Oxygen Therapy PDF

OXYGEN THERAPY Terminologies Hypoxia - is a condition in which there is insufficient oxygen to meet the metabolic demands of the tissues and cells resulting from hypoxemia. Hypoxemia - a deficiency of arterial blood oxygen rogeledrada Hemoglobin (Hgb) - is the carrier of respiratory gas...

OXYGEN THERAPY Terminologies Hypoxia - is a condition in which there is insufficient oxygen to meet the metabolic demands of the tissues and cells resulting from hypoxemia. Hypoxemia - a deficiency of arterial blood oxygen rogeledrada Hemoglobin (Hgb) - is the carrier of respiratory gases, oxygen and carbon dioxide (CO2). - It combines with a gas to carry it to and from the cells. - Decreased hemoglobin levels reduce the amount of oxygen transported to the cells and carbon dioxide transported away from the cells.  Hemoglobin levels and acid base status directly affect oxygenation. Acidemia increases the ability of hemoglobin to release oxygen to the tissues. Alkalemia decreases the ability of hemoglobin to release oxygen to the tissues. rogeledrada Cyanosis - a bluish discoloration of the skin and mucous membranes, is a late sign of hypoxia. (FiO2) Inspired oxygen percentage (PaCO2) Arterial Carbon dioxide Pressure Humidifier – a device used to humidify O2 * Drying of mucous membranes are common to patients receiving supplemental oxygen. The O2 picks up humidity by flowing through a water bottle connected to the concentrator or liquid system Flow meter – used to set flow rate during O2 therapy rogeledrada Oxygen therapy - is the administration of supplemental oxygen (O2) to a patient to prevent or treat hypoxia. NOTE: Oxygen toxicity may occur when too high a concentration of oxygen (greater than 50%) is administered for an extended period (longer than 48 hours). It is caused by overproduction of oxygen free radicals, which are by products of cell metabolism. Indications:  COPD (emphysema, chronic bronchitis)  Breathlessness  Arterial oxygen partial pressure Pa02 of = or less than 55mmHg  Arterial oxygen saturation SaO2 of = or less than 88%  First aid by emergency medical services rogeledrada  Resuscitation, major trauma, major bleeding, shock, active convulsions  Should be stopped if saturation is above 96%  Usually no harm occurs with short-term use of oxygen. However, *Acute respiratory failure from COPD: uncontrolled O2 administration may cause acute hypoventilation and carbon dioxide retention with dire consequences. * Recommendation: limit oxygen administration to the minimum needed that provides adequate oxygen to tissues (88% to 92%) and no higher.  Dosage or concentration of oxygen must be monitored and doctor’s order must be routinely checked rogeledrada Signs and symptoms of hypoxia:  Apprehension, anxiety, behavioral changes(restlessness)  Decreased level of consciousness, confusion, drowsiness, altered concentration  Increased pulse rate  Increased rate and depth of respiration or irregular respiratory patterns  Decreased lung sounds, adventitious lung sounds (e.g., crackles, wheezes)  Elevated blood pressure evolving to decreased blood pressure  Pulse oximetry (SpO2) less than 90%  Dyspnea rogeledrada  Use of accessory muscles of respiration, rib retractions  Cardiac dysrhythmias  Pallor, cyanosis  Increased fatigue  Dizziness  Clubbing of nails resulting from prolonged, chronic hypoxia Oxygen delivery systems – used to deliver, regulate, supplement O2 *Choice of devices to administer oxygen depends on level of oxygen support that the patient needs, the severity of the hypoxia, and the disease process rogeledrada 2 categories of devices: depending on their ability to provide enough O2 flow to match the patient’s spontaneous minute volume. High flow - devices that discourage entraining room air, which dilutes the inspired oxygen percentage (FiO2) - ”fixed FiO2” Venturi mask T-piece Nonrebreather masks with reservoir and one way valve Face tents Low flow – room air entrained, dilutes FiO2 – “variable FiO2” deliver O2 at flow rates lower than patient’s inspiratory demands Nasal cannula Simple mask partial rebreather masks. rogeledrada  OXYGEN THERAPY  given when respiratory system is compromised or tissu hypoxia is present. Low Flow  nasal cannula or catheter  O2 tent  provides controlled environment into which steam, O2 vaporized is given rogeledrada  OXYGEN THERAPY High Flow  can deliver 100% concentration of O2 venturi mask  face mask designed to allow inspired air to mix with O2 partial rebreathing mask  has an inflatable bag that stores 100% O2  on inspiration patient inhales from the mask.  on expiration the bag refills with O2 and expires gases into the sides of the mask. non rebreathing mask  has an inflatable bag  stores 100% of O2 and one way valve between the bag and mask to prevent exhaled air from entering the bag.  hyperbaric O2 chamber rogeledrada  used to treat carbon monoxide poisoning, air embolism, smoke inhalation and acute cyanide poisoning. Oxygen flowmeter- regulates the flow rate in liters per minute Oxygen is dispensed from a cylinder or a piped-in system. Oxygen cylinders - used in hospital and institutional care settings comes in different sizes rogeledrada rogeledrada OXYGEN SAFETY GUIDELINES  Remind patients that oxygen is a medication and is not adjusted without a health care provider’s order.  In the home setting place an “Oxygen in Use” sign on the door of the residence.  Keep oxygen delivery systems at least 5 ft from any heat source (American Lung Association, 2012).  Oxygen supports combustion; however, it will not explode.  No smoking is allowed on the premises.  When using oxygen cylinders, secure them so they will not fall over. Store oxygen cylinders upright, chained, or in appropriate holders. rogeledrada  Determine that all electrical equipment in the room is functioning correctly and properly grounded. An electrical spark in the presence of oxygen will result in a serious fire.  Avoid using items that create a spark (e.g., electric razor) with a nasal cannula in use; an electrical or mechanical toy in oxygen tent; or objects of synthetic fabrics that cause static electricity.  Check the oxygen level of portable tanks before transporting a patient to ensure that there is enough oxygen in the tank. rogeledrada Administering Oxygen via nasal cannula Nasal cannula - is a simple, effective, and comfortable device for delivering oxygen allows a patient to breathe through the mouth or nose, is available for all age-groups, and is adequate for short- or long-term use. - inexpensive, disposable, and easily accepted by most patients - Oxygen is delivered via the cannula at a flow rate from 1 to 6 L/min. rogeledrada Nasal cannula/Nasal prongs  Inexpensive and easy to use, permit talking, eating and suctioning  Disadvantage:  Cannot provide high oxygen concentration rogeledrada METHODS OF OXYGEN ADMINISTRATION 1. NASAL CANNULA (NASAL PRONGS) 1. A flexible plastic tubing with 2 nasal ports and adjustable elastic strap. 2. Low flow oxygen delivery system 3. Provides up to 44% oxygen. 4. Advantages: 1. Well tolerated by most patients. 2. No rebreathing of expelled air. 3. Valuable to patients with COPD. rogeledrada 5. Disadvantages: 1. Can only be used by spontaneous breathing patients. 2. Actual amount of inspired oxygen depends on respiratory rate and depth. 6. Special considerations: 1. Contraindicated to patient with nasal obstructions. 2. Flow rate of >6LPM may dry mucus membranes; may cause headache. 3. Can be easily dislodge. rogeledrada  Flow rate FiO2 1 L/min: 24% 2 L/min: 28% 3 L/min: 32% 4 L/min: 36% 5 L/min: 40% 6 L/min: 44% rogeledrada  Nasal cannula proper placement rogeledrada  Administering Oxygen via Oxygen mask Simple Face mask - is for short-term oxygen therapy - delivers oxygen concentrations from 40% to 60%. Venturi mask - Controls amount of specified oxygen concentration - cone-shaped high-flow device with entrainment ports of various sizes at the base of the mask rogeledrada  Partial rebreather - Useful for patients requiring high O2 concentration - have a reservoir bag that must remain inflated during both inspiration and expiration - No inspiratory valve; thus exhaled air mixes with inspired air Nonrebreathing mask - Valve closes during expiration; thus exhaled air does not enter reservoir and mix with inhaled air - An ideal non-rebreather mask does not permit air from the surrounding environment to be inhaled hence in an event of a source gas failure is life threatening. rogeledrada Difference between partial rebreather mask and non rebreather mask Non-rebreather Mask: It is a face mask with 2 one-way valves. This face mask covers both nose and mouth. A one-way valve is present between the reservoir bag and the face mask. Oxygen can only flow from the reservoir bag to the mask. The valve prevents entry of exhaled air into the bag. Another one-way valve lets the exhaled air to flow out to the atmosphere but prevents atmospheric air entering into it. Hence. there is no re-breathing. Partial Rebreather Mask: It is a face mask with 1 two-way valve. It is similar to non-rebreather Mask. The difference is in the valve that connects the reservoir bag and the face mask. Here, the valve is a two-way valve. This allows the first 1/3rd (usually 150 ml) of breathe to get into the reservoir bag. Remaining exhaled air flows out to the atmosphere through the exhalation port. rogeledrada  VENTURI MASK  Delivers 4-10 liters/min (24% - 55%)  Precise delivery system  Noisy  Fio2 delivered: 24% to 55% Fio2 with flow rates of 4 to 10 L/min. Adapter & O2 source holes of different sizes allow only specific amounts of air to mix with the rogeledrada oxygen  Atmospheric air Atmospheric air Expired air Atmospheric air x 2. One-way valve x via exhalation port inhale inhale O 2 Patient mask Patient mask exhale exhale x O 1. Two- 1. One- way valve O 2 way valve 2 Non Rebreather Mask Partial Rebreather Mask Reservoir bag Reservoir bag rogeledrada Simple O2 Face mask Nonrebreathing mask Venturi mask rogeledrada Partial rebreathing mask Other O2 Delivery systems: Face tent - is a shieldlike device that fits under a patient’s chin and sweeps around the face - Used when a patient cannot or will not tolerate a tight-fitting mask. Oxygen hoods and tents - commonly used in the pediatric setting. - These devices are able to provide high concentrations of humidified oxygen. rogeledrada  OXYGEN HOOD  Deliver oxygen to infants at rates approaching 100%  Placed over the infant’s head  Made up of hard plastic or vinyl with a metal frame rogeledrada  OXYGEN TENT ( Croupette)  Used in children who will not leave a face mask or nasal cannula in place  Made of a transparent plastic canopy that is suspended from a frame, with an electric cooling unit. rogeledrada SELF INFLATING BREATHING BAG AND MASK  Often called the Ambu Bag  Provides artificial ventilation to the person who is in respiratory arrest or is dependent on a ventilator for breathing  Can be used for rescue breathing or CPR rogeledrada rogeledrada OXYGEN THERAPY  O2 supports combustion  Assess s/sx of hypoxia (nailbeds, capillary refill/cyanosis) mucous membrane  Check ABG before O2 therapy  Evaluate the advantage and disadvantage between high and low flow according to needs of the patient.  Consider ETT/TT insertion if O2 therapy will be given for long period of time. rogeledrada  OXYGEN THERAPY  More than 24 hours exposure to 100% O2 may lead to formation of hyaline membrane into lining of alveoli causing atelectasis adult  may cause retrolental fibroplasia (formation of connective tissue in the retina and brain causing blindness and brain damage) infant rogeledrada  OXYGEN THERAPY  May lead to pulmonary edema  Tracheobronchitis is a mild form of O2 toxicity.  Administer O2 in the lowest possible concentration to relieve hypoxemia  FIO2 below 60% - safe for long period of O2 therapy rogeledrada  OXYGEN THERAPY  COPD patients must receive 2-3 L of O2 only to prevent cessation of breathing  Proper positioning is always Fowler’s=GOOD LUNG DOWN  Check the content of the tank and open the regulator (hissing sound) to remove tiny particles.  Refill the container of the humidifier with sterile water.  if hissing sound occurs during O2 therapy, suspect kinking of the tube rogeledrada Special Considerations Teaching If oxygen therapy continues after discharge, teach patient and family the importance of and rationale for it, how to use the oxygen delivery device, how to contact the supplier of medical equipment, and when to contact the health care provider. Discuss safety precautions for oxygen use with patient and family. Discuss signs of oxygen toxicity and carbon dioxide retention (e.g., confusion, headache, decreased LOC, somnolence, carbon dioxide narcosis, respiratory arrest) that patient needs to report to the health care provider. Pediatric Some infants and small children are able to tolerate a nasal cannula. Secure the prongs of the cannula with Dermiclear tape or strips of transparent dressing over the child’s cheek. rogeledrada rogeledrada