Professional Documents
Culture Documents
Module 1 - Oxygen Therapy (Student)
Module 1 - Oxygen Therapy (Student)
Module 1 - Oxygen Therapy (Student)
LEARNING OBJECTIVES:
By the end of the module, the student will be able to:
1. Give the indications for oxygen therapy.
2. Identify different oxygen delivery systems (low-flow and high-flow).
3. Enumerate the parts of an oxygen setup (portable & in-line).
4. Describe procedure in administering oxygen through different oxygen delivery systems including how
to attach the device and regulate oxygen delivery.
5. Identify the parts of a bag-valve-mask resuscitator (Ambu®-bag).
6. Describe procedure in performing bag-valve-mask ventilation.
7. Explain accurately the rationale for each step of the procedure.
a. Nasal Cannula
• the most common method of oxygen administration
• oxygen is delivered through a flexible catheter that has
two short nasal prongs
• allows the patient to eat & talk, and it is generally more
comfortable than other oxygen delivery devices
• requires nose breathing for the device to be effective
• delivers a relatively low concentration of oxygen (24% to
45%) at flow rates of 2 to 6 L per minute.
1
VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)
b. Simple Mask
• delivers oxygen concentrations from 40% to 60% at
liter flows of 5 to 8 L per minute, respectively.
d. Non-breather Mask
• delivers the highest oxygen concentration possible -
95% to 100% - by means other than intubation or
mechanical ventilation, at liter flows of 10 to 15 L
per minute
• one-way valves on the mask and between the
reservoir bag and the mask prevent the room air
and the client’s exhaled air from entering the bag so
only the oxygen in the bag is inspired.
• The nonrebreather bag must not totally deflate
during inspiration (Rationale: high oxygen
concentration will not be achieved, and the mask
will provide only the flow rate setting on the
flowmeter)
2
VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)
2. High-flow systems = provide the total amount of inspired air. A specific percentage of oxygen is
delivered independent of the patient’s breathing. High-flow systems are indicated
a. Venturi Mask
• the most reliable & accurate method for delivering
precise concentrations of oxygen through
noninvasive means
• the mask is constructed in a way that allows a
constant flow of room air blended with a fixed flow
of oxygen
• delivers oxygen concentrations varying from 24% to
40% or 50% at liter flows of 4 to 10 L per minute
b. Face Tent
• used when oxygen masks are poorly tolerated by
patients
• the tent is attached to the patient’s chin and
strapped around the neck; it is connected to an
oxygen source and humidifier through wide-bore
tubing
• provides varying concentrations of oxygen
• frequently inspect the client’s facial skin for
dampness or chafing and dry and treat as needed
c. Tracheostomy Collar
• a mask-like device that fits loosely over the
tracheostomy and is held in place with an
elastic band around the neck
• the collar is connected to a wide-bore
tubing that receives aerosolized oxygen
from a jet nebulizer
• provides varying concentrations of oxygen
d. T-piece/Briggs adapter
• is used to administer oxygen to patient with
endotracheal tube or tracheostomy tube
who is breathing spontaneously
• is useful in weaning patients from
mechanical ventilation
• provides varying concentrations of oxygen
3
VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)
4
VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)
Nursing Skills to Develop in this Module & Materials/Equipment Needed: [materials/items with an
asterisk (*) are the materials the students should bring during skills laboratory period]
Procedure Guidelines:
A. Administering Oxygen Therapy
1. Determine client history and acute and chronic health problems.
2. Assess the client’s baseline respiratory signs, including airway, respiratory pattern, rate, depth, and
rhythm, noting indications of increased work of breathing.
3. Check the extremities and mucous membranes closely for color.
4. Review arterial blood gas and pulse oximetry results.
5. Note lung sounds for rales/crackles.
6. Assess the nares, behind the earlobes, cheek, tracheostomy site, or other places where oxygen tubing
or equipment is in constant contact with the skin to look for signs of skin irritation or breakdown.
7. Perform hand hygiene.
8. Verify the doctor’s order for prescribed liters per minute of oxygen.
9. Explain procedure and hazards to the client & SOs including NO smoking and keeping oxygen at least 6
feet away from any source of flame or electrical sparks.
10. If using humidity, fill humidifier to fill line with distilled water and close container (ready-to-use
humidifier systems are also available). Clients with artificial airway should use HUMIDIFIED oxygen.
11. Attach humidifier to oxygen flow meter.
12. Insert humidifier and flow meter into oxygen source in wall or portable unit.
5
VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)
13. Attach the oxygen tubing and appropriate oxygen delivery device to the flow meter and turn it on to
the prescribed flow rate (1 to 5 liters per minute).
14. Use extension tubing for ambulatory clients so they can get up to go to the bathroom.
15. Check for bubbling in the humidifier which indicates that oxygen is flowing through it.
16. Apply appropriate delivery device to patient to commence oxygen therapy:
▪ For oxygen via nasal cannula: Place the nasal prongs in the client’s nostrils. Secure the cannula
in place by adjusting the tubing around the client’s ears and using the slip ring to stabilize it
under the client’s chin.
▪ For oxygen via simple face mask, partial rebreather & nonrebreather mask: Place the mask on
the client’s face, fasten the elastic band around the client’s ears and tighten until the mask fits
snugly. Allow the reservoir bag of the nonrebreathing or partial rebreathing mask to fill
completely.
▪ For oxygen via an artificial airway using a T-piece: Attach the T-piece to the client’s artificial
airway. Be sure it is firmly attached to the airway. Position wide-bore tubing of T-piece so that it
is not pulling client’s airway.
17. Monitor vital signs, oxygen saturation, and client condition every 4 to 8 hours (or as indicated or
ordered) for signs and symptoms of hypoxia.
18. Wean client from oxygen as soon as possible using standard protocols.
6
VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)
7. Keeping your nondominant hand on the patient's mask, exert downward pressure to seal the mask
against his face.
8. If ventilating through an artificial airway, remove clear face mask from bag-valve-mask resuscitator
and insert adapter to client’s tracheostomy or endotracheal tube (ET). [see illustration A for ventilating
through a tracheostomy & illustration B through an endotracheal tube]
A B
9. For an adult patient, use your dominant hand to compress/squeeze the bag every 5 seconds.
(approximate amount of air delivered per ventilation in an adult is stated below)
▪ 1000 to 1500 mL = amount of air delivered after 1 full squeeze on ventilation bag with BOTH
hands
▪ 600 to 800 mL = amount of air delivered after 1 full squeeze on ventilation bag with ONE hand
ONLY.
10. For a child & infant, deliver 20 breaths/minute, or one compression of the bag every 3 seconds. Infants
and children should receive 250 to 500 mL of air with each bag compression. Use age-appropriate bag-
valve-mask resuscitator for pediatric clients [see accompanying illustration].
11. Deliver breaths with the patient's own inspiratory effort, if it's present. Don't attempt to deliver a
breath as the patient exhales.
7
VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)
12. Observe the patient's chest to ensure that it rises and falls with each compression. Auscultate for
breath sounds with each ventilation. If ventilation fails to occur, check the fit of the mask and the
patency of the patient's airway; if necessary, reposition his head and ensure patency with an oral
airway.