Oxygen therapy

1. By
Mohd Nazrim Akmad
Intensive Care unit
CCN

2. Learning Objectives:
• Define the oxygen therapy and its indications
• Discuss the type of oxygen therapy
• List the purpose of using the oxygen therapy
• Explain the procedure
• Demonstrate the procedure
• List complication of oxygen therapy and hazards

3. DEFINITION
• Oxygen therapy is the administration of oxygen at
concentrations greater than that of ambient air.
• 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 care.

4. INDICATIONS
 Head trauma or acute head injury
 Acute Tachypnea
Respiratory rate increased from normal (RR)
normal range 12 – 24 breaths per minute (bpm)
Significant respiratory rates increasing to more than
30 bpm
Visible with a Hemodynamic monitor or an ordinary
monitor

5. Acute Tachycardia
• Heart Rate increased from normal (HR)
Increased Myocardial work
Normal range 60 – 100 beats per minute (bpm)
Significant heart rate increasing to more than 110
bpm
Visible with a Hemodynamic monitor or and ordinary
monitor

6. Acute Hypoxemia
Oxygen Saturation level is decreased
(desaturation)
Normal range for saturation 90-100 SpO2
Significant decrease of oxygen saturation level below
85.
Visible with a Hemodynamic monitor or an ordinary
monitor or can be internally checked via ABG.

7. CONTRAINDICATIONS
 There is no contraindication
BUT KEEP IN MIND
 High levels of oxygen in the blood and tissue can be
helpful or damaging depending on circumstances

8. COMPLICATION
PREVENTION
Oxygen should be handled with precaution:
Side effect
Oxygen is a drug

9. Absorption Atelectasis
 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.

11. The air we breathe contains nearly 78% of nitrogen.
Nitrogen - helps keep the alveoli open and prevents
the collapse of the alveoli.
Hospital settings:
surgery and general anesthesia, large amounts of
oxygen are usually administered. This decreases the
nitrogen concentration in the air and leads to
absorption atelectasis.
Patients who had gone heart or lung surgery and
abdominal surgery?

12. Oxygen Induced Hypoventilation
 • Suppression of ventilation
 • Can lead to increased CO2 and carbon dioxide
narcosis

13. Oxygen Toxicity
 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 patients.
PRECAUTIONS – FIRE HAZARD..

14. Signs and symptoms
of oxygen toxicity
 Non-productive cough
 Nausea and vomiting
 Substernal chest pain
 Fatigue
 Nasal stuffiness
 Headache -Sore throat
 Hypoventilation
 Nasal congestion
 Dyspnea
 Inspiration pain

17. WHAT IS: LOW FLOW
The delivery of oxygen to the patient with variability
of concentration
OR
The oxygen concentration is not determined only
estimated
OR
The FI,O2 is influenced by breath rate, tidal volume
and pathology.

18.  Depending on:
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 practitioners?
A. call the doctor?
B. B. Increase the oxygen?

19. Breathing pattern is slow
• What happens to the concentrations of oxygen being
delivered?
• Is it going to be higher even were giving a small
amount?
• Will the concentration of oxygen were giving be the
same?

22. NASAL CANNULA
HOW TO USE?
• disposable.
• plastic devise with two protruding prongs for
insertion into the nostrils, connected to an oxygen
source.

23. • 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 FIO2.

24. Facts
ADVANTAGES
Patients are able to talk
and eat with oxygen in
place
Easily used in home
setting
DISADVANTAGES
may cause irritation to the
nasal and pharyngeal
mucosa
if oxygen flow rates are
above 4 liters/minute
Variable FIO2

25. NURSING INTERVENTION
• 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.

27. 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

28. • Open ports for
exhaled gas
• Air entrained
through ports if O2
flow through does
not meet peak
inspiratory flow.

29. • 5 – 10 liters per minute
• < 5 liters will not flush CO2 from mask
• 40 – 60% FIO2 approximately depending on the pattern
of breathing.

30. FACTS
Advantages
 Can provide increased delivery of
oxygen for short period of time
 The face mask is indicated in
patients with nasal irritation or
epistaxis.
 It is also useful for patients who
are strictly mouth breathers.
Disadvantages
 Tight seal required to deliver
higher concentration
 Difficult to keep mask in position
over nose and mouth
 Potential for skin breakdown due
(pressure, moisture)
 Uncomfortable for patient while
eating or talking.
 Obtrusive, uncomfortable and
confining.
 It muffles communication,
obstructs Coughing.

31. NURSING INTERVENTION
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

32. 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 inspiration
• Allow the mixture or oxygen and carbon dioxide in
the mask.

33. PARTIAL REBREATHING
MASK
• O2 directed into
reservoir
• Insp: draw gas from
bag & ? room air
• Exp: 1/3 of exhaled gas
goes into bag( dead
space)
• Dead spaces gas mixes
with ‘New’ O2 going
into bag
• Deliver 60% O2

34. Facts
ADVANTAGES
Can inhale room air through
openings in mask if oxygen
supply is briefly interrupted.
Not as drying to mucous
membranes
DISADVANTAGES
Requires tight seal
Eating and talking difficult,
uncomfortable

35. NURSING INTERVENTION
• Set flow rate so mask remains two-thirds full during
inspiration
• Keep reservoir bag free of twists or kinks
• Prevents the reservoir bag to collapse or be empty
• Prevents anyone to squeeze the bag while on the
patient.

36. NON REBREATHING
MASK
• The one-way valve closes and all of the expired air is
deposited into the atmosphere, not the reservoir
bag.
• 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 exhaled air.

38. FACTS
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
Feeling of suffocation
Uncomfortable

39. NURSING INTERVENTION
• 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 empty

42. Mask with reservoir
6 0.60
7 0.70
8 0.80
9 0.80+
10 0.80+
Nasal Cannula
1 0.24
2 0.28
3 0.32
4 0.36
5 0.40
6 0.44
Oxygen Mask
5-6 0.4
6-7 0.5
7-8 0.6
Estimated
Fio2

43. HIGH FLOW DELIVERY DEVICES
Or
FIXED DELIVERY SYSTEMS

44. AIR ENTRAINMENT
DEVICES
• High flow device (o2 concentration)
• Entrains air through side ports to achieve high flows
• Variable entrainment ports and/or jets adjust FIO2
• Air Entrainment or Venti Masks
• Manufacturer recommends liter flows for each FIO2

45. 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 (jet adapter).
• Applying the Bernoulli principle

47. • 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

48. FACTS
ADVANTAGES
Delivers most precise
oxygen concentration
Doesn’t dry mucous
membranes (humidity)
DISADVANTAGES
uncomfortable
Risk for skin irritation
produce respiratory
depression in COPD patient
with high oxygen
concentration 50%

49. NURSING INTERVENTION
• 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 concentration 50%

51. TRACHEOSTOMY
COLLAR
• 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
• Less expensive

52. FACTS
ADVANTAGES
• Delivers high concentrations
of oxygen directly to the lungs.
• Stable and not moved when
the patient is moved or
cleaned.
• Maintains saturation levels.
DISADVANTAGES
• Viscosity of secretions
• Ability to cough and
expectorate
• 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 inadequate

53. NURSING INTERVENTIONS
• Suctioning
• Maintains patent bronchial airway
• Make sure the tracheostomy site is clean and
uninfected
• 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

55. BAG VALVE MASK
• Bag-valve-mask (BVM) ventilation is an essential
emergency skill.
• This basic airway management technique allows for
oxygenation and ventilation of patients until a more
definitive airway can be established and in cases
where endotracheal intubation or other definitive
control of the airway is not possible.
• For the emergency medical technician, basic BVM
ventilation is most often the only option for airway
management.

56. • Bags for BVM ventilation also come in different
types.
• Newer bags are equipped with a pressure valve.
Some bags have one-way expiratory valves to
prevent the entry of room air;
• these allow for delivery of more than 90% oxygen to
ventilated and spontaneously breathing patients.
Bags lacking this feature deliver a high concentration
of oxygen during positive-pressure ventilation (PPV)
but deliver only 30% oxygen during spontaneous
breaths

57. Contraindications
• BVM ventilation is absolutely contraindicated in the
presence of complete upper-airway obstruction.
• It is relatively contraindicated after paralysis and
induction (because of the increased risk of
aspiration).

58. Complications
Potential complications of BVM ventilation include the
following:
• Aspiration
• Hypoventilation
• Hyperventilation

59. REFERENCE
• Medical surgical nursing 3rd edition.
• Medscape.com
• https://www.respiratorytherapyzone.com/oxygen-
therapy-test-bank/