Oxygen therapy By Dr Hanan ALMosa Out line

Oxygen therapy By Dr. Hanan ALMosa

Out line ü ü ü Definition of the oxygen therapy Types of oxygen therapy purposes of using the oxygen therapy Administration of oxygen therapy Complication of oxygen therapy

Learning objectives: ü Define the oxygen therapy ü Discuss the type of c oxygen therapy ü List the purpose of using the oxygen therapy ü Explain the procedure ü Demonstrate the procedure ü List Complication of oxygen therapy

Oxygen therapy Definition: v Oxygen is a colorless, odorless, tasteless gas that is essential for the body to function properly and to survive.

What is meaning of O 2 therapy v. Oxygen therapy is the administration of oxygen at a concentration of pressure greater than that found in the environmental atmosphere v. The air that we breathe contain approximately 21% oxygen vthe heart relies on oxygen to pump blood.

Purpose v. Oxygen therapy is a key treatment in respiratory care. v. The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury.

oxygen therapy is used to treat v. Example in case : Documented hypoxemia Severe respiratory distress (acute asthma or pneumonia) Severe trauma Chronic obstructive pulmonary disease (COPD, including chronic bronchitis, emphysema, and chronic asthma)

oxygen therapy is used to treat Pulmonary hypertension Acute myocardial infarction (heart attack) Short-term therapy, such as postanesthesia recovery Oxygen may also be used to treat chronic lung disease patients during exercise.

Preparation A physician's order is required for oxygen therapy, except in emergency use. Clinical observations. indicated in Artial Blood Gas measurements, (ABGs ). Pulse Oximetry.

Pulse oximetry

Cautions For Oxygen Therapy Oxygen toxicity – can occur with FIO 2 > 50% longer than 48 hrs Danger of fire Infection

Methods of oxygen administration:

Classification of Oxygen Delivery Systems Low flow systems contribute partially to inspired gas client breathes Ex: nasal cannula, simple mask , non-re breather mask , Partial rebreather mask High flow systems deliver specific and constant percent of oxygen independent of client’s breathing Ex: Venturi mask, , trach collar, T-piece

Methods of oxygen administration: 1 - Nasal cannula

Nasal cannula v It is a disposable. vplastic devise with two protruding prongs for insertion into the nostrils, connected to an oxygen source. v. Used for low-medium concentrations of Oxygen (24 -44%).

Method Nasal Cannula Amount Priority Nursing Delivered Interventions F 1 o 2 (Fraction Inspired Oxygen) Advantages Disadvantages ØCheck frequently that Low flow both prongs 24 -44 % are in clients 1 Lmin=24% nares 2 Lmin=28% 3 Lmin=32% ØNever 4 Lmin=36% deliver more 5 Lmin=40% than 2 -3 Lmin 6 Lmin=44% to client with chronic lung disease Ø Client able to talk and eat with oxygen in place Ømay cause irritation to the nasal and pharyngeal mucosa ØEasily used Øif oxygen flow rates are in home above 6 setting liters/minute Variable FIO 2

Face mask Ø The simple Oxygen mask Ø The partial rebreather mask: Ø The non rebreather mask: Ø The venturi mask:

The simple Oxygen mask Ø Simple mask is made of clear, flexible , plastic or rubber that can be molded to fit the face.

The simple Oxygen mask Ø It delivers 35% to 60% oxygen. Ø A flow rate of 6 to 10 liters per minute. Ø Often it is used when an increased delivery of oxygen is needed for short periods Ø (i. e. , less than 12 hours).

Method Amount Delivered F 1 o 2 (Fraction Inspired Oxygen) Priority Nursing Interventions Simple mask üLow Flow üMonitor client ü 6 -10 Lmin frequently to check placement of ü 35%-60% the mask. üSupport client if claustrophobia is concern üSecure physician's order to replace mask with nasal cannula during meal time Advantages Disadvantages üCan provide increased delivery of oxygen for short period of time üTight seal required to deliver higher concentration üDifficult to keep mask in position over nose and mouth üPotential for skin breakdown (pressure, moisture) üWasting üUncomfortable for pt while eating or talking üExpensive with nasal tube

The partial rebreather mask: Ø The mask is have with a reservoir bag must romaine inflated during both inspiration & expiration Ø It collection of the first parts of the patients' exhaled air. Ø It is used to deliver oxygen concentrations up to 80%.

The partial rebreather mask Ø The oxygen flow rate must be maintained at a minimum of 6 L/min to ensure that the patient does not rebreathe large amounts of exhaled air. Ø The remaining exhaled air exits through vents.

The non rebreather mask Ø This mask provides the highest concentration of Ø oxygen (95 -100%) at a flow rate 6 -15 L/min. Ø It is similar to the partial rebreather mask Ø except two one-way valves prevent conservation of exhaled air. Ø The bag is an oxygen reservoir

Method Amount Priority Nursing Delivered Interventions F 1 o 2 (Fraction Inspired Oxygen) Partial Rebreather Mask ØLow Flow ØSet flow rate so 6 Lmin mask remains Ø 75%-80% tow-thirds oxygen full during inspiration ØKeep reservoir bag free of twists or kinks Advantages Disadvantages ØPT can inhale room air through openings in mask if oxygens supply is briefly interrupted ØRequires tight seal (eating and talking difficult, uncomfort able ØNot as drying to mucous membrane s

Amount Delivere d F 1 o 2 rebreather MASK ØLow Flow 6 -15 L min Non Method Priority Nursing Interventions ØMaintain flow rate so reservoir bag collapses only slightly during inspiration Ø 80%100% ØCheck that valves and rubber flaps are function properly (open during expiration ) ØMonitor Sa. O 2 with pulse oximeter Advantages ØDelivers the highest possible oxygen concentration ØSuitable for pt breathing spontaneous with sever hypoxemia Disadvantages ØImpractical for long term Therapy Malfunction cause CO 2 buildup Øsuffocation ØExpensive ØFeeling of suffocation ØUncomfortable ØCostly

Venturi mask Ø It is high flow concentration of oxygen. Ø Oxygen from 40 - 50% Ø At liters flow of 4 to 15 L/min.

Method Amount Delivered F 1 o 2 Venturi Mask Priority Nursing Interventio ns Advantage s Disadvantages ØRequires careful mointoring to verify Øof 4 to 15 F 1 O 2 at L/min. flow rate ordered ØCheck that air intake valves are not blocked ØDelivers most precise oxygen concentrati on ØDoesn’t dry mucous membrane s (humidity Øuncomfortable ØRisk for skin irritation Øproduce respiratory depression in COPD patient with high oxygen concentration 50% ØOxygen from 40 -50%

T-piece Ø Used on end of ET tube when weaning from ventilator Ø Provides accurate FIO 2 Ø Provides good humidity

Side effect & complication of oxygen therapy ØOxygen toxicity ØRetrolental fibroplasia ØAbsorption atelectasis

oxygen toxicity It is a condition in which ventilator failure Ø occurs due to inspiration of a high concentration of oxygen for aprolonged period of time. Ø Oxygen concentration greater than 50% over 24 to 48 hours can cause pathological changes in the lungs.

Signs and symptoms of oxygen toxicity: • Non-productive cough. • Nausea and vomiting. • Substernal chest pain. • Fatigue. • Nasal stuffiness. • Headache. • Sore throat. • Hypoventilation. . Nasal congestion. . Dyspnea. . Inspiration pain.

Evaluation: Ø Breathing pattern regular and at normal rate. Ø pink color in nail beds, lips, conjunctiva of eyes. Ø No confusion, disorientation, difficulty with cognition. Ø Arterial oxygen concentration or hemoglobin Ø Oxygen saturation within normal limits.

Documentation: v. Date and time oxygen started. v. Method of delivery. v. Oxygen concentration and flow rate. v. Patient observation. v. Add oronasal care to the nursing care plan

O 2 DELIVERY DEVICES EQUIPMENT FLOW FIO 2. 24 – 44 SPECIAL NOTES NASAL CANNULA 1/2 - 6 L/M SIMPLE O 2 MASK (WITHOUT BAG) 6 - 10 L/M . 35 – 55 RESERVOIR MASK (MASK WITH BAG) 10 -15 L/M . 60 -80 VENTI MASK 3 L/M 6 L/M . 24, 26, 31, . 35, . 40, . 50 READ ENCLOSED INSTRUCTIONS NEBULIZER 8 L/M OR > . 28, . 30, . 35. 40, . 50, 70 MIST MUST BE VISIBLE *** SHOWS THAT FIO 2 VARIES WITH DIFFERENT F, VT, INSPIRATORY FLOW RATES. 6 L/M MAX. USE 5 L/M MINIMUM PAGE RT IF USED (BAG TO NOT COLLAPSE)

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