of positions) & Postural Drainage techniques

helps clear secretions

• percussion=pt must breath slow/deeply, uses fists

• vibration=done when pt exhales through pursed lips, used instead of percussion if in pain

Oropharyngeal & Nasopharyngeal Suctioning

• clears the oral airway of secretions

• prevents pooling of secretions

• never longer than 10-15s

• uses negative pressure

• for when yankauer device ineffective

• apply pulse oximeter throughout

Discharge education for pts

• be aware of hydration status and diet

• use of water soluble nasal sprays, balms and moisturizers

• cautious if smoking or around those who are smoking

• potential complications such as pneumonia

If Mr. Vader is breathing room air, the Fi02 (% of inspired air) that he is breathing is which of the following?

21%

what if a pt has pneumonia with thick secretions and coughing

humidification of oxygen is recommended to loosen secretions

what factors determine if pt needs oxygen therapy

• need

• o2 sat levels

• doctor/resp therapist recommendations

• hypoxemia

emphysema def

condition where alveoli become abnormally enlarged and destroyed over time

• condition of COPD with chronic bronchitis

how should we administer o2 to pt with COPD

• titrate o2 to lowest effective dose according to o2 sat levels

• continually assess pt

what positions are best during postural drainage for specific lobes

• secretions=upright

• lower/middle lob bronchi=head down position

• upper lobe bronchi=head up position

does suctioning require gloves

yes

how often do we check the nasal cannlua/oxygen device

every 8 hrs, keep the humidification container filled at all times

what do we do before administering any oxygen

check dosing etc and resp assessment on pt

if at oxygen flow rate at 4L/min or longer/higher, what do you do

add humidification

do we check the oxygen level in the portable cylinder before you ambulate or transport a patient

yes

what diff techniques can you use to collect a sputum sample

expectoration or by suctioning (in nose, suction valve off, 2-10ml)

• do not use mouthwash or toothpaste before

• take deep breaths before coughing into cup (5-10ml)