Oxygen Therapy

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Oxygen Therapy

• Terri Slifer Lynch, MSN, RN, BC

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Oxygen Therapy

• Administration of oxygen at an FIO2 gt 21

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Factors Influencing Oxygen Transport

• Cardiac output
• Arterial oxygen content
• Concentration of Hgb
• Metabolic requirements

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• Hypoxemia decrease in the arterial oxygen
  content in the blood
• Hypoxia decreased oxygen supply to the tissues.

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Clinical Manifestations of Hypoxia

• Impaired judgment, agitation (restlessness),
  disorientation, confusion, lethargy, coma
• Dyspnea
• Tachypnea
• Tachycardia, dysrhythmias
• Elevated BP
• Diaphoresis
• Central cyanosis

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Need For Oxygen Is Assessed By

• Clinical evaluation
• Pulse oximetry
• ABGs

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Cautions For Oxygen Therapy

• Oxygen toxicity can occur with FIO2 gt 50
  longer than 48 hrs
• Suppression of ventilation will lead to
  increased CO2 and carbon dioxide narcosis
• Danger of fire
• Infection

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Methods of Dispensing Oxygen

• Piped in
• Cylinder
• Oxygen concentrator

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Classification of Oxygen Delivery Systems

• Low flow systems
• contribute partially to inspired gas client
  breathes
• do not provide constant FIO2
• Ex nasal cannula, simple mask
• High flow systems
• deliver specific and constant percent of oxygen
  independent of clients breathing
• Ex Venturi mask, non-rebreather mask, trach
  collar, T-piece

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Nasal Cannula

• Used for low-medium concentrations of O2
• Simple
• Can use continuously with meals and activity
• Flow rates in excess of 4L cause drying and
  irritation
• Depth and rate of breathing affect amount of O2
  reaching lungs

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Simple Mask

• Low to medium concentration of O2
• Client exhales through ports on sides of mask
• Should not be used for controlled O2 levels
• O2 flow rate- 6 to 8L
• Can cause skin breakdown must remove to eat

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Partial Rebreather Mask

• Consists of mask with exhalation ports and
  reservoir bag
• Reservoir bag must remain inflated
• O2 flow rate - 8 to 10L
• Client can inhale gas from mask, bag, exhalation
  ports
• Poorly fitting must remove to eat

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Non-rebreather Mask

• Consists of mask, reservoir bag, 2 one-way valves
  at exhalation ports and bag
• Client can only inhale from reservoir bag
• Bag must remain inflated at all times
• O2 flow rate- 10 to 15L
• Poorly fitting must remove to eat

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Venturi Mask

• Most reliable and accurate method for delivering
  a precise O2 concentration
• Consists of a mask with a jet
• Excess gas leaves by exhalation ports
• O2 flow rate- 4 to 15L
• Can cause skin breakdown must remove to eat

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Tracheostomy Collar/ Mask

• O2 flow rate 8 to 10L
• Provides accurate FIO2
• Provides good humidity comfortable

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T-piece

• Used on end of ET tube when weaning from
  ventilator
• Provides accurate FIO2
• Provides good humidity

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Pulse Oximetry

• Non-invasive monitoring technique that estimates
  the oxygen saturation of Hgb (SaO2)
• May be used continuously or intermittently
• Must correlate values with physical assessment
  findings
• Normal SaO2 values 95 to 100

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Factors Affecting SaO2 Measurements

• Low perfusion states
• Motion artifact
• Nail polish when using a finger probe
• Intravascular dyes
• Vasoconstrictor medications
• Abnormal Hgb
• Too much light exposure

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Nursing Interventions Related to Pulse Oximetry
Monitoring

• Determine if strength of signal is adequate
• Notify RN/physician if SaO2 lt 92 or outside
  specific ordered limits
• If continuously monitored, evaluate sensor site
  every 8 hrs and move PRN
• Document SaO2, O2 requirements, clients activity
  according to policy

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Purpose of Peak Flow Monitoring

• Measures peak expiratory flow rate (PEFR)
• Provides objective data to assess respiratory
  function
• Allows better control of asthma

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Procedure To Use Peak Flow Meter

• Have client sit in Fowlers position or stand
• Move blue/red indicator to bottom of scale
• Instruct client to inhale as deeply as possible
  and place mouth firmly around mouthpiece
• Client should exhale as hard and fast as possible
  
• Slide the indicator back to the base of the scale
  and repeat 2 more times

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• Record the clients best effort
• Determine zone client is in
• Green zone- 80-100 personal best
• Yellow zone- 50-80 personal best
• Red zone- less than 50 personal best
• Encourage client to perform monitoring twice
  daily, before and after bronchodilators
• Clean mouthpiece with soap and water and air dry

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Metered Dose Inhaler

• A pressurized device containing an aerosolized
  powder of medication
• A spacer enhances the deposit of medication into
  the lungs

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Instructions For Use Of MDI

• Shake the inhaler canister well
• When opening a new canister, expel the first puff
  into air
• Exhale slowly and place inhaler 1 in from mouth

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• If using spacer, place lips on mouthpiece
• Press down on inhaler as start to breathe in
• Hold breath for 3-5 seconds

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• When multiple puffs ordered, wait 1-2 minutes
  between puffs
• If using more than one type of drug, administer
  quick acting bronchodilator first, then slower
  acting
• Administer steroid last and rinse mouth with
  water and spit
• Clean spacer with soap and water and air dry

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Hand Held Nebulizer (HHN)

• Method of administering medication that has been
  aerosolized into a fine mist
• With bronchodilators, pulse, respiratory rate,
  breath sounds are assessed before and after
  treatment

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Procedure For Use of HHN

• Assemble nebulizer and place proper med dose and
  diluent into neb cap using sterile technique
• Have client sit in comfortable Fowlers position
• Set source of gas flow to 6-8 LPM
• Instruct client to place mouthpiece in mouth and
  slowly inhale

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• Have client hold breath for a few seconds and
  slowly exhale
• Encourage client to cough during and after
  treatment
• Mouthpieces and nebs are changed every three days
  or as policy guides
• At home, follow manufactures directions to clean