OXYGEN THERAPY -prescribed by primary health care provider, who specifies the concentration, method of delivery, and depending

on the method, liter flow per minute - Administering oxygen is an emergency measure - the nurse may administer oxygen without the doctors order for clients with COPD, or in just a low flow oxygen rate (2LPM)

Who benefits from Oxygen therapy? Clients who have difficulty on ventilating in all areas of the lungs Clients with impaired gas exchange People with heart failure

OXYGEN THERAPY SAFETY PRECAUTIONS

For home oxygen use or for the facility permits smoking, teach family members to smoke only outside or in provided smoking rooms away from clients and oxygen equipment

Place cautionary signs reading No Smoking: Oxygen in Use on the clients door, at the foot or head of the bed, and on the oxygen equipment

Instruct the client and visitors about the hazard of smoking with oxygen in use Make sure that electric devices (such as hearing aids, razors, radios, tv) are in good working order to prevent the occurrence of short circuit sparks

Avoid materials that generate static electricity, such as woolen blankets and synthetic fabrics. Cotton blankets should be used, and clients and care givers should be advised to wear cotton fabrics

Avoid the use of volatile, flammable materials, such as oils, greases alcohol, and acetone (ex. Nail polish remover), near clients receiving oxygen

Be sure that electric monitoring equipment, suction machines, and portable diagnostic machine are all electrically grounded

Make known the location of fire extinguishers, and make sure that personnels are trained in their use

Oxygen is supplied in different ways:

a. -

In hospital and long-term care facilities: it is usually piped into wall outlet at the client bedside, making it readily available for use at all times Tanks and cylinders of oxygen under pressure is also frequently available for use when wall oxygen is either unavailable or impractical (ex. Transporting oxygen dependent clients between treatment areas)

b. -

In home care: Clients who require oxygen therapy at home may use small cylinders of oxygen, oxygen in liquid form, or an oxygen concentrator.

Portable oxygen delivery system are available to increase clients independence

Oxygen administered from a cylinder or wall outlet is a dry. Dry gases dehydrate respiratory mucous membrane Humidifying devices that add water vapor to inspired air are thus, an essential adjunct of oxygen therapy, particularly for liters flow over 2LPM

Functions of humidifier: it prevents mucous membranes from drying and becoming irritated loosen secretion for easily expectoration

Very low liter flows (ex. 1-2LPM via nasal cannula) do not require humidification because there is enough atmospheric air inhaled on it naturally has water vapor in it to prevent mucosal drying

Oxygen Cylinder -needs to be handled and stored with cautions and strapped securely with wheeled transport devices or strands to prevent possible falls and outlet breakages

OXYGEN DELIVERY SYSTEM

1.

Cannula a. Nasal Cannula (2-6LPM)

Most common and inexpensive devise use to administer oxygen Easy to apply and does not interfere with clients ability to talk Comfortable and permits some freedom of movement Delivers relatively low concentration of oxygen (24%-45%) at flow rate of 2-6LPM (6L and above; the client tends to swallow air)

Disadvantages; Inability to deliver higher concentrations of oxygen Can dry and irritate the mucous membrane

2.

Face Mask Covers the clients nose and mouth; may be used for oxygen inhalation Exhalation ports on the sides of the mask allowed exhaled carbon dioxide to escape Initiating oxygen by mask is much the same as initiating oxygen by cannula, except that the nurse must find a mask of appropriate size.

a.

Simple face mask (5-8LPM)

Delivers oxygen concentration from 40% - 60% at liter flows of 5 to 8 LPM, respectively.

b.

Partial Rebreather Mask (6-10LPM)

Deliver oxygen concentrations of 60% - 90% at liter flows of 6-10LPM, respectively Oxygen is attached allows client to rebreath about the first third of exhaled air in conjunction of oxygen

Partial rebreather bag must not totally deflate during inspiration to avoid carbon dioxide build up. If this problem occurs, the nurse must increase the liter flow of oxygen

c.

Nonrebreather mask (10-15LPM)

Delivers the highest oxygen concentration possible 95-100% by means other than intubation or mechanical ventilation at liter flows at 10-15LPM

There is a oneway valve on the mask and between the reservoir bag and the mask prevent the room air and the clients exhailed air from entering the bag so only the oxygen in the bag is inspired

To prevent carbon dioxide build up, the non-rebreather bag must not totally deflate during inspiration If carbon dioxide build up happened, the nurse must increase the flow of oxygen to correct this problem

d.

Venturi Mask (4-10LPM)

Delivers oxygen varying from 24% to 40% to 50% at liter flows of 4 to 10 LPM Has wide-bore tubing and color coded jet adapters that corresponds to a precise oxygen concentration and liter flow (ex. Blue adapter delivers a 24% concentration of oxygen @4LPM; green adapter delivers a 35% concentration of oxygen at 8LPM)

3.

Face Tent (4-8LPM) -can replace oxygen mask when mask are poorly tolerated by clients. -provide varying concentration of oxygen, ex. 30-50% concentration of oxygen at 4-8LPM - frequently inspect the clients facial skin for dampness or chaffing, and drying and treat as needed. - the clients facial skin must be kept dry

ADMINISTERING OXYGEN BY CANNULA, FACE MASK OR TENT

Before administering oxygen, the nurse must check: a. Doctors order for O2; including administrative device and the liter flow rate (LPM) or the percentage of oxygen b. Levels of oxygen (Pa02) and carbon dioxide (paCO2) in the clients arterial blood (normally PaO2 is 80100 mmHg) and (PaCO2 is 35-45 mmHg)

c.

Whether the client has COPD

Purposes: a. Cannula

To deliver a relatively low concentration of oxygen when only minimal oxygen support is required To allow uninterrupted delivery of oxygen while client ingests food or fluids

b. -

Face mask

To provide moderate oxygen support and a higher concentration of oxygen and/or humidity than is provided by cannula

c. -

Face tent

To provide high humidity To provide oxygen when a face mask is poorly tolerated To provide a high flow of oxygen when attached to a venture system