Cebu Doctors’ University

College of Nursing
Mandaue City, Cebu

OXYGEN THERAPY
E1
Aballe, Rio Princess J.
Arregadas, Althea Lorraine E.
Asok, Paulene D.
Avelino, Patricia Louise C.
Bacallo, Melbourne Jericho S.
Bernales,Brinoj Sophia Jose
Bombio, Elaiza Kate B.
Cagasan, Rochine Claire V.
Chiu, Laeticia Marie A.
Iway, Janess Ruchelle
Lano, Andre Luise

BSN 2-E

Ms. Patricia Chiu

Clinical Instructor
 OBJECTIVES

After 4.5 hours of various classroom and laboratory activities, the Level II students will
be able to:
1. define the following terms:
1.1 oxygen therapy 1.4 ventilation
1.2 oxygen system 1.5 inspiration
1.3 respiration 1.6 expiration
2. trace the physiology of respiration as to the following:
2.1 structure of the respiratory system
2.2 pulmonary ventilation
2.3 alveolar gas exchange
2.4 transport of oxygen and carbon dioxide
2.5 respiratory regulation
3. identify normal values for the following:
3.1 respiratory rate
3.2 respiration rhythm
3.3 oxygen saturation(SpO2)
4. explain how the following factors affecting respiratory function:
4.1 age
4.2 environment
4.3 lifestyle
4.4 health status
4.5 medications
4.6 stress
5. discuss alterations in respiratory function:
5.1 hypoxia
5.1.1 causes
5.1.2 signs
5.2 altered breathing patterns
5.2.1 eupnea
5.2.2 tachypnea
5.2.3 bradypnea
5.2.4 apnea
5.2.5 hyperventilation
5.2.6 Kussmaul’s breathing
5.2.7 abnormal respiratory rhythm
5.2.7.1 Cheyne-Stokes respirations
5.2.7.1 Biot’s (cluster) respirations
5.2.8 orthopnea
5.2.9 dyspnea
5.3 obstructed airway (to include adventitious breath sounds)
6. describe the following:
6.1 sources of oxygen
6.1.1 wall outlets
6.1.2 oxygen cylinders
6.1.3 oxygen strollers
6.1.4 oxygen concentrators
 6.1.5 hyperbaric chamber
6.2 methods of oxygen delivery
6.2.1 types
6.2.2 nursing considerations
7. point out the following:
7.1 indications
7.2 contraindications
7.3 potential complications
7.4 scientific principles involved
7.5 guidelines in oxygen therapy
7.6 equipment needed for basic oxygen therapy set-up
7.7 nursing responsibilities before, during and after oxygen therapy
8. perform beginning skills in oxygen therapy

1. DEFINITION OF TERMS

1.1 Oxygen Therapy

A treatment that provides a person with supplemental or extra oxygen

1.2 Oxygen System

Oxygen systems are designed to store or to generate a supply of pure oxygen and to regulate,
dilute as required and then provide to the patient.
1.3 Respiration

The process of gas exchange between the individual and the environment

1.4 Ventilation

Ventilation or breathing, the movement of air in and out of the lungs as we inhale and exhale

1.5 Inspiration

Inspiration (inhalation), an act of breathing in which air flows into the lungs
1.6 Expiration

Expiration (exhalation), an act of breathing in which air moves out of the lungs

2. PHYSIOLOGY
2.1 structure of the respiratory system
 The respiratory system is divided structurally into the upper respiratory system
and the lower respiratory system.
UPPER RESPIRATORY SYSTEM LOWER RESPIRATORY SYSTEM
Mouth Trachea
Nose Lungs
Pharynx Bronchi
Larynx Bronchioles
Alveoli
Pulmonary Capillary Network
Pleural membranes

 Nose
- where the air enters
- Where air is warmed, humidified and filtered
- Hairs at the entrance of the nares trap large particles in the air
 Pharynx
- where air inspired passes through
- Shared pathway for air and food
- Includes the nasopharynx and oropharynx which are richly
supplied with lymphoid tissue that traps and destroys pathogens
entering with the air
 Larynx
- Cartilaginous structure that can be identified externally as the
Adam’s Apple
- Provides speech
- Important for maintaining airway patency and protecting the
lower airways from swallowed food and fluids
 Epiglottis
- Inlet to the larynx
- Closes during swallowing, routes food to the esophagus
- Open during breathing, allowing air to move freely into the lower
airways
 Trachea
- Leads to the right and left main bronchi (primary bronchi) and the
other conducting aiwarys of the lungs.
 Primary Bronchi
- Divide repeatedly into smaller and smaller bronchi ending with the
terminal bronchioles
 Respiratory Bronchioles
 Gas exchange or Respiratory Zone includes:
- Respiratory bronchioles
- Alveolar ducts
- Alveoli
 Alveoli
- Where gas exchange occurs
- Have very thin walls, composed of a single layer of epithelial cells
covered by a thick mesh of pulmonary capillaries
  Pleura
- A thin, double layer of tissue that covers the outer surface of the
lungs
 Parietal Pleura
- Lines the thorax and surface of the diaphragm
 Visceral Pleura
- Covering the external surface of the lungs

2.2. Pulmonary Ventilation

 First process of the respiratory system
 Ventilation of the lungs is accomplished through the act of breathing:
- Inspiration (inhalation) , air flows into the lungs
- Expiration (exhalation), air moves out of the lungs
 Intrapleural pressure
- Pressure in the pleural cavity surrounding the lungs
- Always slightly negative in relation to atmospheric pressure
- Negative pressure essential because it creates the suction that
holds the visceral pleura and the parietal pleura together as the
chest cage expands and contracts
 Intrapulmonary pressure
- Pressure within the lungs
- Always equalizes with atmospheric pressure

- Inspiration occurs when the diaphragm and intercostal muscles

contract, increasing the size of the thoracic cavity. The volume of
the lungs increases, decreasing intrapulmonary pressure. Air then
 rushes into the lungs to equalize this pressure with atmospheric
pressure. Conversely, when the diaphragm and intercostal
muscles relax, the volume of the lungs decreases, intrapulmonary
pressure rises, and air is expelled. Normal elastic recoil of the
thorax and lungs is essential to exhalation.
2.3 Alveolar Gas Exchange
 Second phase of the respiratory process
 Diffusion of oxygen from the alveoli and into the pulmonary blood
o Diffusion – movement of gases or other particles from an area of greater
pressure or concentration to an area of lower pressure or concentration.
o When the pressure of oxygen is greater in the alveoli than in the blood, oxygen
diffuses into the blood.
2.3 Transport of Oxygen and Carbon Dioxide
 Third part of the respiratory process involves the transport of respiratory gases.
 Oxygen needs to be transported from the lungs to the tissues and carbon dioxide must
be transported from the tissues to back to the lungs
 Normally most of the oxygen (97%) combines loosely with hemoglobin (oxygen-
carrying pigment) in the red blood cells (RBCs) and is carried to the tissues as
oxyhemoglobin (the compound of oxygen and hemoglobin)
Systemic Diffusion
 Fourth process of respiration
 Diffusion of oxygen and carbon dioxide between the capillaries and the tissues and cells
down to a concentration gradient similar to diffusion at the alveolar-capillary level.
2.4 Respiratory Regulation
 Includes both neural and chemical controls to maintain the correct concentrations of
oxygen, carbon dioxide and hydrogen ions in body fluids
 The nervous system of the body adjusts the rate of alveolar ventilations to meet the
needs of the body so that PO2 and PCO2 remain relatively constant.
 The body’s “respiratory center” is actually a number of groups of neurons located in the
medulla oblongata and pons of the brain.
 A chemosensitive center in the medulla oblongata is highly responsive to increases in
blood CO2 or hydrogen ion concentration. By influencing other respiratory centers, this
center can increase the activity of the inspiratory center and the rate and depth of
respirations.
 Of the three blood gases (hydrogen, oxygen, and carbon dioxide) that can trigger
chemoreceptors, increased carbon dioxide concentration normally has the strongest
effect on stimulating respiration.
3. Normal values
3.1 Respiratory Rate
Respirations are relaxed, effortless, and quiet. Normal respiratory rate according to age are as
follows:
Infant : 30-60 breaths/min
Toddler : 25-32 breaths/min
Child: 20-30 breaths/min
Adolescent: 16-20 breaths/min
Adult: 12-20 breaths/min
3.2 Respiration Rhythm
A regular rhythm means that the frequency of the respiration follows an even tempo with equal
intervals between each respiration. Infants tend to breathe less regularly. The young child often
breathes slowly for a few seconds and then suddenly breathes more rapidly. Normal
respirations are regular of rhythm.
3.3 Oxygen Saturation(SpO2)
Red blood cells contain haemoglobin. One molecule of haemoglobin can carry up to four
molecules of oxygen after which it is described as “saturated” with oxygen. If all the binding
sites on the haemoglobin molecule are carrying oxygen, the haemoglobin is said to have a
saturation of 100%. Most of the haemoglobin in blood combines with oxygen as it passes
through the lungs. A healthy individual with normal lungs, breathing air at sea level, will have
an arterial oxygen saturation of 95% – 100%.
Venous blood that is collected from the tissues contains less oxygen and normally has a
saturation of around 75%.

4. FACTORS AFFECTING RESPIRATORY FUNCTION

4.1 Age
The respiratory system undergoes various anatomical, physiological and immunological changes
with age. The structural changes include chest wall and thoracic spine deformities which impairs
the total respiratory system compliance leading to increased work of breathing. Respiratory
muscle strength decreases with age and can impair effective cough, which is important for airway
clearance. This makes them more vulnerable to ventilatory failure during high demand states (ie,
heart failure, pneumonia, etc.) and possible poor outcomes.
4.2 Environment
The lungs are one of the most important organs exposed to environmental agents. The lungs
have the ability to protect themselves by both immunological and non-immunological
mechanisms. An individual's susceptibility to the impact of environmental agents will determine
their adverse effects. certainly interferes with a specific and specific lung defenses, thus
facilitating the development of pulmonary diseases, such as exacerbation of chronic obstructive
pulmonary disease, allergies and asthma.
 4.3 Lifestyle
Lifestyle habits such as smoking affect the lungs the most. It also results to the irritation of the
trachea (windpipe) and larynx (voice box) and may lead to reduced lung function and
breathlessness due to swelling and narrowing of the lung airways and excess mucus in the lung
passages.

4.4 Health Status

The health status can affect affect respiratory function because we should take into account the
presence of biological or physiological dysfunction, and if these dysfunctions are present it may
alter the normal breathing pattern and may result in shortness of breath and other respiratory
diseases.

4.5 Medications
Types of lung problems or diseases that may be caused by medicines include:

 Allergic reactions -- asthma, hypersensitivity pneumonitis, or eosinophilic pneumonia

 Bleeding into the lung air sacs called alveoli (alveolar hemorrhage)
 Swelling and inflamed tissue in the main passages that carry air to the lungs (bronchitis)
 Damage to lung tissue (interstitial fibrosis)
 Drugs that cause the immune system to mistakenly attack and destroy healthy body
tissue, such as drug-induced lupus erythematosus
 Granulomatous lung disease -- a type of inflammation in the lungs
 Inflammation of the lung air sacs (pneumonitis or infiltration)
 Lung vasculitis (inflammation of lung blood vessels)
 Lymph node swelling
 Swelling and irritation (inflammation) of the chest area between the lungs (mediastinitis)
 Abnormal buildup of fluid in the lungs (pulmonary edema)
 Buildup of fluid between the layers of tissue that line the lungs and chest cavity (pleural
effusion)

4.6 Stress
Stress and strong emotions can present with respiratory symptoms, such as shortness of breath
and rapid breathing, as the airway between the nose and the lungs constricts. For people
without respiratory disease, this is generally not a problem as the body can manage the
additional work to breathe comfortably, but psychological stressors can exacerbate breathing
problems for people with pre-existing respiratory diseases such as asthma and chronic
obstructive pulmonary disease (COPD; includes emphysema and chronic bronchitis).

5. ALTERATIONS IN RESPIRATORY FUNCTION

5.1 Hypoxia
Is inadequate tissue oxygenation at the at the cellular level. It results from a
deficiency in oxygen delivery or oxygen use at the cellular level. It is a life-threatening
condition. Untreated it produces possibly fatal cardiac dysrhythmias.
 5.1.1 Causes
 A decreased hemoglobin level and lowered oxygen-carrying capacity of the blood
 A diminished concentration of inspired oxygen, which occurs at high altitudes
 The inability of the tissues to extract oxygen from the blood, as with cyanide poisoning
 Decreased diffusion of oxygen from the alveoli to the blood, as in pneumonia
 Poor tissue perfusion with oxygenated blood, as with shock
 Impaired ventilation, as with multiple rib fractures or chest trauma

5.1.2 Signs
 Apprehension
 Restlessness
 Inability to concentrate
 Decreased level of consciousness
 Dizziness
 Behavioral Changes
 Unable to lie flat
 Blood pressure is elevated

5.2 Altered Breathing Patterns

5.2.1 Eupnea
 Is the normal, good, unlabored breathing, sometimes known as quiet breathing or
resting respiratory rate. In eupnea, expiration employs only the elastic recoil of the
lungs.
 an efficient and effective form of breathing, which maximizes air intake, and
minimizes muscular effort
 12-20 breaths/min

5.2.2 Tachypnea
 a condition that refers to rapid and shallow breathing
 Causes buildup of carbon dioxide in the lungs leading to an increase of carbon
dioxide in the blood.
 more than 24 breaths/min
 may be a normal response to fever, anxiety, or exercise
 can occur with respiratory insufficiency, alkalosis, pneumonia

5.2.3 Bradypnea
 an abnormally slow breathing rate
 less than 10 breaths/min
 can occur with medication-induced depression of the respiratory center, diabetic
coma, neurologic damage

5.2.4 Apnea
 Cessation of Breathing
 Lapse of spontaneous breathing for 20 or more seconds.
 Three recognized types are:
o Central Apnea: an absence of diaphragmatic and other respiratory muscle
function
 o Obstructive Apnea: when an air flow stops because of upper airway
obstruction, yet chest or abdominal wall movement is present
o Mixed Apnea: a combination of central and obstructive apnea and most
common form of apnea seen in preterm infants.

5.2.5 Hyperventilation
 A rapid and deep breathing. It is also called overbreathing, and it may leave you
feeling breathless.
 characterized by abnormally prolonged and rapid breathing, resulting in decreased
carbon dioxide levels and increased oxygen levels that produce faintness, tingling of
fingers and toes, and if continued, alkalosis and loss of consciousness

5.2.6 Kussmaul’s breathing
 Type of hyperventilation that accompanies metabolic acidosis by which the body
attempts to compensate for increased metabolic acids by blowing off acid in the form of
CO2.

5.2.7 Abnormal respiratory rhythm

5.2.7.1 Cheyne-Stokes respirations

- marked rhythmic waxing and waning of respirations from very

deep to very shallow with short periods of apnea commonly
caused by chronic diseases, increased intracranial pressure, or
drug overdose

5.2.7.2 Biot’s (cluster) respirations

- shallow breaths interrupted by apnea; may be seen in clients with

CNS disorders

5.2.8 Orthopnea
 is the inability to breathe easily unless sitting upright or standing.

5.2.9 Dyspnea

 Difficulty breathing or the feeling of being short of breath (SOB). Dyspnea may occur
with varying levels of exertion or at rest. The client with dyspnea will generally have
observable (objective) signs such as flaring of the nostrils, labored-appearing breathing,
increased heart rate, cyanosis, and diaphoresis

5.3 Obstructed Airway

 Obstructed airway is a blockage in any part of the airway
 An obstruction may be partially or totally prevent air from getting into your lungs.

Types of airway obstruction:

* Upper Airway Obstruction - occurs in the area from your nose and lips to your larynx
 * Lower airway obstruction - occurs between your larynx and the narrow passageways
of your lungs
* Complete airway obstructions - does not allow any air to pass
* Acute airway obstructions - blockages that occur quickly. Choking on a foreign object
is one example
* Chronic airway obstruction - occur two ways: by blockages that take a long time to
develop or blockages that last for a long time

Causes can be:

 Inhaling or swallowing a foreign object
 Small object lodged in nose or mouth
 Allergic reaction
 Trauma to the airway
 Vocal cord problem
 Breathing in a lot of smoke from a fire
 Viral or bacterial infections

Adventitious breath sounds:

1. Crackles: discontinuous, brief, popping sounds
2. Wheezes: continuous, musical sounds, high or low pitched; usually more pronounced in
expiration
3. Pleural Rub: Creaking or grating sounds that have been described as being similar to
walking on fresh snow
4. Stridor - Loud, high pitched sound heard during inspiration

6. DESCRIBE THE FOLLOWING:

6.1 Sources of Oxygen:

6.1.1 Wall Outlets

A wall outlet is installed next to each bed. Wall outlets and adapters vary, not only by the
type of gas they supply, but also in terms of shape, color, and connection method.
 6.1.2 Oxygen Cylinders
Oxygen cylinders are available in many sizes, but are grouped into two main categories:
large and small.A large cylinder is identifiable not only by its size, but also by the presence of a
metal cap screwed onto its top to protect the valve from damage. The valve itself also has an
attached handle and threaded connection site. Large cylinders are generally used when high
flow rates are essential or when a client requires oxygen for an extended period.A small
cylinder is identifiable by its rectangular valve with no handle and three holes on one side. Small
cylinders are used when transporting clients or for short-term emergencies.

6.1.3 Oxygen Strollers

Portable oxygen can also be provided by a liquid-oxygen stroller. The liquid-oxygen
portable unit consists of a thermos-type vessel in a shoulder bag or small carrying case.
Liquid oxygen is denser than gaseous oxygen, so a portable stroller can carry more oxygen
and yet be lighter and more compact than a steel gas cylinder. Liquid oxygen is allowed to
evaporate within a warming coil into its gaseous state. It is then metered to the person
through tubing connected to an oxygen delivery device.

6.1.4 Oxygen Concentrators

 Oxygen concentrators are widely used in home and extended care settings. They
compress room air and extract oxygen, providing concentrated oxygen flows in the range of 1
to 5 LPM. An oxygen concentrator is much safer and more convenient to use than an oxygen
tank. It also does not need to be refilled.

6.1.5 Hyperbaric Chamber

A Hyperbaric chamber simulates deep sea diving by increasing atmospheric pressure. In
the chamber, the person can take oxygen into the body in concentrations higher than is
possible at normal atmospheric pressure. With the increased pressure, the client’s hemoglobin
and other blood components can carry more oxygen. HBO is used to treat air or gas embolism,
carbon monoxide poisoning, and anaerobic infections ; administer some types of radiation
therapy for cancer; and perform some surgeries. It is also used to treat crush injuries or
traumatic ischemias and enhance wound healing in necrotizing soft tissue infections,
compromised skin grafts and flaps, thermal burns, and chronic osteomyelitis.

6.2 Methods Of Oxygen Delivery

6.2.1 Types

Simple face mask

a mask fits over the mouth and nose of the patient and consists of exhalation ports
(holes on the side of the mask) through which the patient exhales CO2 (carbon dioxide). This
device is best used for short-term emergencies, operative procedures, or for those patients
where a nasal cannula is not appropriate.

Nasal cannula
it is consists of a small bore tube connected to two short prongs that are inserted into
the nares to supply oxygen. It provides a concentration of approximately 50%, with an oxygen
flow of 4 L/min. It is generally used wherever small amounts of supplemental oxygen are
required, without rigid control of respiration.

The non-breather face mask

(also known as snug-fitting oxygen mask) the patient only breathes in from the
reservoir bag; on exhalation, gases are prevented from flowing into the reservoir bag and are
directed out through the exhalation ports. It is a method for supplying nearly 100% oxygen
and is used in emergencies.

Endotracheal Intubation
 (also known as nasal or oral intubation) is a means of securing an airway of a
patient who is unable to oxygenate and/or ventilate adequately on his or her own
temporarily. A tube is inserted into the trachea and mostly used for newborn resuscitation.

Tracheostomy Mask
a mask that covers the opening into the trachea to create an artificial airway. It is
most often performed in patients who require prolonged ventilation but can provide a more
stable airway.

Oxygen Tent
also known as croupette. A tent-like device that is used in a medical setting to deliver
high levels of oxygen to a bedridden patient. The tent covers the entire head and upper body,
and oxygen is pumped in from a tank.

6.2.2 Nursing Considerations

General Considerations:
 Oxygen therapy should be closely monitored
 Assess at regular intervals therapeutic procedures and handling may increase the child's
oxygen consumption and lead to worsening hypoxemia
 One must consider the age of patient, oxygen requirements/therapeutic levels, patient
intolerance to selected interface and humidification needs
 Inform patients to tape tubing at the back of their shirt to prevent tripping over tube or
oxygen tank
  Proper storage of oxygen tank in open space where oxygen can move freely
 Smoking, being near open flames, or heaters oxygen tanks can cause a fire or explosion
 For patients with a history of smoking or drinking, encourage them not to smoke or drink
as it can slow their breathing
 Verify the flow rate of oxygen prescribed by the doctor
 Consider when oxygen therapy is needed for patient
 Be aware of, and understand, local oxygen policy/guidelines
 Be able to discuss the indications for oxygen and the potential risks

CONSIDERATIONS USING NASAL CANNULA:

 Assess their nostrils carefully when using these as the pressure of prongs can cause areas
of necrosis, particularly on the nasal spectrum
 Position the tubing over the ears and secure behind the patient’s head. Ensure straps and
tubing are away from the patient's neck to prevent risk of airway obstruction.
 Position the nasal prongs along the patient’s cheek and secure the nasal prongs on the
patient’s face with adhesive tape.
 Change the adhesive tape weekly or more frequently as required
 Check nasal prong and tubing for patency, kinks or twists at any point in the tubing and
clear or change prongs if necessary.
 Check nares for patency - clear with suction as required.

CONSIDERATIONS USING NON-REBREATHING FACE MASK:

 Non-rebreathing face mask are not designed to allow added humidification.
 Ensure the flow rate from the wall to the mask is adequate to maintain a fully inflated
reservoir bag during the whole respiratory cycle (i.e. inspiration and expiration).
 To ensure the highest concentration of oxygen is delivered to the patient the reservoir
bag needs to be inflated prior to placing on the patients face.
 Not routinely used outside of ED and PICU and should only be used in consultation with
the medical team.
CONSIDERATIONS USING ENDOTRACHEAL INTUBATION AND TRACHEOSTOMY:
 Make sure tubes are carefully secured; otherwise, children can easily dislodge them
 Children will need reassurance after tracheostomy tube replacement.
 Sterile cleaning is generally done with a cotton-tipped application and saline
 Change ties when they become soiled or loose and check them frequently to be certain
they remain tied.
 Assess the ties not only fit snugly but also allow for one finger to be inserted underneath
them so they do not rub and cause pain.

7.POINT OUT THE FOLLOWING:

7.1 Indications For Oxygen Therapy

• Abdominal paralysis patient

- Lungs themselves are not affected by paralysis, but the muscles of the chest, abdomen
and diaphragm, can be. As the various breathing muscles contract, they allow the lungs to
expand, which changes the pressure inside the chest so that air rushes into the lungs. If paralysis
occurs in C3 or higher, the phrenic nerve is no longer stimulated and therefore the diaphragm
does not function. This means mechanical assistance, usually a ventilator, will be required to
facilitate breathing. People with paralysis at the mid-thoracic level and higher may have trouble
taking a deep breath and exhaling forcefully. Because they may not have use of abdominal or
intercostal muscles, these people also lose the ability to force a strong cough. This can lead to
lung congestion and respiratory infections.

• Asthma (severe)
- Asthma is a chronic inflammatory disorder of the respiratory tract. It occurs when an
allergen invades and mast cells release histamine and leukotrienes that result in diffuse
obstructive and restrictive changes in the airway because of a triad of inflammation,
bronchoconstriction, and increased mucus production. Severe asthma is not responsive to asthma
therapy. It requires hospital evaluation and cardiopulmonary monitoring. Both oxygen saturation
and PO2 are low; PCO2 is elevated because the bronchi are so constricted the child cannot exhale,
resulting in CO2 accumulation. The rising PCO2 rapidly leads to acidosis.

• Carbon monoxide poisoning

- Carbon monoxide is a colorless, odorless, tasteless gas produced by burning gasoline,
wood, propane, charcoal or other fuel. Improperly ventilated appliances and engines, particularly
in a tightly sealed or enclosed space, may allow carbon monoxide to accumulate to dangerous
levels. Carbon monoxide poisoning occurs when carbon monoxide builds up in the bloodstream.
When too much carbon monoxide is in the air, the body replaces the oxygen in the red blood
cells with carbon monoxide. This can lead to serious tissue damage, or even death.

• Heart failure
- Heart failure is the inability of the heart to supply adequate oxygenated blood to meet
the metabolic demands of the body. Children and infants affected with this may experience
breathlessness, and be noted to have rapid respirations and to use accessory muscles of
respiration, indicating low oxygen saturation levels.

• Hypoxemia
- Hypoxemia is an abnormally low concentration of oxygen in the blood, causing low
oxygen saturation levels.

• Pneumonia
- Pneumonia is an infection and inflammation of alveoli. It often has a bacterial or viral
origin and is categorized as hospital- or community-acquired. The onset of pneumonia is
generally abrupt and follows an upper respiratory tract infection. Children may often appear
acutely ill, with high fever, tachycardia, chest or abdominal pain, chills, and signs of respiratory
distress. Oxygen saturation levels should be assessed frequently. Humidified oxygen may help
labored breathing and prevent hypoxemia.
7.2 Contraindications For Oxygen Therapy

• Absorption Atelectasis
- About 80% of the gas in the alveoli is nitrogen. If high concentrations of oxygen are
provided, the nitrogen is displaced. When the oxygen diffuses across the alveolar-capillary
membrane into the bloodstream, the nitrogen is no longer present to distend the alveoli (called
a nitrogen washout). This reduction in alveolar volume results in a form of collapse called
absorption atelectasis. This situation also causes an increase in the physiologic shunt and resulting
hypoxemia. Respirations become irregular, with nasal flaring and apnea.

• Carbon dioxide retention

- Oxygen therapy may cause adverse effects to patients with carbon dioxide retention by
further elevating the carbon dioxide levels in the blood due to increased ventilation perfusion
mismatch.

• Chronic Obstructive Pulmonary Disease (COPD)

- COPD is constriction of the airway associated most often with long-term cigarette
smoking. Constrictive air disease limits the amount of oxygen that can reach the lungs. Care
needs to be exercised in people with chronic obstructive pulmonary disease, such as emphysema,
especially in those known to retain carbon dioxide (type II respiratory failure). Such people may
further accumulate carbon dioxide and decreased pH (hypercapnation) if administered
supplemental oxygen, possibly endangering their lives. However, the risk of the loss of respiratory
drive are far outweighed by the risks of withholding emergency oxygen, and therefore emergency
administration of oxygen is never contraindicated.

• Oxygen toxicity
- Oxygen toxicity, caused by excessive or inappropriate supplemental oxygen, can cause
severe damage to the lungs and other organ systems. High concentrations of oxygen, over a long
period of time, can increase free radical formation, leading to damaged membranes, proteins,
and cell structures in the lungs. It can cause a spectrum of lung injuries ranging from mild
tracheobronchitis to diffuse alveolar damage.

• Patients in fire risk areas

- Highly concentrated sources of oxygen promote rapid combustion. Oxygen itself is not
flammable, but the addition of concentrated oxygen to a fire greatly increases its intensity, and
can aid the combustion of materials (such as metals) which are relatively inert under normal
conditions.

• Retrolental fibroplasia
- Retinopathy of prematurity (ROP), also called retrolental fibroplasia (RLF) and Terry
syndrome, is a disease of the eye affecting prematurely born babies generally having received
intensive neonatal care. Both oxygen toxicity and relative hypoxia can contribute to the
development of ROP due to the premature development of the lungs.

7.3 Potential Complications

 Hypoxemia - occurs when levels of oxygen in the blood are lower than normal. If blood
oxygen levels are too low, your body may not work properly. It can cause mild problems
 such as headaches and shortness of breath. In severe cases, it can interfere with heart
and brain function.

 Oxygen Toxicity - caused by high concentrations of oxygen, over a long period of time,
can increase free radical formation, leading to damaged membranes, proteins, and cell
structures in the lungs. It can cause a spectrum of lung injuries ranging from mild
tracheobronchitis to diffuse alveolar damage.

 Bronchopulmonary dysplasia (BPD) - is a form of chronic lung disease that affects

newborns (mostly premature) and infants. It results from damage to the lungs caused by
mechanical ventilation (respirator) and long-term use of oxygen. Most infants recover
from BPD, but some may have long-term breathing difficulty.

 Retrolental fibroplasia - High oxygen levels can cause vasoconstriction and “vaso-
cessation” followed by a delay in physiologic retinal vascular development.

 Hyaline membrane formation or Hyaline membrane disease - HMD occurs when

there is not enough of surfactant in the lungs, which is made by the cells in the airways
and consists of phospholipids and protein. When there is not enough surfactant, the tiny
alveoli collapse with each breath. As the alveoli collapse, damaged cells collect in the
airways, which makes it even harder to breath.

 Absorption Atelectasis - is a complete or partial collapse of the entire lung or area

(lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become
deflated or possibly filled with alveolar fluid. This situation also causes an increase in the
physiologic shunt and resulting hypoxemia. Respirations become irregular, with nasal
flaring and apnea.

 Oxygen induced hypoventilation - If patients with a hypoxic drive are given a high
concentration of oxygen, their primary urge to breathe is removed and hypoventilation or
apnea may occur.

7.4 Scientific Principles

 Anatomy and Physiology

- The knowledge of the relevant physiology and pathophysiology of the body specifically
the respiratory system to oxygen therapy could provide understanding on the flow of gases
function, for proper patient monitoring and oxygen prescribing.

 Microbiology
- This involves the preventive measures such as sanitary care, medical handwashing and
gloving may reduce the incidence of nosocomial infections by preventing the transmission of
highly pathogenic microorganisms to the patient by reducing the colonization of the reservoir
site .The respiratory care equipment which include ventilators, humidifiers, nebulizers may
have been identified as the potential vehicles which cause major nosocomial infections if they
are colonized by fungi or bacteria.
  Psychology
- Gentle and loving caring care while assessing must be done to give comfort to the patient
and reduce anxiety.

 Sociology
- The nurse works with other members of the medical team. It is important to have
establish rapport with the client to provide cooperation.

 Chemistry
- The element oxygen provides life and comfort into the patient. It also support the
process of combustion. There may be a risk of oxygen flare ups if near an ignition source.

 Physics
- Breathing occurs when the contraction or relaxation of muscles around the lungs changes
the total volume of air within the air passages (bronchi, bronchioles) inside the lungs. Pressure
of oxygen from the tank to the tubing of the oxygen medium.

 Pharmacology
- Oxygen, an atmospheric gas, increases saturation of hemoglobin oxygen levels. When
used at therapeutic concentrations, it can help oxygenate certain tissues as long as the patient
is not in shock or dealing with another complication that could affect the distribution or
reception of oxygen.

 Body Mechanics
-Patients should be positioned in an upright position unless contraindicated (e.g., if they
have spinal injuries or loss of consciousness).

7.5 Guidelines In Oxygen Therapy

 Prepare all needed materials ahead of time

 Done Medical Hand washing
 Observe microbiology principle
 Create an environment with comfortable interaction between nurse and patient
 Ask client permission before performing the procedure
 Explain to patient and family what happens during the procedure and the purpose of
oxygen therapy
 Observe for patent airway and remove secretions by having patient cough and
expectorate mucus or by suctioning.
 Remind patient to breathe normally as possible
 If the patient is anxious and reluctant to accept device, provide extra reassurance
 Gently place device on face and confirm patient is comfortable
 Check cannula or mask every 8 hours. Keep humidification container filled at all times
 If using an oxygen face mask, adjust elastic band over ears until mask fits comfortably
over the patient's face and mouth.
 Maintain sufficient slack on oxygen tubing and secure to patient’s clothes
7.6 Equipment Needed For Basic Oxygen Therapy Set-Up

 Oxygen tank with gauge

A device used to store either compressed gas or liquid oxygen under high pressure,
used in a variety of circumstances but commonly for medical use. Most oxygen tanks are
tall, slender aluminum or steel cylinders featuring valves and gauges.

 Oxygen rate regulator

pressure reducing devices designed to regulate or lower oxygen pressure from a cylinder
to levels that can be safely used by the patient. A Regulator simply regulates the (free)
flow from an oxygen cylinder

 Humidifier with distilled water

humidifier bottle may be used to help alleviate a sore, dry and/or bloody nose. The
oxygen picks up humidity by flowing through a water bottle connected to the
concentrator or liquid system.

 Cannula/ mask/ coupette

a device used to deliver supplemental oxygen or increased airflow to a patient or person

in need of respiratory help.

 Connecting tube

used to connect the nasal mask or cannula to the oxygen reservoir. It is mostly made of
plastic and serves to deliver a steady flow of oxygen to the patient.

 Clean gloves

To protect the nurse and patient from cross contamination of possible microorganisms
present.

7.7 Nursing Responsibilities

Before
  Check doctor’s order
 Prepare materials
 Prepare the client and support people
 Explain procedure to the patient including the restriction of smoking
 Wash hands and observe appropriate infection control procedures
 Provide client privacy, if appropriate
 Set up the oxygen equipment and the humidifier
 Turn on the oxygen at the prescribed rate and ensure proper functioning

During

Cannula

 Put the cannula over the client’s face, with the outlet prongs fitting into the nares and
the elastic band around the head. Some models have a strap to adjust under the chin
 If cannula will not stay in place, tape it at the sides of the face
 Pad the tubing and band over the ears and cheekbones as needed

Face Mask

 Guide the mask toward the client’s face, and apply it from the nose downward
 Fit the mask to the contours of the client’s face.
 Secure the elastic band around the client’s head so that the mask is comfortable but
snug
 Pad the band behind the ears and over bony prominences

Endotracheal tube

 Secure the endotracheal tube with tape to prevent accidental movement of the tube
further into or out of the trachea.
 Unless contraindicated, place the client in a side lying or semi prone position as
tolerated to prevent aspiration of oral secretions.
 Using sterile technique, suction the endotracheal tube as needed to remove excessive
secretions
 Provide humidified air or oxygen
 If the client is on mechanical ventilation, ensure that all alarms are enabled at all times
 Communicate frequently with the client, providing a notepad or picture board for the
client to use in communicating

Oxygen tent

 Place tent over the client’s face, and secure the ties around the head.

After

 Inspect the equipment on a regular basis

  Document Findings in the client record using forms or checklists supplemented by
narrative noted when appropriate.
 Assess the client regularly

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