Eunice Lois B.

Faldas
BSN 2

OXYGEN THERAPY
Definition:
● Oxygen therapy is the administration of oxygen at a concentration of pressure
greater than that found in the environmental atmosphere. It is a key treatment in
respiratory care.
● Oxygen is a colourless, odourless, tasteless gas that is essential for the body to
function properly and to survive.
● The air that we breathe contains approximately 21% oxygen. This amount is
enough for children who have healthy lungs and many with lung disease. However,
some children with lung disease are unable to get enough oxygen in their bodies
through normal breathing.
● Children with lung problems who live or travel to areas at high altitude may also
need oxygen because there is less oxygen in the air. The oxygen therapy is
required to help these children grow and develop.
How do I know if my child needs oxygen?
A healthcare provider will figure out if your child needs oxygen therapy by
measuring the oxygen level (oxygen saturation or O2 sat) using a device called a pulse
oximeter.
This device can be clipped painlessly onto your child’s finger, toe or earlobe. This
device can check your child’s O2 sat over a period of time, for example, during sleep or
exercise.
The general goal is to keep your child’s oxygen at a level that meets the body’s
need for oxygen, usually 90-93% O2 sat or higher. Your healthcare provider will also help
you define an acceptable lower limit O2 sat for your child. Another test that is sometimes
done to check the level of oxygen in the blood is called a blood gas.

INDICATIONS:
● Acute Respiratory Failure
● Acute Myocardial Infarction
● Cardiac Failure
● Shock
● Hypermetabolic state induced by trauma, burns or sepsis
● Anaemia
● Cyanide poisoning
● During CPR
● During anaesthesia for surgery
 OXYGEN
- Must be written legibly by the doctor
- Prescription should be dated by the doctor
- Doctor must indicate duration of O2 therapy
- The O2 % concentration must be prescribed
- The flow rate must be prescribed
Sources of oxygen:
1. Oxygen cylinder
- The oxygen cylinder is delivered with a protective to prevent accidental force
against the cylinder outlet.
- To release oxygen safety and at a desirable rate, a regulator is used.
- A reduction gauge that shows the amount of oxygen in the tank.
- A flow meter that regulates the control of oxygen in litres per minutes.
- Oxygen is moistened by passing it through a humidifier to prevent the
mucous membranes of the respiratory from becoming dry.
2. Wall-outlet oxygen
- The oxygen is supplied from a central source through a pipeline.
- Only a flow meter and a humidifier are required.

METHODS OF OXYGEN ADMINISTRATION

Oxygen Delivery Systems:
1. Nasal Cannula
2. Simple Mask
3. Partial re-breather mask
4. Non- rebreather Mask (NRBM)
5. Venturi mask
6. Oxygen hood
7. Oxygen Tent
8. AMBU bag
9. Tracheostomy Collar
10. T-piece
METHODS OF OXYGEN ADMINISTRATION
1. Nasal Cannula (prongs)
- It is a disposable, plastic device with two protruding prongs for
insertion into the nostrils, connected to an oxygen source.
- Used for low-medium concentrations of Oxygen (24-44%)
Nasal cannula (prongs)
Advantages
● Client able to talk and eat with oxygen in place
● Easily used in home setting
● Safe and simple
● Easily tolerated
● Delivers low concentrations
Disadvantages
● Unable to use with nasal obstruction
● Drying to mucous membranes, so flow greater than 4 L/ min needs to be
humidified
● Can dislodged from nares easily
● Causes skin irritation or breakdown over ears or at nares
● Not good for mouth breathers
● Patient’s breathing pattern affects exact FIO2
NURSING INTERVENTIONS
1. Be alert for skin breakdown over the ears and in the nostrils from too tight an
application
2. Observe for mucosal dryness
3. Check frequently that both prongs are in client’s nares

❖ FACE MASK
➢ Simple face mask
➢ Partial Re-breather Mask
➢ Non Re- breather Mask
➢ Venturi Mask
2. Simple Oxygen mask - is made of clear, flexible, plastic or rubber that can be moulded
to fit the face.
- It is held to the head with elastic bands.
- Some have a metal clip that can be bent over the bridge of the nose foe a
comfortable fit.

- It delivers 35% to 60% oxygen.

- A flow rate of 6 to 10 liters per minute.
- It has vents on its sides in at many places, thereby diluting the source oxygen
- Often, it is used when an increased delivery of oxygen is needed for short
periods (i.e., less than 12 hours).
Advantages
● Can provide increased delivery of oxygen for short period of time
Disadvantages
● Tight seal required to deliver higher concentration
● Difficult to keep mask in position over nose and mouth
● Potential for skin breakdown (pressure, moisture)
● Uncomfortable for pt while eating/talking
● Expensive with nasal tube
NURSING INTERVENTIONS
1. Monitor client frequently to check placement of the mask
2. Secure physician’s order to replace mask with nasal cannula during meal time

3. Partial Re Breather Mask

- The mask is with a reservoir bag that must remain inflated during both inspiration &
expiration
- It collects part of the patient’s exhaled air
- It is used to deliver oxygen concentrations up to 80%
 - The oxygen flow rate must be maintained at minimum of 6L/ min to ensure that the
patient does not re-breathe large amounts of exhaled air. The remaining exhaled air
exists through vents.
Advantages
● Client can inhale room air through openings in mask if oxygen’s supply is
briefly interrupted
Disadvantages
● Requires tight seal (difficulty in eating and talking; uncomfortable)
PRIORITY NURSING INTERVENTIONS
1. Set flow rate so mask remains two-thirds full during inspiration
2. Keep reservoir bag free of twists or kinks

4. Non Re-breather Mask - this mask provides the highest concentration of oxygen (95%
- 100%) at a flow rate 6-15 L/min
- It is similar to the partial re-breather mask except two one-way valves
present conservation of exhaled air.
- The bag has an oxygen reservoir

- When the patient exhales air the one-way valve closes and all of the expired air is
deposited into the atmosphere, not the reservoir bag.
- In this way, the patient is not re-breathing any of the expired gas.
Advantages
● Delivers the highest possible oxygen concentration
● Suitable for pt breathing spontaneous with severe hypoxemia
Disadvantages
● Impractical for long term therapy
 ● Malfunction can cause CO2 buildup
● Suffocation
● Expensive and uncomfortable
PRIORITY NURSING INTERVENTIONS
1. Maintain flow rate so reservoir bag collapses only slightly during inspiration
2. Check that valves and rubber flaps are functioning properly (open during
expiration)
3. Monitor SaO2 with pulse oximeter
5. Venturi Mask
- It is a high flow oxygen delivery device
- Oxygen from 40%-50% at liters flow of 4 to 15 L/min
- The mask is constructed so that there is a constant flow of room air blended with a
fixed concentration of oxygen

- Designed with wide- bore tubing and various color-coded jet adapters.
- Each color code corresponds to a precise oxygen concentration and a specific liter
flow
- It is used primarily for patients with Chronic Obstructive Pulmonary Disease
Advantages
● Delivers most precise oxygen concentration
● Doesn’t dry mucous membranes
Disadvantages
● Uncomfortable
● Risk for skin irritation
● Produce respiratory depression in COPD patient with high oxygen concentration of
50%
PRIORITY NURSING INTERVENTIONS
1. Requires careful monitoring to verify FiO2 at flow rate ordered
2. Check that air intake valves are not blocked
6. Oxygen Hood
- It is used for babies who can breathe on their own but still need extra oxygen
- A hood is a plastic dome or box with warm, moist oxygen inside
- The hood is place over the baby’s head

Advantages
● Hoods give up to 90% oxygen,excellent humidification, and temperature control
without the use of pressure.
● Hoods can be utilised in a variety of beds for infants of varied sizes. They make it
simple to get to the child for various reasons.
Disadvantages
● Oxygen hood is a high-flow device (4–6 L/min) and leads to a lot of wastage
● Can lead to limited mobility, limited access to the head, and skin irritation.
● It is necessary to maintain a neutral temperature environment by employing
warmed gas, especially with premature infants.
 ● The ability of the caregiver to see the infant’s face may be obstructed by mist or
moisture.
● It’s not normally disposable, and it’s hard to clean AND DISINFECT.

7.Oxygen tent
- Consists of a canopy placed over the head and shoulders, or over the entire body of
a patient to provide oxygen at a higher level than normal.
- Typically the tent is made of see-through plastic material
- It can envelop the patient’s bed with the end sections held in place by a mattress to
ensure that the tent is airtight
- The closure often has a side opening with a zipper

- The prescribed oxygen flow rate is 'a minimum of 10 litres per minute' for a flushing
period of 20 minutes after setting up the tent and thereafter at 8 litres per minute
except for periods of 10 minutes for re-flushing after any of the zippered apertures
has been opened for nursing procedures.

Advantages

● If provides an environment for patient with controlled concentration,

temperature regulation and humidity control
● It allows freedom for free movement in bed

Disadvantages

● It creates feeling of isolation

● There is an increased chance of fire
● It requires much time and effort to clean and maintain a tent
NURSING INTERVENTIONS

1. Since oxygen acts as a drug. It must be prescribed and administered in specific dose in
order to avoid oxygen toxicity. The dosage of O2 is started in terms of concentration and rate
of flow

2. When using oxygen cylinder uses a regulator and humidifiers. The purpose of the regulator
is to reduce the pressure of the O2 in the cylinder to a safer level. The humidifier helps to
saturate the oxygen with water vapor to prevent the drying of the mucus membranes of
respiratory tract

3.The glass tube should be summered under the water so that oxygen is bubbled through the
water. Every water of the apparatus should be clean to prevent infection.

8. AMBU Bag
- Artificial Manual Breathing Unit or Bag Valve Mask Ventilation is a hand-held
device commonly used to provide positive pressure ventilation to patients who are not
breathing or not breathing adequately.

- The frequency of squeezing the Ambu bag or bag-mask device depends on the
patient's respiratory status and the provider's training and experience. In general,
rescuers should squeeze the bag at a rate of 10-12 breaths per minute for adults
and children and 20-30 breaths per minute for infants.

Advantages
● This basic airway management technique allows for oxygenation and ventilation of
patients until a more definitive airway can be established.

Disadvantages
 ● It requires training and practice to effectively use a BVM, and even with much
practice, many find it is difficult to maintain adequate mask seal and ventilate
● sufficient volumes when only one rescuer is available to use it.

9. Tracheostomy Collar/ Mask

- Inserted directly into trachea and Indicated for chronic O2 therapy need
- O2 flow 8 to 10L
- Provides accurate FIO2 and good humidity
- Comfortable and more efficient

Advantages

● It may allow a person with chronic breathing difficulties to talk.

● It may eliminate the need for care in an intensive care unit.
● It builds a more stable airway that is less likely to suffer serious injuries.
● It may improve breathing. This may speed healing and improve outcomes in
people with chronic, long-term medical conditions.
● It may reduce the need for sedation and eliminate the need for masks and
other facial equipment, potentially improving relationships and quality of life.
● It may enable a person who was on a feeding tube to again eat by mouth.

Disadvantages
● Pain and trauma. Tracheostomy can be painful, especially in an emergency
setting. Its placement can also be scary. When there is a less intrusive
emergency option available, first responders should utilise it.
 ● Scarring. In patients for whom a tracheostomy is likely to be
temporary—including those in emergency settings and people with breathing
difficulties that may improve—scarring can be a serious disadvantage.
● Comfort issues. In someone whose length of life is limited, a tracheostomy may
improve comfort, or it may be an additional source of trauma. Providers must
work with the patient and their caregivers to assess what will be most
comfortable in the patient’s final days.
● Complications. A tracheostomy can get infected and cause tracheal bleeding,
nerve damage, and erosion of the trachea. Because a tracheostomy bypasses
normal infection prevention strategies in the body, the risk of infection is
significant.
● Cleaning and additional support. A tracheostomy requires regular cleaning
when it is used over the long term. People with tracheostomies may also
require more breathing support. This skilled care may limit their living
arrangements and compromise their lifestyles.

10. T-piece
- A T-shaped adapter used to provide oxygen to either an endotracheal or
Tracheostomy tube.
- Used on end of Et tube when weaning from ventilator
- The flow rate should be at least 10 with humidification. Flow can also be provided
by a ventilator.

Advantages

● Prevents drying of mucous

● Helps to thin secretions
● Accurate FIO2 can be delivered
Disadvantages

● Tubing can become heavy with accumulated water

● Accidentally accumulated water may drain into patients airway during position
change

SIDE EFFECTS & COMPLICATIONS OF OXYGEN THERAPY

1. Oxygen Toxicity - a condition which occurs due to inspiration of a high

concentration of oxygen for a prolonged period of time
2. Retrolental Fibroplasia - blindness due to vasoconstriction and ischemia
(premature infants)
3. Absorption Atelectasis - a loss of lung volume caused by the resorption of air
within the alveoli, the small air sacs of the lungs.

SAFETY PRECAUTIONS DURING OXYGEN THERAPY

● Oxygen is a therapeutic gas and must be prescribed and adjusted only with a health
care provider’s order
● Place an “Oxygen in Use” sign on the patient’s door and in the patient’s room
● If using oxygen at home, place a sign on the door of the house.
● No smoking should be allowed on the premises