OXYGEN THERAPY

Fundamental of Nursing
 Learning objectives
2

The learner will be able to know…..

 Anatomy and Physiology of Respiration
 What is Oxygen therapy
 Indications for oxygen therapy
 Types of Oxygen Delivery
 Why Humidification is necessary
 Nursing Responsibilities
 Anatomy and Physiology of Respiration
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Normal functioning depends on essentially three

factors:
 The integrity of the airway system to transport air to

and from the lungs

 A properly functioning alveolar system in the lungs

to oxygenate venous blood and to remove carbon

dioxide from the blood
 A properly functioning cardiovascular and
hematologic system to carry nutrients and wastes to
and from body cells
 Physiology of Respiratory System
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Gas exchange, the intake of oxygen and release of

CO2 is made possible by pulmonary ventilation,
respiration and perfusion
Pulmonary ventilation: refers to the movement of air
into and out of he lungs.
Respiration: involves gas exchange between the
atmospheric air in the alveoli and blood in the
capillaries
Perfusion: is the process by which oxygenated
capillary blood passes through body tissues.
 Organs in the Respiratory System
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STRUCTURE FUNCTION

Nose / nasal cavity Warms, moistens, & filters air as it is inhaled

Pharynx (throat) Passageway for air, leads to trachea

Larynx The voice box, where vocal chords are located

Keeps the windpipe "open“ trachea is lined with fine hairs

Trachea (windpipe)
called cilia which filter air before it reaches the lungs

Bronchi Two branches at the end of the trachea, each lead to a lung

A network of smaller branches leading from the bronchi into the

Bronchioles
lung tissue & ultimately to air sacs

The functional respiratory units in the lung where gases are

Alveoli
exchanged
 The Pathway
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 Air enters the nostrils

 Passes through the nasopharynx,
 The oral pharynx
 Through the glottis
 Into the trachea
 Into the right and left bronchi, which branches and
rebranches into
 Bronchioles, each of which terminates in a cluster of
alveoli
 Respiratory System
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 Inspirations and Expirations
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 Surfactant
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 Surfactant is a detergent-like substance which is

secreted in fluid coating alveolar surfaces – it
decreases tension

 Without it the walls would stick together during

exhalation

 Premature babies – problem breathing is largely

because lack surfactant
 Factors affecting respiratory functioning
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 Level of health/Medical conditions e.g. Anemia

 Age/Developmental considerations
 Medications
 Lifestyle/Habbits
 Environment
 Exercise/Activity
 Occupation
 Airway Patency/Clearance
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 It is the ability of a person to breathe, with airflow

passing to and from the respiratory system through
the oral and nasal passages.

“it may be imacted of affect by different anatomical

of physiological changes”
 Measure for patent airway
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 Position the patient properly, possibly upright

position (Head elevation).
 Reposition the head/neck position
 Chest physiotherapy to mobilize secretions
 Suctioning airway to removes thick ecretions
 Nebulization/Use of inhaler
 Artificial airway device use
 Maintain patient of tube (if intubated)
 Airway devices/Airway Tubes
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 Oxygen therapy
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- is the administration of oxygen at a concentration

greater than that found in the environmental
atmosphere.

Purpose :
- is to provide adequate transport of oxygen in the
blood while decreasing the work of breathing and
reducing stress on the myocardium.
 Oxygen Therapy
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 Oxygen therapy is prescribed by the physician who

specifies the concentration, method of delivery and
flow rate i.e. liter per minute. The concentration is of
more importance than the liter flow per minute.
When administering oxygen in an emergency
measure, the nurse may initiate the therapy. For
clients who have COPD, a low flow oxygen system
is essential.
 Oxygen Therapy
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 Clients who have difficulty ventilating all areas of

their lungs, those whose gas exchange is impaired or
people with heart failure may require oxygen therapy
to prevent hypoxia.
 Hypoxia: Hypoxia is the medical condition
characterized by the shortage of oxygen in the body
or a particular region of the body
 Indications for oxygen therapy
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 Respiratory compromise
 Cyanosis: Cyanosis is a physical sign causing bluish

discoloration of the skin and mucous membranes

 Tachypnea: Tachypnea is the medical term for an

increase in the rate of respiration (breathing).

 Hypoxemia: Hypoxemia refers to decreased partial

pressure of oxygen in blood.

 Partially obstructed airway
 Indications for oxygen therapy
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 Cardiac compromise
 Chest pain
 Shock
 Tachycardia
 Arrhythmias

 Neurological deficits
 CVA
 Spinal injuries
 Coma
 Indications for oxygen therapy
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 Lung disease
 Chest injuries
 Airway obstruction
 Stroke
 Shock
 Seizures
 Diabetes
 Trauma
 Major blood loss
 Types of Oxygen Delivery
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 Nasal cannula
 Face masks
- simple face masks
- partial rebreather masks
- non rebreather masks
- venturi masks
 Face tents
 Transtracheal oxygen delivery
 Nasal Cannula (Prong)
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 Flow rate up to 6L/min

 Unable to determine exact concentration
 Comfortable – allows patient to eat, drink talk
 Can still be used if patient’ mouth breathing
 Delivers O2 into the patient’s nostrils by way of two
small plastic prongs
 Delivers low concentration of O2 (24% to 45%) at
flow rates of 2-6 L/min
 Most common inexpensive device
 Nasal cannula
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23

Nasal Cannula
or
Nasal Prongs
 Face Masks
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Face masks that cover the client’s nose and mouth

may be used for oxygen inhalation. Exhalation ports
on the sides of the masks allowed exhaled carbon
dioxide to escape.
 Face Masks
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 Simple Face Masks

- delivers oxygen concentrations from 40% to 60% at
liters flows of 5 – 8 L/minute, respectively.
 Face Masks
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 Partial Rebreather Masks

- delivers oxygen concentrations of
60% to 90% at liter flows of 6 to 10
L/ minute, respectively. Partial
rebreather masks are designed to
capture the first 150ml of the
exhaled breath into the reservoir bag
for inhalation during the subsequent
breath. It allows the client to
rebreathe about the first third of the
exhaled air in conjunction with
oxygen.
 Partial Rebreather Mask
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 Face Masks
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 Non Rebreather Masks

- delivers the highest oxygen
concentration possible –
95% to 100% - by means
other than intubation or
mechanical ventilation at
liter flows of 10 – 15 L/
minute, respectively.
 Non Rebreather mask
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Non-
 Face Masks
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 Venturi Masks
- the venturi masks delivers oxygen concentrations
varying from 24% to 40% or 50% at liter flows of 4
to 10 L/ minute.
 Venturi Mask
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 Face Tents
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 Face tents can replace oxygen masks when masks

are poorly tolerated by clients. Face tents provide
varying concentration of oxygen, for example 30% to
50% concentration of oxygen at 4 to 8 L/minute.
Frequently inspect the client’s facial skin for
dampness or chafing, and dry and treat as needed. As
with face masks, the client’s facial skin must be kept
dry.
 Adult Oxygen Face Tent Pediatric Oxygen Tent
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 Transtracheal Oxygen Delivery
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- used by oxygen dependent client. Oxygen is

delivered through a small, narrow plastic cannula
surgically inserted through the skin directly into the
trachea. A chain around the neck holds the catheter in
place.
- the nurse keeps the catheter patent by injecting 1.5
ml of normal saline into it, moving a cleaning rod in
and out of it and then injecting another 1.5 ml of
normal saline. This is done 2 or 3x a day.
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Transtracheal
Oxygen Setup
37

Adjusting the
flow rate
Types of Oxygen Delivery Concentration of oxygen Flow rate
% L / min

Nasal Cannula 24% - 45% 2 - 6 L / min

Simple face masks 40% - 60% 5 - 8 L / min

Partial rebreather masks 60% - 90% 6 - 10 L / min

Non rebreather masks 95% - 100% 10 - 15 L / min

Venturi masks 24 % - 50% 4 - 10 L / min

Face tents 30% - 50% 4 - 8 L / min

 Response to Oxygen
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1) Improves skin color

2) Decreases respiratory distress

3) Decreased restlessness
 Humidifiers
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 Humidifiers prevent mucous membranes from drying

and becoming irritated and loosens secretions for easier
expectoration. Oxygen passing through water picks up
water vapor before it reaches the client.
( The oxygen passes through sterile distilled water or tap
water and then along a line to the device through which
the moistened oxygen is inhaled ( e.g. a cannula, nasal
catheter, or oxygen mask).
41

 Oxygen humidifier attached to

a wall outlet oxygen flow
meter
 Safety
42

• If O2 tank gets punctured, or valves

break off, tank becomes a missile
• O2 supports combustion, causing
fire to burn rapidly
• When under pressure, O2 and oil
DON’T MIX
- Can cause a reaction which may
cause an explosion
 Safety
43

• Don’t lubricate the O2 tank or gauges with petroleum

products
• Never roll a tank
• Never store in heat or in a closed vehicle in the sun
• No smoking or exposure to open flame around O2
• No tape on tank/gauges
– O2 reacts with some adhesives
• Store tanks upright and secured
 Nursing Responsibilities
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 The nurse should explain the reason and the objective

for the therapy.
 The nurse should know the proper care of and
administration of oxygen.
 Instruct the patient and family the methods for
administering oxygen.
 Demonstrate safe and appropriate use of oxygen and
oxygen device.
 Identify to patient and family the signs and
symptoms indicating the need for oxygen.
 Nursing Responsibilities
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1. Explain procedure to the patient and review safety

precautions necessary when oxygen is in use. Place
NO SMOKING sign on appropriate areas.
2. Wash your hands.
3. Attach the face mask to the oxygen setup with
humidification. Start the flow of oxygen at the
specified rate. For a mask with a reservoir, allow
oxygen to fill the bag before placing the mask over
the patient’s nose and mouth.
 Nursing Responsibilities
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4. Position the face mask over the patient’s nose and

mouth. Adjust it with the elastic strap so that the
mask fits snugly but comfortably on the face.
5. Use gauze pads to reduce irritation to the patient’s
ear and scalp.
6. Wash your hands.
7. Remove the mask and dry the skin every 2 to 3
hours if the oxygen is running continuously. Do not
powder around the mask.
8. Assess and chart patient’s response to therapy.
 Pulse Oximetry
47

 Pulse oximetry is a non-invasive method that

measures the arterial oxyhemoglobin saturation
(SaO2 or SpO2 ) of arterial blood. A range of 95% to
100% is considered normal SpO2; value less than
85% indicate that oxygenation to the tissues is
inadequate.
 Patients receiving oxygen therapy
 Risk for hypoxia
 Postoperative patients
 Malfunctions & Diseases of the
Respiratory System
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Asthma Severe allergic reaction characterized by the constriction of bronchioles

Bronchitis Inflammation of the lining of the bronchioles

Condition in which the alveoli deteriorate, causing the lungs to lose their
Emphysema
elasticity

Condition in which the alveoli become filled with fluid, preventing the exchange
Pneumonia
of gases

Lung cancer Irregular & uncontrolled growth of tumors in the lung tissue
 What is Asepsis???
49

Asepsis is the freedom from disease-causing

microorganisms.
OR
The absence of bacteria, viruses, and other microorganisms.

The two basic types of sepsis are medical and surgical.

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 Asepsis
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Medical Asepsis Surgical Asepsis

 “Clean technique”  “Sterile technique”

 Kill pathogenic organisms  Destroy pathogenic or non-

pathogenicorganisms
 Prevent spread of
pathogens from one person  Prevent intorduction of
to another. organisms into open wound
or sterile body cavity.
 Ways to control Infection exposure
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 Frequent hand washing

 Use of appropriate Personal Protective Equipments
(PPEs)
 Isolation practices
 Fumigation: is a method of pest control or the
removal of harmful micro-organisms by
completely filling an area with gaseous
pesticides
 Education about disease process
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