Oxygen-Therapy_Version_21.pdf

Oxygen Therapy Juan Paulo Atienza, RN, MSN Carolyn M. Alcantara, RN, MSN  Objectives 01 02 03 04 Define O2 Therapy Discuss Hypoxia Methods of Oxygen Nursing Administrati...

Oxygen Therapy Juan Paulo Atienza, RN, MSN Carolyn M. Alcantara, RN, MSN  Objectives 01 02 03 04 Define O2 Therapy Discuss Hypoxia Methods of Oxygen Nursing Administration Responsibilities RESPIRATORY SYSTEM  Oxygen Therapy - Is the administration of oxygen at a concentration greater than that found in the environmental atmosphere. - Is to provide adequate oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium.  Purpose of Oxygen Administration To relieve dyspnea To prevent hypoxemia To increase oxygenation in tissue To administer higher concentration of oxygen  Indications Respiratory distress Shock Pre intra and post-operative patient Hypoxia and hypoxemia Severe trauma Acute MI The need for Oxygen is assessed by ABG, Pulse oximetry, and clinical evaluation. Interpreting ABG: Ph- 7.35 – 7.45 PaO2 - 80 – 100 mmHg PaC02- 35 – 45 mmHg HC03- 22 – 26 mEq/L  Pulse oximetry monitoring: is receiving oxygen therapy and clinically unstable is clinically unstable and the need for oxygen therapy is yet to be determined has a nasopharyngeal airway or tracheostomy and requiring acute nursing care is receiving respiratory support (e.g., invasive or non-invasive ventilation)  Pulse oximetry monitoring: is undergoing a procedure where respiratory depressants are used is a high risk patient receiving an opioid infusion is in the immediate post-operative period has a decreasing conscious status Signs of Hypoxia Tachypnea Dyspnea Use of accessory muscle Noisy breathing Decrease O2 sat level  Flaring of nostrils or pursed lip Skin color Position of the patient Ability of patient to speak in full sentences LOC Restlessness or anxiety Types of Hypoxia Hypoxemic Hypoxia - the PO2 of the arterial blood is reduced. O2 content and O2 saturation is decreased. Circulatory Hypoxia – blood flow to a tissue is low that adequate O2 is not delivered to it despite normal PO2 and hemoglobin concentration.  Types of Hypoxia Anemic Hypoxia – the arterial PO2 is normal but the amount of hemoglobin available to carry O2 is reduced. Histotoxic Hypoxia – the amount of O2 delivered to a tissue is adequate but the tissue cells cannot make use of the O2 supplied. Complications: It is important to observe for subtle indicators of inadequate oxygenation when oxygen is administered by any method. Oxygen Toxicity - may occur when too high a concentration is administered for an extended period. Signs and symptoms: Substernal discomfort Paresthesia Dyspnea Restlessness  Fatigue Malaise Progressive respiratory difficulty Refractory hypoxemia Alveolar atelectasis and infiltrates Suppression of Ventilation: In many patients with COPD: Stimulus for respiration is decrease in blood oxygen rather than an elevation in C02 levels. Administration of high concentration Oxygen removes the respiratory drive. Oxygen-induced Hypoventilation is prevented by administering oxygen at low flow rates and by closely monitoring the RR and the O2 sat. Other complications: Oxygen supports combustion Oxygen Therapy equipment is a potential source of bacterial cross-infection Methods of Oxygen Administration: Oxygen can be dispensed thru: - Cylinder - Piped-in system   Oxygen cylinders Flow meter Part of OxygenPart of Oxygen  Flow adjuster  Oxygen output  Humidifying bottle  Oxygen input pipe  Pressure gauge  Oxygen input plug  Pressure adjuster  Oxygen mask  Nasal cannula  Oxygen stand /transporter Piped - in System Methods of Oxygen Administration: Oxygen can be dispensed thru: Oxygen Concentrator Oxygen Administration devices: Low Flow systems: Nasal Cannula Deliver 23-30% O2 Flow rate 1-4 L/min Used in non-acute situations or if only mildly hypoxic Oxygen Administration devices: Low Flow systems: Oropharyngeal Catheter Deliver 23-42% O2 Flow rate 1-6 L/min Inexpensive, does not require tracheostomy Oxygen Administration devices: Low Flow systems: Face Mask, simple Deliver 40-60% O2 Flow rate 6-8 L/min Inexpensive, simple to use Poor fitting, variable FI02, must remove to eat. Oxygen Administration devices: Low Flow systems: Face Mask, partial rebreather Deliver 50-75% O2 Flow rate 8-11 L/min Moderate O2 concentration Warm, Poor fitting, must remove to eat. Face Mask, non-rebreather Deliver 80-100% O2 Flow rate 12 L/min High O2 concentration Non – rebreathing mask Rebreather Mask Oxygen Administration devices: High Flow systems: Transtracheal Catheter Deliver 60-100% O2 Flow Rate: ¼ to 4 L/min More comfortable, concealed by clothing Requires frequent and regular cleaning, require surgical intervention. Oxygen Administration devices: High Flow systems: Venturi Mask Deliver 24-60% O2 Different colors deliver different rates Flow rate varies with color Oxygen Administration devices: High Flow systems: Mask, Aerosol Deliver 30-100% O2 Flow Rate 8-10 L/min Good humidity, Accurate Fi02 Uncomfortable for some Nursing Responsibilities 1.Verify provider order or protocol. 2.Gather supplies: pulse oximeter, oxygen delivery device, and tubing. 3.Perform safety steps: Perform hand hygiene. Check the room for transmission-based precautions. Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take. Confirm patient ID using two patient identifiers (e.g., name and date of birth). Explain the process to the patient and ask if they have any questions. Ensure the patient’s privacy and dignity. Assess ABCs. Nursing Responsibilities 4. Perform a focused respiratory assessment including airway, respiratory rate, pulse oximetry rate, and lung sounds. 5. Employ safety measures for oxygen therapy. 6. Connect flow meter to oxygen supply source. 7. Apply adapter for tubing. 8. Connect nasal cannula tubing to flow meter. 9. Set oxygen flow at prescribed rate. 10. When using a nasal cannula, place the prongs into the patient’s nares and fit the tubing around their ears. When using a mask, place the mask over the patient’s mouth and nose, secure a firm seal, and tighten the straps around the head. If using a non-rebreather mask, partially inflate the reservoir bag before applying the mask. Place the patient in an upright position as clinically appropriate.  Nursing Responsibilities 10. Evaluate patient’s response to oxygen therapy including airway, respiratory rate, pulse oximetry reading, and reported dyspnea. 11. Institute additional interventions to improve oxygenation as needed. 12. Assist the patient to a comfortable position, ask if they have any questions, and thank them for their time. 13. Ensure safety measures when leaving the room: 14. Perform hand hygiene. 15. Document the assessment findings. Report any concerns according to agency policy.  Procedures Determine need for oxygen therapy , check physicians order for rate , device to be used and concentration Perform an assessment of vital signs , level of consciousness lab values and record Assess risk factors for oxygen administration in patient and environment like hypoxia drive in patient and faulty electrical connection Explain procedure to patient and relatives and emphasize how he has to co operate  Procedures Post NO SMOKING signals on patient door in view of patient and visitors and explain to them the dangers of smoking when oxygen is on flow. Wash hands Set up oxygen equipment and humidifier a. Fill humidifier up to the mask on it b. Attach flow meter to source set flow meter OFF position c. Attach humidifier bottle to base of the flow meter d. Attach tubing and face mask to humidifier  Procedures Guide mask to patients face and apply it from nose downward. Fit the piece mask to conform to shape of nose Secure elastic band around patients head Apply padding ears as well as scalp where elastic band assess Ensure that safety prevention are followed Inspect patient and equipment frequently for flow rate clinical condition level of water in humidifier Etc..  Procedures Wash hand Remove the mask and dry the skin every 2 to 3 hours. if oxygen is administrated continuously do not put powder around the mask Document relevant data in patient record Gerontologic Considerations: The respiratory system changes throughout the aging process, and it is important for nurses to be aware of these changes when assessing patients who are receiving oxygen therapy. Respiratory muscles weaken Large bronchi and alveoli becomes enlarge Surface area of the lungs decreases Functional cilia decreases Osteoporosis Risk for aspiration Gerontologic Considerations:  The immune system also can get weaker, making older patients more susceptible to lung infections such as pneumonia.  Common respiratory diseases experienced by older patients include chronic obstructive pulmonary disease (COPD) and emphysema.  References Brunner & Suddarth’s Textbook of Medical-Surgical Nursing Vol.1 12th edition https://wtcs.pressbooks.pub/nursingskills /chapter/11-6-checklist-for-oxygen- therapy/  Thanks Do you have any questions? [email protected] [email protected] CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, and infographics & images by Freepik. Please keep this slide for attribution.  CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, and infographics & images by Freepik.