Oxygen Therapy and Hypoxia Management

• Oxygen therapy addresses conditions causing impaired gas exchange and hypoxia
• Prompt initiation of oxygen therapy and adherence to medication administration rules are crucial
• Hypoxia severity, age, overall health, current disease, and medical history all affect how a patient responds to hypoxia

Signs and Symptoms of Hypoxia

• Restlessness, confusion, anxiety, elevated vital signs, and cyanosis can indicate hypoxia
• Untreated hypoxia can lead to decreased activity, confusion, reduced consciousness, and coma

Oxygen Therapy Equipment

• Essential equipment includes a flow meter, extension tubing, and an oxygen-delivery device
• Humidification with sterile water is required when the flow rate exceeds 4 L/min

Oxygen Flow Meter

• Attaches to the oxygen outlet to regulate oxygen delivery to patients
• Most hospitals use flow meters indicating liters per minute (L/min).

Oxygen-Delivery Devices

• Various devices include nasal cannulas, simple masks, partial rebreather masks, and non-rebreather masks
• The device choice relies on the patient's needs and the required flow rate

Initiating Oxygen Therapy

• Assess the patient's oxygen saturation and vital signs before starting oxygen therapy
• Choose the proper oxygen-delivery device and flow rate based on the patient's needs
• Regularly monitor the patient's response to therapy and adjust the oxygen flow and device usage as necessary

Setting Up Oxygen Therapy

• Flow meter should be connected to the oxygen outlet marked with a green label not an air outlet which is yellow
• Six-foot tubing should be used for bedridden patients
• Sterile water for humidification should be replaced every 24 hours

Parts of the Flow Meter

• Two metal prongs for the wall outlet
• Green collar to release the flow meter
• A cylinder with numbers and lines for liters per minute (L/min).
• Knob to adjust the flow rate
• Adapter for extension tubing and oxygen-delivery device

Oxygen-Delivery Device Selection

• Consider patient's condition, age, consciousness, airway, and environment
• Options include nasal cannulas, simple and nonrebreather face masks, Venturi masks, face tents, and oxygen tents

Nasal Cannulas

• It is a common device for oxygen therapy
• Oxygen concentrations delivered range from 24% to 44% with flow rates of 1 to 6 L/min
• Easily used, mostly tolerated by patients

Humidification

• Required for high flow rates (FiO2 of 4 L/min or more)
• Attach a sterile water bottle to the oxygen-delivery equipment

Oxygen Masks

• A simple face mask is suitable for short moderate flow rate needs, with oxygen concentrations of 35%–60% with flow rates from 5 to 10 L/min
• Flow rates must be cautiously monitored with a simple mask greater than 5 L/min to avoid carbon dioxide buildup

Nonrebreather Face Mask

• Provides high flow rates and oxygen concentrations of 80% to 95% with flow rates from 10 to 15 L/min
• Ensure the reservoir bag remains inflated to prevent the patient from re-breathing exhaled carbon dioxide

Partial Rebreather Mask

• Delivers an FiO2 of 60% to 90% with a flow rate of 10 to 15 L/min.
• It has ports for exhaled air to escape and mixes some exhaled air with the inspired air

Venturi Mask

• Mask for critically ill patients needing specific oxygen concentrations
• Different size adapters are used to deliver a fixed or predicted FiO2, to minimize carbon dioxide buildup
• Humidifiers aren't typically used.

Face Tent

• An alternative to an aerosol mask for patients who feel claustrophobic with an aerosol mask
• Composed of a soft mask that fits under the chin and loosely covers the mouth and nose
• Adjustable elastic strap holds it in place
• Delivers oxygen concentrations of 24% to 100% with flow rates of at least 10 L/min

Manual Resuscitation Bag

• Used to provide high concentrations of oxygen to a patient prior to a procedure and during respiratory or cardiac arrest
• Can assist patients who are breathing but not adequately

Tracheostomy Mask

• A small mask that fits over a tracheostomy site
• An adjustable elastic strap secures it around the patient's neck
• Has an exhalation port that remains patent and a port connected to the oxygen source with large-bore tubing

T-Piece

• A T-shaped device connects the oxygen source to the artificial airway (endotracheal tube or tracheostomy)
• The recommended flow rate with a T-tube is 10 L/min, with a nebulizer set at the appropriate oxygen concentration

Importance of Humidification

• Continuous humidification is required for patients with artificial airways
• It is since the airway bypasses the normal filtering and humidification process
• Two devices used are a T-piece and a tracheostomy mask

Noninvasive Ventilation

• Maintains positive airway pressure to improve alveolar ventilation
• Commonly used for congestive heart failure, sleep disorders, and pulmonary diseases

CPAP and Oxygen Tents/Hoods

• CPAP provides set positive airway pressure, prevents upper airway collapse
• Oxygen tents and hoods for pediatric clients with airway inflammation or infections
• Oxygen hood delivers 28% to 85% oxygen concentration

Oxygen Cylinder Preparation

• A key, regulator, pressure gauge, flow meter, and oxygen-delivery device is used
• Regulator pressure gauge indicates the pressure in the cylinder
• Flow meter controls the oxygen delivery rate in liters per minute

Oxygen Therapy Precautions

• Check the oxygen cylinder and flow rate before placing the oxygen-delivery device on the patient
• Ensure no open flames or potential sparks are present when oxygen is in use
• Display an "Oxygen In Use" sign
• Handle oxygen tanks carefully and store them upright
• Monitor patients receiving oxygen therapy closely, notably those with COPD, maintain SpO2 between 90% and 93% on the lowest flow rate possible
• Position patients in a semi- or high-Fowler's position to facilitate lung expansion

Preventing Complications

• Perform respiratory assessment and document patient's condition if oxygen therapy doesn't improve hypoxia
• Obtain a prescription for adjusting the flow rate

Preventing Irritation and Skin Breakdown

• Consider padding areas where the oxygen-delivery device comes into contact with the client's skin
• Inspect the nose, ears, and under the chin for redness, irritation, and skin breakdown

Hazards of Oxygen Therapy

• Fire
• Equipment malfunction
• Pressure hazards

Client and Family Education

• Educate on the safe use of oxygen.
• Teach children receiving oxygen therapy not to play with electric or friction toys

Home Oxygen Therapy

• Recommended if the flow rate is 4 L/min or more
• Increase fluid intake and oral care to alleviate dryness of mucous membranes
• Indicated for patients unable to maintain oxygen saturation of 88% or greater
• Commonly used for patients with COPD, emphysema, advanced cardiac disease
• Improves exercise tolerance and reduces fatigue
• Used for hospice clients to manage dyspnea and can be administered via nasal cannulas, face masks, T-tubes, or trach collars

Home Oxygen Delivery Systems

• Compressed gas cylinders are inexpensive and require no electricity, but are bulky and heavy, delivers oxygen up to 15 L/min
• Liquid oxygen systems are expensive and require no electricity, but evaporation occurs when not in use, and delivers oxygen up to 6 L/min
• Oxygen concentrators, while least expensive and not ambulatory, have decreasing oxygen concentration as liter flow increases, with most units delivering 4 or 5 L/min

Safety Considerations

• No smoking
• Caution with electrical equipment
• Maintain a well-ventilated area
• Have a backup system for electrical failures (if using an oxygen concentrator)
• Know whom to call for equipment malfunction

Documentation

• Provides information about care, client status, and communication between health care workers
• Essential for quality and continuity of care

General Documentation Guidelines

• Format for documentation varies by agency
• All health care providers, including students, must follow HIPAA regulations.
• In clinical settings, students should gather only necessary information from the client's medical record
• Student-prepared materials must exclude identifiable demographic information

Documentation for Oxygen Therapy

• Date and time oxygen therapy was initiated
• Method of oxygen delivery (cannula, simple mask)
• Flow rate in liters per minute
• Condition of the client's skin where the delivery device rests (ears, nose)
• Respiratory assessment findings before and after oxygen therapy
• Client's response to oxygen therapy and any adverse reactions
• Any client and family teaching done

HIPAA Regulations

• HIPAA regulations protect patient privacy and confidentiality
• Healthcare providers must adhere to HIPAA regulations when documenting patient care