Oxygen Therapy and Delivery Devices

Oxygen Therapy

• Initiated to treat and prevent hypoxia, a condition resulting from insufficient oxygen supply to cells, tissues, and organs.
• Indications: PaO2 < 60 mmHg, SaO2 < 90%, fever, infection, anxiety, or anemia.
• Contraindications: Generally no contraindications with appropriate assessment of respiratory disease and indications. Exercise extreme caution with patients who have chronic hypercapnia (high PaCO2).
• Monitoring: Physical assessment, pulse oximetry, and arterial blood gas (ABG) analysis.
• ABG values: pH: 7.35-7.45; PaCO2: 35-45 mmHg; HCO2: 22-26 mEq/L; PaO2: 80-95 mmHg.

Oxygen Delivery Devices

• Nasal cannula: Low flow device delivering 24%-44% oxygen (1-6 L/min). Most common, comfortable, and easy to use.
• Simple face mask: Moderate flow device delivering 40%-60% oxygen (5-10 L/min). Suitable for short-term use and patient transportation.
• Partial rebreather mask: Low flow device delivering 50%-75% oxygen (8-10 L/min). Reservoir bag stabilizes oxygen levels.
• Nonrebreather mask: Low flow device delivering 90% oxygen (10 L/min). One-way valves prevent rebreathing of CO2.
• Venturi mask: High flow device delivering 24%-60% oxygen (2-15 L/min). Delivers precise oxygen concentrations.
• Aerosol mask: High flow device for patients needing humidified oxygen and thick secretions.
• T-piece adapter: Used when weaning from a mechanical ventilator.
• Face tent: High flow device for patients with facial trauma, burns, or upper airway surgery. Delivers up to 60 L/min.

Alterations in Oxygenation

• Influenza (Flu): Highly contagious viral infection spreading person-to-person via aerosolized droplets. Symptoms include rapid onset, fever, headache, sore throat, nasal congestion, cough, myalgia and fatigue.
• Diagnosis typically involves rapid influenza diagnostic tests (RIDTs) and/or sample respiratory secretion testing. Treatment includes annual vaccination, hand hygiene, avoiding secondary smoke and vaccination for pneumonia. Risk factors include older adults (65+), immunocompromised individuals (HIV/AIDS), and COPD patients.
• Pneumonia: In extreme cases, influenza can lead to pneumonia. Risk factors include immunocompromised individuals, HIV/AIDS, COPD and elderly adults.

Chronic Respiratory Diseases

• Manifestations include fever, chills, tachypnea/ tachycardia, dyspnea, cough (productive and nonreproductive), chest pain, fatigue and rusty sputum, malaise and respiratory distress.
• Interventions involve prioritizing antibiotics, bronchodilators, increased fluid intake, elevated position, incentive spirometer, monitoring for sepsis, pneumonia, and infection control. Prophylactic measures such as vaccinations and infection control like hand hygiene should be prioritized.

Tuberculosis

• Tuberculosis (TB) is a potentially serious infectious bacterial disease, frequently affecting the lungs. Symptoms include chronic productive cough, excess mucus production, shortness of breath, wheezing, cyanosis, and frequent respiratory infections.
• Diagnosis can include chest X-rays, pulmonary function tests (PFTs), arterial blood gas (ABG) testing, sputum cultures, and skin tests.
• Management often involves smoking cessation, bronchodilators, corticosteroid use and oxygen therapy according to severity.

Asthma

• Airway inflammation leading to bronchospasm and shortness of breath, chest tightness, and coughing.
• Clinical manifestations may include dyspnea, chest tightness, coughing (dry cough), wheezing, and increased respiratory rate.
• Treatment usually involves corticosteroids, bronchodilators, and anticholinergics. Assessment includes patient history, pulmonary function tests (PFTs), chest x-rays, and ABG testing.
• Status asthmaticus: A severe form of asthma characterized by rapid onset and potential for acute ventilatory failure.

COPD

• A group of lung diseases including Chronic Bronchitis and Emphysema. Symptoms include chronic low oxygen saturation, shortness of breath, use of accessory muscles, anterior-posterior diameter change and productive cough. Management includes high calorie high protein diet, good hydration, interventions for deep breathing and coughing, and medication/nursing interventions tailored to the specific condition.

Additional Issues

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