Oxygen Therapy for Adults in the
Acute Care Facility for Chronic
and Acute conditions
CLAIRE VELASQUEZ – CONSTANTINO
Define the oxygen therapy and its
Discuss the type of oxygen therapy
List the purpose of using the oxygen
Explain the procedure
Demonstrate the procedure
List Complication of oxygen therapy and
• Oxygen therapy is the administration of
oxygen at concentrations greater than that of
• Intent of treating or preventing the symptoms
and manifestations of hypoxia.
• Is the administration of oxygen as a medical
intervention, which can be for a variety of
purposes in both chronic and acute patient
• Head trauma or acute head injury
• Acute Tachypnea
Respiratory rate increased from normal (RR)
normal range 12 – 24 breaths per minute
Significant respiratory rates increasing to
more than 30 bpm
Visible with a Hemodynamic monitor or an
• Heart Rate increased from normal (HR)
Increased Myocardial work
Normal range 60 – 100 beats per minute
Significant heart rate increasing to more
than 110 bpm
Visible with a Hemodynamic monitor or an
Oxygen Saturation level is decreased
Normal range for saturation 90-100
Significant decrease of oxygen
saturation level below 85.
Visible with a Hemodynamic monitor
or an ordinary monitor or can be
internally checked via ABG.
THERE ARE NO
BUT…. KEEP IN MIND
•High levels of oxygen in the
blood and tissue can be
helpful or damaging
Oxygen should be handled with precautions :
OXYGEN IS A DRUG
Atelectasis - refers to the partial or complete
collapse of the lungs.
• Absorption Atelectasis Refers to the condition
where the reduction of nitrogen concentration
in the lungs causes a collapse.
A B A B
PCO2 = 40
PH2O = 47
After ~15 minutes,
blood N2 is depleted.
Poorly ventilated &
well perfused units (A)
The air you breathe contains nearly 78% of
nitrogen - helps keep the alveoli open and prevents the
collapse of the alveoli.
surgery and general anesthesia, large amounts of oxygen
are usually administered. This decreases the nitrogen
concentration in the air and leads to absorption
Patients who had gone heart or lung surgery and
Oxygen Induced Hypoventilation
•Suppression of ventilation
• Can lead to increased CO2
and carbon dioxide narcosis
Occurs due to inspiration of a high concentration of
oxygen for a prolonged period of time.
Oxygen concentration greater than 50%over 24 to 48
hours can cause pathological changes in the lungs.
More evident in infants especially prematurely delivered.
(retinopathy of prematurity and in some fibrotic lung –
stiffness develops to pulmonary fibrosis) in adults is mostly
coincides with oxygen induced hypoventilation in copd
PRECAUTIONS – FIRE HAZARD..
WHAT IS: LOW FLOW
The delivery of oxygen to the patient with variability of
The oxygen concentration is not determined only
The FI,O2 is influenced by breath rate, tidal volume and
- Breathing pattern
• If the breathing is fast or labored what
happens to the concentration of oxygen?
• How do we know that the patient is having
labored breathing just by looking?
• And what do we do first as medical
–A. call the doctor?
–B. Increase the oxygen?
• Breathing pattern is slow
• What happens to the concentrations of oxygen
• Is it going to be higher even were giving a small
• Will the concentration of oxygen were giving be the
HOW TO USE?
plastic devise with two protruding
prongs for insertion into the nostrils,
connected to an oxygen source.
- The standard nasal cannula delivers an
inspiratory oxygen fraction (FIO2) of 24-44% at
supply flows ranging from 1-6 L·min-1.
- The formula is FIO2 = 20% + (4 × oxygen litre
flow). The FIO2 is influenced by breath rate,
tidal volume and pathophysiology.
- The slower the inspiratory flow the higher the
Patients are able
to talk and eat with
oxygen in place
Easily used in
may cause irritation
to the nasal and
if oxygen flow rates
are above 4
Check frequently that both prongs
are in clients nasal nares
Never deliver more than 2-3
Lmin to patients with chronic lung
disease if patient doesn’t need it.
SIMPLE OXYGEN MASK
Simple mask is made of clear, flexible , plastic
or rubber that can be molded 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 for a comfortable fit
• Open ports for
• Air entrained through
ports if O2 flow
through does not
meet peak inspiratory
• 5 – 10 liters per minute
• < 5 liters will not flush CO2
• 40 – 60% FIO2 approximately
depending on the pattern of
• Can provide increased
delivery of oxygen for
short period of time
• The face mask is
indicated in patients
with nasal irritation or
• It is also useful for
patients who are strictly
-Tight seal required to deliver
- Difficult to keep mask in
position over nose and mouth
-Potential for skin breakdown
- Uncomfortable for pt while
eating or talking.
- Obtrusive, uncomfortable
- It muffles communication,
Monitor client frequently to check
placement of the mask.
Support client if claustrophobia is concern
Secure physician's order to replace mask
with nasal cannula during meal time
PARTIAL REBREATHING MASK
• Mask is a simple mask with a reservoir bag.
• Same as the Non re-breathing bag
but..without a one way valve.
• Low flow, medium concentration
• 50 – 70%
• 8 – 12 liters per minute
• Bag should remain at least 1/3 full during
• Allow the mixture or oxygen and carbon
dioxide in the mask.
Partial Rebreather mask
• O2 directed into
• Insp: draw gas from bag
& ? room air
• Exp: first 1/3 of exhaled
gas goes into bag (dead
• Dead space gas mixes
with ‘new’ O2 going into
• Deliver ~60% O2
- Can inhale room
openings in mask if
oxygen supply is
- Not as drying to
- Requires tight
- Eating and
Set flow rate so mask remains two-
thirds full during inspiration
Keep reservoir bag free of twists or
Prevents the reservoir bag to collapse
or be empty
Prevents anyone to squeeze the
bag while on the patient.
NON REBREATHING MASK
the one-way valve closes and all of the expired air is
deposited into the atmosphere, not the reservoir
This mask provides the highest concentration of oxygen
(95-100%) at a flow rate 8-15 L/min.
It is similar to the partial rebreather mask except
two one-way valves prevent conservation of
• Valve prevents exhaled
gas flow into reservoir
• Valve over exhalation
ports prevents air
• Delivers ~100% O2, if
bag does not
Delivers the highest
Suitable for pt breathing
spontaneous with sever
- Impractical for long term
- Malfunction can cause
Feeling of suffocation
Maintain flow rate so reservoir bag collapses
only slightly during inspiration
Check that valves and rubber flaps are
function properly (open during expiration )
Monitor SaO2 with pulse oximeter
Never allow anybody to squeeze the bag
One way valves
AIR ENTRAINMENT DEVICES
• High flow device (o2 concentration)
• Entrains air through side ports to achieve
• Variable entrainment ports and/or jets
• Air Entrainment or Venti Masks
• Manufacturer recommends liter flows for
The Venturi System
Room air dilutes the oxygen entering
the tubing to a certain concentration
The amount of air drawn in is
determined by the size of the orifice
Applying the Bernoulli principle
Oxygen from 24 - 50%
At liters flow of 4 to 15 L/min.
The mask is so constructed that there is a
constant flow of room air blended with a fixed
concentration of oxygen
Is designed with wide- bore tubing and
various color - coded jet adapters.
Each color code corresponds to a precise
It is high flow concentration of oxygen.
Oxygen concentration and a specific liter flow.
Risk for skin irritation
depression in COPD
patient with high
Maintains on the patient’s face
all the time.
Makes sure that the flow from
the flow meter is appropriately on
the level prescribed.
Produce respiratory depression in
COPD patient with high oxygen
Directed into trachea
Is indicated for chronic o2 therapy need
O2 flow rate 8 to 10L
Provides accurate FIO2
Provides good humidity.
Comfortable ,more efficient
• Delivers high
concentrations of oxygen
directly to the lungs.
• Stable and not moved
when the patient is moved
• Maintains saturation
• Viscosity of secretions
• Ability to cough and
• Clinical status
• Systemic hydration
• Patient compliance
• Method of humidification in use
• if any of the above list remain a
problem the current method of
humidification may be
• Maintains patent bronchial airway
• Make sure the tracheostomy site is clean and
• Check the cuff pressure if needed to be
inflated or the trach tube is properly secured.
• Make sure adequate humidification is present
to prevent further complications
Additional devices for high flow
• T-PIECE ADOPTOR
Used on end of ET tube
Prove when weaning from
is accurate FIO2
Provides good humidity
provide a baseline data for
Oxygen may depress the
hypoxia drive ( decrease
respiratory rate , alliterate
Check the physician order.
Assesses physical condition
Assess vital signs ,
Assess level of consciousness
Assess the laboratory results,
especially the ABG analyses,
Assess risk of CO2 retention
with oxygen administration
plastic nasal cannula
Administering oxygen by nasal cannula
not be ordered if the flow
rate is <4 /l/min
To be sure you are
performing the procedure
for the correct patient.
To gain his cooperation.
This position permits
easier chest expansion and
hence easier breathing.
To prevent dehydration
of mucous membrane.
Humidifier filled with distilled
No smoking signs
Identify the patient.
Explain procedure to the
Assist the patient to a semi-
fowler's position if possible.
Attach the oxygen supply tube
with humidification to the
cannula , face mask.
To facilitate oxygen
administration and comfort
To reduce irritation and
pressure and protect the skin.
Allow 3-5 L oxygen to flow
through the tubing.
Place the prongs in the
patient's nostrils and adjust it
Use gauze pads both behind
the head or the ears and under
the chin and tighten to comfort.
To provide optimal
delivery of oxygen to
Oxygen dries the mucous
membrane and cause
Adjust the flow rate to the
Encourage patient to breath
through his nose with his mouth
Assess the patient nose and
mouth and provide oronasal care
at least every 8 hours.
Administering oxygen by Face Mask
Ensure pt receive
flow sufficient to meet
respiratory demand &
Produce the flow rate ( 5 -10/min)
Attach the oxygen supply tube to
the mask .
Regulate the oxygen flow.
Position the mask over the
patient's nose and mouth.
And fit it securely, shaping the
metal band on the mask to the
bridge of the nose.
There is danger of
inhaling powder if it is
placed on the mask.
Remove the mask
and dry the skin every
2-3 hours if the oxygen
around the mask.
Wash your hands.
Administering oxygen by:
• The partial re-breather mask
• The non-rebreather mask
• The venturi mask
correct air /
Attach tubing to flow meter
Show the mask to pt & explain
Turn on oxygen flowmeter &
prescribed rate ( usually indicated on
Place mask over pt nose & mouth
Breathing pattern - regular and at normal rate.
Color - nail beds, lips, conjunctiva of eyes -
No confusion, disorientation, difficulty with
Arterial oxygen concentration or hemoglobin
Oxygen saturation within normal limits.
. Identify the type of oxygen equipment and
oxygen source in your facility
Hospitals – O2 inlet or O2 cylinders (E type)
in clinics – O2 inlet or O2 cylinders (E type)
Date and time oxygen started.
Method of delivery.
Oxygen concentration and flow rate.
Add oronasal care to the nursing care
THANK YOU FOR
LEARNING WITH ME