O2 administration, it types and nurses responsibilities
Download as PPT, PDF2 likes7,174 views
Oxygen therapy is the administration of oxygen at concentrations greater than 21% to treat conditions like hypoxia and respiratory failure. It can be delivered through nasal cannulas, masks, tents, or ventilators. Precise monitoring is needed to ensure safe and effective delivery while avoiding toxicity from high concentrations over long periods.
O2 administration, it types and nurses responsibilities
- 1. Oxygen administration By Mr. Anandh Sam Perera. S. M.Sc (N) Professor
- 2. Definition • Oxygen is a colorless, odorless, tasteless gas that is essential for the body to function properly and to survive. • Oxygen therapy is the administration of oxygen at a concentration of pressure greater than that found in the environmental atmosphere The air that we breathe contain approximately 21% oxygen. • Oxygen therapy is a key treatment in respiratory care.
- 3. Indications • peri and post cardiac or respiratory arrest • hypoxia - diminished blood oxygen levels (oxygen saturation levels of <92%) • acute and chronic hypoxemia • low cardiac output • chronic type two respiratory failure (hypoxia and hypercapnia) • Increased myocardial work • Pulmonary hypertension
- 4. FiO2: Fraction of inspired oxygen (%). PaCO2: The partial pressure of CO2 in the blood. It is used to assess the adequacy of ventilation. PaO2: The partial pressure of oxygen in the blood. It is used to assess the adequacy of oxygenation. SaO2: Arterial oxygen saturation measured from blood specimen. SpO2: Arterial oxygen saturation measured via pulse oximetry. Normal Values Partial pressure of arterial oxygen (PaO2) 80 -100 mmHg - children/adults, 50 - 80 mmHg - neonates Partial pressure of arterial CO2 (PaCO2) 35 - 45 mmHg children/adults SpO2 >95% for infants, children and adults • >60% Cyanotic heart disease
- 5. Parts of an oxygen cylinder
- 6. Method of administration 1. Nasal Cannula 2. Simple Mask 3. Partial Re-Breather Mask 4. Non-Re Breather Mask (NRBM) 5. Venturi Mask 6. Oxygen Hood 7. Oxygen Tent 8. AMBU Bag 9. Tracheostomy Collar 10. T-piece
- 7. Nasal cannula (prongs): • It is a disposable, plastic devise with two protruding prongs for insertion into the nostrils, connected to an oxygen source. • Used for low-medium concentrations of Oxygen (24-44%). Advantages: • Client able to talk and eat with oxygen in place • Easily used in home setting • Safe and simple • Easily tolerated • Delivers low concentrations
- 8. Disadvantages: • Unable to use with nasal obstruction • Drying to mucous membranes, so flow greater than 4 L/min needs to be humidified • Can dislodge from nares easily • Causes skin irritation or breakdown over ears or at nares • Not good for mouth breathers NURSING interventions: Be alert for skin breakdown over the ears and in the nostrils from too tight an application Observe for mucosal dryness Check frequently that both prongs are in clients nares
- 9. FACE MASK • The Simple Oxygen Mask • The Partial Re-Breather Mask • The Non Re- Breather Mask • The Venturi Mask
- 10. THE 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. • It delivers 35% to 60% oxygen . • A flow rate of 6 to 10 liters per minute. • It has vents on its sides which allow room air to leak 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).
- 11. 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 patient while eating or talking • Expensive with nasal tube Nursing interventions: • Monitor client frequently to check placement of the mask. • Secure physician's order to replace mask with nasal cannula during meal time
- 12. THE PARTIAL RE BREATHER MASK: • The mask is with a reservoir bag that must remain inflated during both inspiration & expiration • It collects part of the patients' exhaled air. • It is used to deliver oxygen concentrations up to 80%. • The oxygen flow rate must be maintained at a minimum of 6 L/min to ensure that the patient does not re-breathe large amounts of exhaled air. • The remaining exhaled air exits through vents.
- 13. Advantages : • Client can inhale room air through openings in mask if oxygen supply is briefly interrupted Disadvantages : • Requires tight seal (eating and talking difficult, uncomfortable) Priority Nursing Interventions : • Set flow rate so mask remains two- thirds full during inspiration Keep reservoir bag free of twists or kinks
- 14. THE 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 prevent 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. • A non-rebreather mask is primarily used to deliver oxygen to treat hypoxia, wherein the arterial blood oxygen saturation is less than 90 percent. Additionally, oxygen therapy is used to alleviate symptoms associated with chest pain, sepsis, shortness of breath and fever.
- 15. • The mask fits over the mouth and nose and elastic straps wrap around the ears or the head. A one-way valve in the mask prevents exhaled air from entering into the tubing or bag containing the oxygen that is to be inhaled. Instead, the exhaled air escapes through one way rubber stoppers in the mask. The rubber stoppers prevent the patient from inhaling any room air. When the patient inhales, the one way valve opens to allow 60 to 80 percent concentration of oxygen to be delivered.
- 16. Advantages: • Delivers the highest possible oxygen concentration • Suitable for pt breathing spontaneous with sever hypoxemia Disadvantages: • Impractical for long term Therapy • Malfunction can cause CO2 buildup • suffocation • Expensive • Uncomfortable Priority Nursing Interventions: • 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
- 17. • With a partial rebreather mask, when the patient inhales, they inhale some of the exhaled air, which contains carbon dioxide. When carbon dioxide enters the lungs, it stimulates breathing. In contrast, non-rebreather masks have vents on the side of the mask that allow all exhaled air to escape. Patients using this kind of mask breathe in fresh oxygen gas at concentrations of 80 to 90 percent.
- 18. VENTURI MASK • It is 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
- 20. 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 50% Priority Nursing Interventions : • Requires careful monitoring to verify FiO2 at flow rate ordered • Check that air intake valves are not blocked
- 21. OXYGEN HOOD An oxygen hood 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 placed over the baby's head
- 22. OXYGEN TENT An 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 enclosure often has a side opening with a zipper.
- 23. AMBU BAG AMBU- 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.
- 24. Tracheostomy Collar/ Mask Inserted 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
- 25. T-PIECE Used on end of ET tube when weaning from ventilator Provides accurate FIO2 Provides good humidity
- 26. Oxygen toxicity Retro lental fibroplasia Absorption atelectasis
- 27. Oxygen Toxicity : It is a condition which 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. Retrolental fibroplasia: Blindness due to vasoconstriction & Ischemia ( premature infants )
- 28. Absorption Atelectasis : During 100% oxygen delivery, nitrogen in alveoli is washed out and replaced by oxygen. In contrast to nitrogen, oxygen is extremely soluble in blood and diffuses very quickly into the pulmonary vasculature, so that not enough gas is left in the alveoli to maintain patency, and the alveolus collapses; this is known as absorption atelectasis
- 29. Safety Precautions During Oxygen Therapy • Oxygen is a highly combustible gas. • Although it does not burn spontaneously or cause an explosion, it can easily cause a fire in a patient’s room if it contacts a spark from an open flame or electrical equipment • 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 • Keep oxygen-delivery systems 10 feet from any open flames. Determine that all electrical equipment in the room is functioning correctly. • When using oxygen cylinders, secure them so they do not fall over. Store them upright and either chained or secured in appropriate holders. • Check the oxygen level of portable tanks before transporting a patient to ensure that there is enough oxygen in the tank
- 30. Evaluation: Breathing pattern regular and at normal rate. pink color in nail beds, lips, conjunctiva of eyes. No confusion, disorientation, difficulty with cognition. Arterial oxygen concentration or hemoglobin Oxygen saturation within normal limits. Documentation: Date and time oxygen started. Method of delivery. Oxygen concentration and flow rate. Patient observation.