NSG-112-RLE-OXYGEN-THERAPY-24-25-SC PDF

OXYGENATION THERAPY SEC. DEF Nasal Cannula, Simple Face Mask, Partial Rebreathing Mask Non Rebreathing Mask, Face Tent, Tracheo T-Bar, Venturi Mask Lemar A. Detorio, MAN, RN, PT, PHDN© NSG 112 RLE1st SEMESTER 2024-2025...

OXYGENATION THERAPY SEC. DEF Nasal Cannula, Simple Face Mask, Partial Rebreathing Mask Non Rebreathing Mask, Face Tent, Tracheo T-Bar, Venturi Mask Lemar A. Detorio, MAN, RN, PT, PHDN© NSG 112 RLE1st SEMESTER 2024-2025 ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  LEARNING OBJECTIVES After the lecture/discussion, you will be able to: 1. Recall the anatomical & physiological concept of respiratory system and its assessment 2. Discuss oxygen therapy as one component of non-invasive respiratory therapy 3. Explain oxygen administration system & its classifications 4. Utilize the concept of oxygenation therapy in the provision of safe & quality nursing care 5. Formulate nursing care plan using the nursing process as a framework of care. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OVERVIEW ▪ The respiratory system performs its functions through pulmonary ventilation, respiration, and perfusion. ▪ Normal functioning depends on three essential factors: 1. The integrity of the airway system to transport air to and from the lungs 2. A properly functioning alveolar system in the lungs to oxygenate venous blood and to remove carbon dioxide from the blood 3. A properly functioning cardiovascular and hematologic system to carry nutrients and wastes to and from body cells ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  NON – INVASIVE RESPIRATORY THERAPY 1. Oxygen Therapy 2. Nebulizer Therapy 3. Incentive Spirometry (Sustained Maximal Inspiration) 4. Chest Physiotherapy Note: ▪ Therapy for respiratory conditions range from simple and non-invasive and highly invasive treatment. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY [SUPPLEMENTAL OXYGEN] ▪ an intervention for administering more oxygen than is present in the atmosphere to prevent or relieve hypoxemia [administer O2 @ a concentration greater than that found in the environmental atmosphere] GOAL ▪ Provide adequate transport of oxygen in the blood while decreasing the work of breathing & reducing the stress on myocardium. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY INDICATIONS ▪ Change in patient’s RR or pattern A. HYPOXEMIA ✓ Decrease in in the arterial oxygen tension in the blood [cardiac emergencies] Manifestations 1. Changes in mental status 4. Changes in HR 7. Diaphoresis 2. Dyspnea 5. Dysrhythmias 3. Increase blood pressure 6. Central cyanosis (late sign) ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY INDICATIONS B. HYPOXIA ▪ Decrease in oxygen supply to the tissue ▪ can occur from either severe pulmonary disease (inadequate oxygen supply) or from extra-pulmonary disease (inadequate oxygen delivery) e.g. Blood disorders ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY INDICATIONS Respiratory Emergencies ▪ Atelectasis, adult RDS impair diffusion, alveolar hypoventilation [O2 administration can reduce pt’s ventilatory effort & boost alveolar oxygen level.] Cardiac emergency ✓ myocardial infarction (MI) or cardiac arrhythmia [O2 administration helps meet the increased myocardial workload.] ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY INDICATIONS C. SUPPLEMENTARY O2 ▪ Chronic Obstructive Pulmonary Disease (COPD) [ 50%) is administered for an extended period (longer than 48 hours) CAUSES ▪ Overproduction of oxygen free radicals Signs & symptoms: 1. Substernal discomfort 3. Dyspnea 5. Fatigue 2. Paresthesia’s 4.Restlessness ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY COMPLICATIONS B. SUPPRESSION OF VENTILATION ▪ In COPD, NEVER administer O2 by nasal cannula at more than 2 LPM because some pts become dependent on a state of hypercapnia [too much carbon dioxide (CO2) in the blood, caused by hypoventilation of the body which leads to CO2 retention, elevation in the partial pressure of carbon dioxide (PaCO2) & hypoxia to stimulate their above 45 mm Hg on Arterial Blood Gas readings] respirations, & supplemental O2 could cause them to stop breathing. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY COMPLICATIONS Retrolental Fibroplasia/ retinopathy of prematurity ▪ severe constriction of retinal vessels at the time of high O2 exposure w/c will later result to fibroblastic overgrowth of the retina leading to blindness ▪ Prolonged high concentration of O2 can cause lung injury, surfactant activity may be impaired & increased capillary congestion, edema SYMPTOMS ▪ coughing ▪ substernal discomfort ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY Oxygen Toxicity ▪ lung damage develops if 60% of O2 concentration is administered for >24hrs ▪ one theory is 2֯ to reduce surfactant ▪ difficult to reverse BEST PREVENTION ▪ administer the lowest Fraction of Inspired Oxygen (FIO2 ) for the shortest amount of time SYMPTOMS ▪ Cough ▪ Dyspnea ▪ decrease pulmonary ventilation. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN ADMINISTRATION SYSTEMS CLASSIFICATIONS ▪ Choice depends on client’s oxygen needs, 1. Low Flow Systems comfort & developmental considerations ▪ ABG, pulse oximetry, & clinical examinations 2. High Flow Systems determine the adequacy of O2 therapy. LOW FLOW SYSTEMS ▪ contributes partially to the inspired gas the patient breathes [Nasal Cannula, Oropharyngeal catheter, Simple mask, Partial-rebreather , Non-rebreather mask] ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN ADMINISTRATION SYSTEMS HIGH FLOW SYSYTEMS ▪ Provide the total inspired air ▪ Indicated in patient who requires a constant & precise amount of oxygen [Transtracheal catheters, venturi masks, aerosol masks, tracheostomy collars, T-pieces, & face tents] ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN EQUIPMENT A. FLOWMETER ▪ A device that attaches to the oxygen outlet to adjust the amount of oxygen being delivered B. HUMIDIFIER ▪ Provided by containers of sterile water which maybe prefilled & are disposable ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph OXYGEN EQUIPMENT ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES LOW FLOW SYSTEM Oropharyngeal catheter ▪ Rarely used , prescribed for short-term therapy to administer low to moderate concentrations of oxygen Nasal Cannula ▪ Used when the patient requires a low to medium concentration of oxygen for which precise accuracy is not essential ▪ Delivers a low O2 concentration (24-45%) & flow rates of (2-6 L/min) ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES OROPHARYNGEAL CATHETER NASAL CANNULA ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph OXYGEN DEVICES ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES Simple mask ✓ Used to administer low to moderate concentrations of oxygen ✓ Cannot be used for controlled oxygen concentrations ✓ for O2 inhalation & has exhalation ports w/c allow CO2 to escape. ✓ O2 concentration (40-60%) @ flow rates of 5-8L/min ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES KEY TAKEAWAYS Simple mask ▪ The efficiency of any mask is affected by how well it fits the face (O2 leaks thus less O2 concentration). Advantage ✓ higher O2 concentration than cannula; effective for mouth breather & nasal disorders Disadvantage ✓ interferes w/ eating & talking; causes anxiety in claustrophobic patient, @ risk for rebreathing retained CO2 w/in the mask ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES PARTIAL REBREATHING MASK ▪ Have a reservoir bag that must remain inflated during both inspiration & expiration ▪ O2 concentration (60-90%) @ flow rates of 6-10L/min. ▪ inhales a mixture of atmospheric air, O2 from its source, O2 contained in the bag. ▪ total deflation of bag is avoided ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES KEY TAKEAWAYS [PARTIAL REBREATHING MASK] ▪ allows client to rebreathe 1/3 of exhaled air together w/ O2 and 2/3 of exhaled air ▪ Chances of CO2 build-up, if it happens (increase the FLOW RATE of O2) Advantage ✓ increase amount of O2 w/ lower flows Disadvantage ✓ requires minimum of 6L/min, suffocation, requires monitoring (bag remains inflated all the time) ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph OXYGEN DEVICES NOTE: ▪ Remove the mask and dry the skin every 2 to 3 hours if the oxygen is running continuously. Do not use powder ▪ around the mask. RATIONALE: ▪ The tight-fitting mask and moisture from condensation can irritate the skin on the face. There is a danger of inhaling powder if it is placed on the mask. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES 2/3 exhaled air 1/3 exhaled air ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES NON-REBREATHING MASK ▪ Delivers the HIGHEST O2 concentration (95-100%) @ flow rates of 10-15L/min. ▪ Similar in design to partial-rebreathing masks except that they have additional valves ✓ used in pt who requires ↑ O2 concentration ✓ one-way valves (bet. mask & bag). ✓ total deflation of bag is avoided. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES NON-REBREATHING MASK KEY TAKEAWAYS ▪ critically ill patient and may eventually need mechanical ventilation ▪ 100%; flow rate of 10-15L/min-spontaneously breathing patient ▪ bag-valve mask device patient who requires assisted ventilation ▪ ONLY the O2 in the bag is inhaled; all air is exhaled from the mask; NO atmospheric air is inhaled Disadvantage ✓ @ risk for O2 toxicity ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES KEY TAKEAWAYS ▪ When the non-rebreathing mask reservoir bag collapses more than slightly during inspiration, increase flow rate until you see only a slight deflation ▪ complete deflation indicates an insufficient flow rate. Keep the reservoir bag from kinking. ▪ Ensure free expansion of the reservoir bag. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES HIGH- FLOW SYSTEM VENTURI MASK ▪ The most reliable and accurate method for delivering precise concentrations of oxygen through non-invasive means ▪ Uses the Bernoulli principle of air entrainment (trapping the air like a vacuum) which provides a high airflow with controlled oxygen enrichment ▪ delivers O2 concentration PRECISELY (24-50%) @ flow rates of 4-10 L/min. ▪ mixes a precise amount of O2 and atmospheric air. ▪ it has an adapter w/in the tube ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES VENTURI MASK ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES HIGH- FLOW SYSTEM FACE TENT ▪ delivers an O2 concentration (30-55%) @ flow rates of 8-12 L/min. ▪ provides O2 to the nose and mouth ▪ useful for patient w/ facial trauma and burns; Advantage ▪ no discomfort of a mask (open and loose around the face);less likely to feel claustrophobic Disadvantage ▪ interferes w/ eating ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph OXYGEN DEVICES ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph OXYGEN DEVICES ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES HIGH- FLOW SYSTEM TRACHEOSTOMY COLLAR ▪ delivers an O2 concentration (24-100%) @ flow rates of 4-10 L/min. ▪ delivers O2 near an artificial opening in the neck. ▪ provides both oxygenation and humidification Disadvantage ✓ moisture that collects (tend to saturate the gauze dressing) ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES T-PIECE ▪ delivers an O2 concentration (24-100%) @ flow rates of 4-10 L/min. ▪ attached directly and securely to the artificial airway ▪ Connects to the endotracheal tube Advantage ▪ useful in weaning patients from mechanical ventilation ▪ allows water vapor to collect in tubing Disadvantage ✓ may pull on the tracheostomy tube ✓ may drain into airway during positioning ✓ causes coughing & discomfort due to the weight of the T-piece ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN DEVICES. ▪ attached directly and securely to the artificial airway ▪ Connects to the endotracheal tube Advantage ▪ useful in weaning patients from mechanical ventilation ▪ allows water vapor to collect in tubing Disadvantage ▪ may pull on the tracheostomy tube ▪ may drain into airway during positioning ▪ causes coughing & discomfort due to the weight of the T-piece ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph OXYGEN DEVICES ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OTHER OXYGEN DEVICES HYPERBARIC OXYGEN THERAPY ▪ involves breathing pure oxygen in a pressurized environment. ▪ a well-established treatment for decompression sickness, a potential risk of scuba diving. Hyperbaric Oxygen Therapy treats: ▪ air pressure is increased 2 to 3 times ▪ Serious infections. ▪ Bubbles of air in blood vessels. ▪ Wounds that may not heal because of higher than normal air pressure. [lungs can gather diabetes or radiation injury. ▪ air embolism, carbon monoxide much more oxygen than would be possible breathing pure oxygen at poisoning, gangrene, tissue necrosis & normal air pressure, helps fight bacteria & triggers the release of hemorrhage substances called growth factors and stem cells, which promote healing] ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY SAFETY PRECAUTION A. Fire hazards ▪ Oxygen supports combustion ▪ Prevent spark or fire in an environment where oxygen is being used ▪ Display a “no smoking” on the patient’s door ▪ Inspect all electrical equipment in the patient’s room ▪ Do not allow the patient to use electrical equipment ▪ Avoid using wool blankets ▪ Do not give electric or friction toys t children ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY SAFETY PRECAUTION B. Pressure hazard ▪ Handle oxygen tank with great care ▪ Large tank should be chained to stands to prevent falling C. Malfunctioning Equipment ▪ Oxygen should always be turned on and checked before being administered to patients ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  OXYGEN THERAPY SAFETY PRECAUTION ▪ Place “NO SMOKING: O2 IN USE” on client’s door or on the O2 tank. ▪ Inform visitors not to smoke inside the room. ▪ Make sure electric devices are in good condition. ▪ Avoid materials that generate static electricity ▪ Avoid the use of flammable materials such as oils, greases, alcohol & acetone near the O2 tank. ▪ Electric monitoring devices should be electrically grounded. ▪ Know the location of fire extinguishers. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  NURSING MANAGEMENT 1. Teaching Patient self Care ▪ Instruct the patient or family in the methods for administering oxygen safely & inform the patient & family that oxygen is available in gas, liquid, & concentrated forms. 2. Continuing Care Reinforce the teaching points on how to use oxygen safely & effectively. NURSING DIAGNOSIS Impaired gas Exchange Ineffective Breathing Pattern ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  NURSING MANAGEMENT What are the possible signs indicate a client is well oxygenated? ▪ RR (12-24 breaths/min at rest) ▪ Breathing is effortless ▪ Cardiac rate (