Administering Oxygen Therapy

• Improves tissue oxygenation.
• There are several indications for oxygen therapy:
• Hypoxia/hypoxemia.
• Decreased cardiac output.
• Increased oxygen demand.
• Decreased oxygen carrying capacity.
• Increased myocardial workload.
• Procedures that may cause hypoxemia.

• The device for delivery of oxygen should be chosen based on the oxygen delivery needs of the patient.

  See Fig. 8.1A Oxygen-Delivery Systems

• Low-flow devices do not provide the total inspired gas; the remainder of the inspired volume is from the surrounding room air. Low-flow devices include
• Nasal cannula.
• Simple face mask.
• Partial rebreather mask.
• Trach collar (used with tracheostomy).
• T-piece (used with tracheostomy and endotracheal tube).
• High-flow devices provide the entire total inspired gas to the patient. High-flow devices include
• Nonrebreather mask (used with nasal or oral airway).
• Venturi mask (used with nasal or oral airway).
• Mechanical ventilator (used with tracheostomy, endotracheal tube, nasotracheal tube).

Special Considerations

Nasal Cannula

• 1–6 L/min delivers 24% to 44% oxygen.
• May cause pressure sores on ears—place gauze pads under cannula at tops of ears.
• May cause dryness and pressure sores in nares—give nasal care every 8 hours, and check position of cannula to ensure that continuous pressure is not concentrated on one spot.

Simple Face Mask

• 6–10 L/min delivers 40% to 60% oxygen.
• Hot, confining, and uncomfortable—clean face mask and wipe face every 4–8 hours.
• Places pressure on bridge of nose and ears—pad with gauze pads to prevent pressure sores and necrosis.
• Interferes with eating and drinking.

Partial Rebreather Mask

• 6–10 L/min delivers 35% to 60% oxygen.
• Never let bag totally deflate because this may cause CO₂ retention.
• Places pressure on bridge of nose and ears—pad with gauze pads to prevent pressure sores and necrosis.
• Interferes with eating and drinking.

Nonrebreather Mask

• 6–10 L/min delivers 60% to 100% oxygen.
• Places pressure on bridge of nose and ears—pad with gauze pads to prevent pressure sores and necrosis.
• Interferes with eating and drinking.

Venturi Mask

• 4 L/min delivers 24% to 28% oxygen.
• 8 L/min deliver 35% to 40% oxygen.
• Places pressure on bridge of nose and ears—pad with gauze pads to prevent pressure sores and necrosis.
• Interferes with eating and drinking.

Safety and Toxicity Considerations

• Some special safety considerations pertain to all types of oxygen therapy including keeping oxygen away from open flames and smoking, and using only water-soluble lubricants and creams with those receiving oxygen therapy.
• Also make sure to observe patient for signs of oxygen toxicity such as substernal retractions, paresthesias in extremities, dry cough, dyspnea, anorexia, nausea, vomiting, fatigue, lethargy, malaise, restlessness, and progressive ventilatory difficulty.

Hypoxic Patient

• Patients who are hypoxic often become combative and may need to have constant supervision and alternative methods, including the possibility of restraints, to facilitate the continuation of oxygen therapy via an artificial airway.

Elderly Patient

• Older adults are at greater risk for skin breakdown; therefore, more frequent skin assessment may be necessary in these individuals.

Relevant Nursing Diagnoses

• Impaired gas exchange related to disease process

• Oxygenation saturation improves
• Tissue oxygenation improves
• Patient's hemodynamics improve

• For all types of oxygen delivery, the following are needed:
• Oxygen source
• Oxygen flowmeter
• Humidifier (if ordered)
• Specific type of oxygen delivery system (nasal cannula, simple face mask, partial rebreather mask, nonrebreather mask, Venturi mask)

Nasal Cannula

• Wash hands.
• Reduces transmission of microorganisms.
• Organize equipment.
• Organizing equipment before beginning procedure enhances efficiency and patient safety.
• Explain procedure to patient.
• Ensures that patient is informed, and decreases patient anxiety.
• Prepare humidifier: Add distilled water if needed or remove prefilled humidifier from package and screw enclosed spike cap to bottle.
• Delivers humidified oxygen to mucous membranes of airway.
• Connect humidifier to flow meter, and connect humidifier to tubing attached to cannula.
• Controls flow of oxygen and connects humidification to oxygen delivery system.
• Turn oxygen flowmeter on until bubbling is noted in humidifier.
• Ensures connections are intact and that oxygen delivered will be humidified.
• Check order.
• Adjust flow of oxygen via flowmeter.
• Regulates oxygen flow delivery.
• Put on gloves.
• Reduces transmission of microorganisms.
• Place tips of cannula in patient's nares; fit tubing over ears, tighten tubing under chin, and adjust to proper fit.
• Ensures proper fit of nasal cannula.
• Position patient for comfort and ease of breathing with head of bed elevated.
• Facilitates lung expansion for adequate gas exchange.
• Evaluate patient's respirations and oxygen saturation.
• Determines adequacy of oxygen delivery system for patient.

Simple Face Mask, Partial Rebreather Mask, Nonrebreather Mask, Venturi Mask

• Wash hands.
• Reduces transmission of microorganisms.
• Organize equipment.
• Organizing equipment before beginning procedure enhances efficiency and patient safety.
• Explain procedure to patient.
• Ensures that patient is informed and decreases patient anxiety.
• Prepare humidifier: Add distilled water if needed or remove prefilled humidifier from package and screw enclosed spike cap to bottle.
• Delivers humidified oxygen to mucous membranes of airway.
• Connect humidifier to flowmeter, and then connect humidifier to mask tubing.
• Controls flow of oxygen and connects humidification to oxygen delivery system.
• Turn oxygen flow meter on until bubbling is noted in humidifier.
• Ensures connections are intact and that oxygen delivered will be humidified.
• Adjust flow of oxygen via flowmeter (with Venturi mask, attach oxygen percentage regulator to oxygen mask and regulate flow as indicated).

  See Fig. 8.1B Oxygen Percentage Regular

• Regulates oxygen flow delivery.
• Put on gloves.
• Reduces transmission of microorganisms.
• Place mask over nose, mouth, and chin; adjust metal strip over bridge of nose to fit securely; and pull elastic band around back of head and tighten to fit.
• Ensures proper fit of mask.
• Position patient for comfort and ease of breathing with head of bed elevated.
• Facilitates lung expansion for adequate gas exchange.
• Evaluate patient's respirations and oxygen saturation.
• Determines adequacy of oxygen-delivery system for patient.

[Outline]

• Nasal Cannula
• Simple Face Mask, Partial Rebreather Mask, Nonrebreather Mask, Venturi Mask

Evaluation and Follow-Up Activities

• Assess the patient's:
• Oxygen saturation, and compare to baseline
• Quality of and rate of respirations, and compare to baseline
• Vital signs, and compare to baseline
• Comfort level

Key Points for Reporting and Recording

• Assessment of the patient's respiratory status prior to initiation of oxygen therapy, including oxygen saturation and a description of respirations including rate.
• Type of oxygen-delivery method initiated.
• Time of initiation of oxygen-delivery method.
• Percentage of oxygen currently being given.
• Assessment of patient's respiratory status after initiation of oxygen therapy to include oxygen saturation and a description of respirations, including rate.