Oxygen therapy

2. Oxygen Therapy
Prepared by:
Kalpana kawan
Gulnaj Begam
BNS 3rd year

3. General Objective
At the end of this session, BNS 3rd year students
will be able to know about Oxygen Therapy.

4. Specific Objectives
At the end of this session, BNS 3rd year students will be
able to:
 Define oxygen and oxygen therapy
 State the purpose of oxygen therapy
 List the indication of oxygen therapy
 State the assessment of need
 State oxygen delivey methods.
 Describe the administration of oxygen therapy.
 List the complication of oxygen therapy
 State key nursing consideration
 Explain when to stop oxygen therapy

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

6. Oxygen therapy
• Oxygen therapy is the administration of
oxygen at a concentration of pressure greater
than that found in the environmental
atmosphere (i.e. 21%) to treat or prevent
hypoxia.
• Oxygen therapy is a key treatment in
respiratory care.

7. Purpose
• The main purpose is to increase oxygen
saturation in tissues where the saturation
levels are too low due to illness or injury.

8. Three clinical goals of oxygen
therapy
• Treat hypoxemia.
• Decrease work of breathing (WOB).
• Decrease myocardial work.

9. Indication of O2 therapy
• Documented hypoxemia
• An acute care situation in which hypoxemia is
suspected.
• Severe trauma
• Acute myocardial infraction
• Short term therapy(eg. Post anaesthesia recovery)
• Increased metabolic demands, i.e burns, multiple
injuries and severe infection.

10. Indication contd….
• Severe respiratory distress( acute asthma or
pneumonia)
• Chronic Obstructive pulmonary disease ( COPD
including chronic bronchitis, emphysema and chronic
asthma)
• Pulmonary hypertension
• Anaemia
• After severe haemorrage
• Poisoning with chemical that alter the tissues ability
to utilize O2 e.g carbon monoxide poisoning.

11. Assessment of need
Need is determined by measurement of
inadequate oxygen tensions or saturations, by
invasive or non-invasive methods, or the
presence of clinical indicators.
• Arterial blood gases
• Pulse oximetry
• Clinical presentation

12. Oxygen delivery methods
Low flow oxygen delivery system: (variable
performance)
• Nasal canula
• Simple face mask
• Partial rebreathing mask
• Non rebreathing mask

13. Contd…
High flow oxygen delivery system( Fixed
performance)
Deliver specific and constant percent of oxygen
independent of client’s breathing. For example:
• Venturi mask
• Face tent
• Aerosol mask
• Tracheostomy collar
• T- piece

14. Administration of Oxygen therapy
• Nasal cannula or prongs

15. Administration of Oxygen therapy
Nasal cannula or prongs
• It is disposable plastic device with two protruding
prongs for insertion into the nostrils, connected to an
oxygen source and used for low-medium
concentrations of oxygen (Fio2 ranges from 24-44%
of O2 at 1-6 liter of O2.
• A flow rate of 0-6 L/minute can be used with nasal
cannula depending upon the requirement of oxygen

16. Nasal cannula Contd…..
Method Amount delivered
Fio2
Priority nursing
interventions
Nasal cannula Low flow % 24-44
1 L/min=24%
2 L/min=28%
3 L/min=32%
4 L/min=36%
5 L/min=40%
6 L/min=44 %
 Check
frequently that
both prongs are
in clients nares.
 Never deliver
more than
2 - 3L/min to
clients with
chronic lung
diseases.

17. Contd…..
Advantages
• Inexpensive
• Well tolerated, comfortable
• Easy to eat, drink, and speak
• Used in patient with COPD

18. Contd…..
Disadvantages
• Pressure sores
• Crusting of secretions
• Drying of mucosa
• Epistaxis
• At flow rate of more than 6 L/minute does not
help in improving oxygenation and of no use.
• Above a flow rate of 4 L/min (without
humidification) there is increased chance of
nasal irritation.

19. Face mask
Face masks that cover the client’s nose and
mouth which is used for oxygen inhalation. Exhalation
ports on the sides of the mask allow exhaled carbon
dioxide to escape. A variety of oxygen masks are:
1. Simple face mask:
2. Partial rebreather mask
3. Non rebreather mask
4. Venturi mask
5. Face tent

20. Contd….
1. Simple face mask:
• A simple face mask is made of clear , flexible ,
plastic or rubber that can be molded to fit the
face.
• There is no reservoir bag.
• The simple face mask delivers oxygen
concentrations from 40% to 60% at liter flows of
5-8 L/min, respectively.

21. Contd…
• Flow rates and percent oxygenation values are as
follows:
 5L/min= 40%
 6L/min= 45%
 7L/min=50%
 8L/min = 55%
 >8L/min = 60%

22. Contd..
Method Amount
Delivered Fio2
Priority Nursing
Intervention
Advantages Disadvantages
Simple
face mask
-Low flow
- 5-8L /min
- 40%- 60%
(5L/min is
minimum
setting)
-Monitor client
frequently to
check placement
of the mask.
-Support client of
claustrophobia is
concern.
-Secure
physician’s order
to replace mask
with nasal cannula
during meal time.
-Can provide
increased
delivery of
oxygen for
short period
of time.
-Tight seal required to deliver
higher concentration
-Difficult to keep mask in
position over nose and mouth
-Potential for skin break
down(Pressure, moisture)
-Uncomfortable for patient
while eating or talking
-Expensive with nasal tube

23. 2)Partial Rebreather Mask

24. Contd….
2)Partial Rebreather Mask
• The mask have a reservoir bag must remaine inflated during
both inspiration and expiration.
• It has one two-way valve connecting the mask and the
reservoir bag
• The two-way valve allows about one-third of exhaled air to
get into the bag.
• O2 concemtration: 70-80%
• Flow rate: 6-15 L/min

25. Contd…..
• 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.
• The remaining exhaled air exits through vents.

26. Contd……..
Method Amount
Delivered
Fio2
Priority
Nursing
intervention
Advantages Disadvantages
Partial
Rebreather
Mask
Low flow
6-15L/min
70%-80%
oxygen
-Set flow rate
so mask remain
two - thirds full
during
inspiration
-Keep reservoir
bag free of
twists or kinks.
-Patient can
inhale room air
through
opening in
mask if oxygen
supply is briefly
interrupted.
-Requires tight
seal
-eating and talking
difficult,
uncomfortable
-Not as drying to
mucous
membranes

28. Contd….
3)Non Rebreather Mask:
• This mask provides the highest concentration
of oxygen (60%-100%)at a flow rate 6-
15L/min
• It is similar to the partial rebreather mask
except two one –way valve prevent
conservation of exhaled air.
• The bag is an oxygen reservoir so only
oxygen flows from the bag to the mask.

29. Contd…
Method Amount
Delivered
Fio2
Priority Nursing
Intervention
Advantages Disadvantages
Non
Rebreather
Mask
-Low Flow
6-15L/ min
80%-100%
-Maintain flow rate
so reservoir bag
collapses only
slightly during
inspiration
-Check that valves
and rubber flaps are
function properly
(open during
expiration and close
during inhalation)
-Monitor Spo2 with
pulse oximeter.
-Delivers the
highest possible
oxygen
concentration.
-Suitable for
patient breathing
spontaneous
with severe
hypoxemia.
-Impractical for
long term therapy.
-Malfunction can
cause Co2 buildup.
-Suffocation
-Expensive, Costly
-Feeling of
suffocation
-Uncomfortable

30. Contd…
4) Venturi Mask

31. Contd….
Venturi Mask(Air Entrainment mask)
• It is high flow concentration of oxygen.
• Most accurate (fix) O2 concentration delivery
system
• This device uses different size adaptors to deliver a
fixed or predicted Fio2.

32. Contd….
• It consists of a mask with holes on each side
that allow exhaled air to escape.
• At the base of the mask are color coded
entrainment port that are adjusted to allow
regulation of the concentration of the
oxygen administered.

33. Contd…
• Flow rate : 2-15L/min
• O2 concentration : 24% -60%
• Use : Acute Respiratory Distress

34. Contd….
Based on Color coded Adapter
Colour Fio2 O2 flow
Blue 24% 2 L/min
White 28% 4 L/min
Orange 31% 6 L/min
Yellow 35% 8 L/min
Red 40% 10 L/min
Green 60% 15 L/min

35. Contd…
Method Amount
Delivered
Fio2
Priority
Nursing
Interventions
Advantages Disadvantages
Venturi
mask
High flow
2 to 15
L/min
Oxygen
from 24%-
60%
-Requires
careful
monitoring to
verify Fio2 at
flow rate
ordered.
- Check that air
intake valves
are not
blocked.
-Delivers
most precise
oxygen
concentration.
- Doesn’t dry
mucous
membranes.
- Uncomfortable
- Risk for skin
irritation.
-Produce respiratory
depression in COPD
patient with high
oxygen concentration
50%.

36. Contd……
• 5)Face tent

37. Contd….
5)A face tent:
• A face tent is used as an alternative to aerosol
mask especially to patient who report
claustrophopic on wearing an aerosol mask.
• A face tent delivers oxygen concentration of
28-100% with flow rate from 8-12L/min.

38. Contd…
Tracheostomy collar:

39. Contd…
Tracheostomy collar:
• It is a small mask that fits over the patient’s
tracheostomy site.
• The mask has an exhalation port which
remains patent at all times and a port that
connects to the oxygen source with a large
bore tubing.
• The flow rate is usually set at 10L/min.

40. Contd…
T-piece
• A T-piece is a T-shaped device which connects
oxygen source to artificial airway (endo-
tracheal tube or tracheostomy). Flow rate 8-10
L/min (deliver 60-100 %).
• Used to deliver oxygen therapy to an
intubated patient who does not require
mechanical ventilation.

41. Contd..
 Advantages
• Provide good humidity
• Comfortable
• Provide accurate FiO2
Disadvantage
• Heavy with tubing

42. Complication of Oxygen Therapy
• Oxygen toxicity
• Drying of mucous membrane
• Oxygen induced hypoventilation
• Retrolental fibroplasias( Children)

43. Key nursing consideration
• Oxygen must be administered with care.
• Since oxygen acts as a drug, it must be prescribed
and administered in specific dose in order to avoid
oxygen toxicity. The dosage of oxygen is started in
terms of concentration and rate of flow.
• Oxygen therapy should be given continuously and
should not be stopped abruptly until the patient has
recovered.

44. Contd….
• Sudden discontinuation can wash-out body stores of
oxygen resulting in fall of alveolar oxygen tension.
• Change the nasal catheters at least 8 hours or more
often.
• When oxygen therapy is discontinued, it should be
done gradually.

45. Contd…
• Watch the patient receiving oxygen therapy
continuously to detect the early signs of oxygen
toxicity.
• Promote safety measures; inform that smoking is not
permitted in the area of oxygen use.
• Place “NO SMOKING” signs in patient’s room or
door.

46. Contd…
• Oxygen cylinder should be stored at a low
temperature because high temperature can cause
expansion of the gas with consequent loss of gas
through safety valve.
• Never increase or decrease the flow of oxygen
when the nasal cannula is in the patient’s nostrils.
• Do not use electrical appliances close to oxygen.

47. Contd…
• Oil or grease should not be used on the regulator
and cylinder because in the presence of high
concentration oil is likely to catch fire and the
cylinder may explode.
• Have fire extinguisher available.
• Ensure the humidifier bottle is always at least 1/3 full
with sterile water.

48. When to stop Oxygen therapy
• Weaning should be considered when the patient
becomes comfortable, underlying diseases is
stabilized, BP, pulse rate , skin color, respiratory
rate are within normal range.
• Weaning can be gradually attempted by lowering
its concentration or discontinuing oxygen for a
fixed time .eg : 30 min and re-evaluating the
clinical parameters and Spo2 periodically.

49. Contd…
• Patients with chronic respiratory diseases
may required oxygen at lower concentration
for prolong period.

51. References
• Crawford.L.R.(2016)Fundamentals of Nursing,elsevier.page no. 958-964.
• Erb’s.K.(2012).Historical and contemporary Nursing Practice,pearson
Education,5th edition.page no. 1427-1437
• Williams and wilkins L.(2008).Fundamentals of Nursing.Wolters
kluwer(india)Pvt.Ltd.6th edition.page no. 1627-1632.
• Pathak P. Devkota R.(2014).A Text book of Fundamentals of
Nursing.Lumbini Printing and publication Pvt.Ltd.4th edition.page no.326-
330.
• Hogston R. Marjoram B.A.(2007).Foundations of Nursing
Practice.palgrave macmillan.3rd edition.page no.213-219.
• Teaching Hospital TU.(2017).A Handbook of Emergency
Nursing.Screentech Printing Support.edition. Feb 2017.page no.59-63.
• Retrived from https://www.healthline.com/health/non-rebreather#when-to-
use on Nov 11,2021
• Kuruvilla J.(2008).Essentials of Critical Care Nursing.Jaypee Brothers
Medical Publishers (P)Ltd.First edition.Page no.658-662.