Oxygenation Therapy – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Oxygenation Therapy
Definition of Oxygen:
Oxygen is the odorless gas that is present in the air and necessary to maintain life. Oxygen may be given in a medical setting, either to reduce the volume of other gases in the blood or as a vehicle for delivering anesthetics in gas form.
or
Oxygen is a colorless and odorless gas which is essential for life. Normally a person will take the oxygen required by the body, normal breath and taken up into the blood.
Definition of Oxygen Therapy:
Oxygen therapy refers to the administration of supplemental oxygen as part of managing illness. In healthy individuals, oxygen is absorbed from the air in adequate amounts, but certain diseases and conditions can prevent some people from absorbing enough oxygen.
or
Oxygen therapy is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care.
or
Oxygen therapy is a method by which oxygen is administered in low concentration through a cannula which is disposable plastic device with two protruding prongs for insertion into the nostrils or administering oxygen to the patient by means of a mask according to requirement of patient.
Purposes of Oxygen Therapy:
1. To relieve dyspnea.
2. To improve tissue oxygenation.
3. Decreased work of breathing (WOB) in dysenteric clients.
4. Decreased work of the heart in clients with cardiac disease.
5. To administer low/higher concentration of oxygen to patients.
6. To allow uninterrupted supply of oxygen during activities like eating, drinking etc.
Factors Affecting Oxygenation:
Adequate of circulation, ventilation, perfusion and transport respiratory gases to the tissues are influenced by four types of factor:
A. Physiological factors: Any condition that affects cardiopulmonary functioning directly affects the body’s ability to meet oxygen demand.
B. Developmental factor: The developmental stage of the client and the normal aging process can affect tissue oxygenation, e.g. children are at risk of acute upper respiratory tract infections and exposure to these infections.
C. Behavioral factors: A person’s behavior or lifestyle may directly or indirectly affect the body’s ability to meet oxygen requirements. Lifestyle factors that influence respiratory functioning include, nutrition (e.g. obesity and malnutrition), exercise (lack of exercise), cigarette smoking, substance abuse (excessive alcohol, drug addiction), and stress (severe anxiety).
D. Environmental factor: The environment can also influence oxygenation. The incidence of pulmonary disease is higher in smoggy, urban areas than rural areas. In addition client’s workplace may increase the risk for pulmonary disease. Occupational pollutions include asbestos, talcum powder, dust and airborne fibers leads to occupation diseases.
Complications of Oxygen Therapy:
100% oxygen is both irritant and toxic if inhaled for more than few hours.
- Premature infants develop retrolental fibroplasia and blindness if exposed to excessive concentrations.
- In adults, pulmonary oxygen toxicity (manifested by pulmonary oedema and free radical damage leading ultimately to fibrosis.
Indications of Oxygenation:
A. Any individual with one or more of the following:
1. Peri and post cardiac or respiratory arrest
2. Hypoxia diminished blood oxygen levels (oxygen saturation levels of <92%)
3. Acute and chronic hypoxemia
4. Signs and symptoms of shock
5. Low cardiac output and metabolic acidosis (HCO3 < 18mmol/l)
6. Chronic type two respiratory failure (hypoxia and hypercapnia
B. Despite a lack of supportive data, oxygen is also administered in the following conditions:
1. Dyspnoea without hypoxemia
2. Post-operatively, dependent on instruction from surgical team
3. Treatment of pneumothorax
4. Anaemia
5. Asphyxia
6. Poisoning
7. Drowning
8. During severe case of injury
9. Bronchial asthma
10. Cardiac asthma
11. Chest trauma
12. After severe haemorrhage.
Contraindications of Oxygen Therapy:
Methods of Oxygen Therapy/Administration:
Oxygen can be administered by-
1. Nasal cannula
2. Mask
- Simple face mask
- Partial rebreather mask.
- Nonrebreather mask.
- Venturi mask
Simple Face Mask
Partial Rebreather Mask
Venturi mask
Oxygen Concentration Rates:
Administering Oxygen Therapy by Nasal Cannula:
A. Equipment:
- Articles needs for oxygen therapy:
- Oxygen source.
- Nasal cannula with connecting tubes.
- Hmidifier with distilled water.
- Flowmeter.
- Gauze pads.
- “No smoking” signs.
B. Procedure:
1. Review chart for physician’s order for oxygen to ensure that it includes method of delivery, flow rate, titration orders; identify client.
2. Wash your hands.
3. Identify client and proceed with 5 rights of medication administration (Fig. 1). Explain procedure to client. Explain that oxygen will ease dyspnea or discomfort, and inform client concerning safety precautions associated with oxygen use. Encourage him or her to breathe through the nose.
Fig. 1: Check client’s identification against physician’s order.
4. Assist client to semi- or high Fowler’s position, if tolerated.
5. Insert flowmeter into wall outlet (Fig. 2). Attach oxygen tubing to nozzle on flowmeter. If using a high O₂ flow, attach humidifier (Fig. 3). Attach oxygen tubing to humidifier (Fig. 4).
Fig. 3: Attach humidifier to flow meter.
Fig. 2: Insert flow meter into wall unit
Fig. 4: Attach oxygen tubing to humidifier.
6. Turn on the oxygen at the prescribed rate (Fig. 5). Check that oxygen is flowing through tubing (Fig. 6).
Fig. 5: Set oxygen to prescribed rate.
Fig. 6: Ensure the oxygen is flowing through the tubing.
7. Hold nasal cannula in proper position with prongs curving downward (Fig. 7).
Fig. 7: Properly position nasal cannula with prongs curving downward.
8. Place cannula prongs into nares (Fig. 8).
Fig. 8: Place cannula prongs into nares.
9. Wrap tubing over and behind ears (Fig. 9).
Fig. 9: Wrap tubing around ears.
10. Adjust plastic slide under chin until cannula fits snugly (Fig. 10).
Fig. 10: Adjust plastic slide under chin until cannula fits snugly.
11. Place gauze at ear beneath tubing as necessary (Fig. 11).
Fig. 11: Place gauze at ear to reduce irritation and promote comfort.
12. If prongs dislodge from nares, replace promptly.
13. Assess for proper functioning of equipment and observe client’s initial response to therapy.
14. Ensure that safety precautions are followed.
15. Wash hands.
16. Document time, flow rate and observations made on patient.
17. Encourage patient to breathe through his/her nose with mouth closed.
18. Remove and clean the cannula with soap and water, dry and replace every 8 hours. Assess nares at least every 8 hours.
Administering Oxygen Therapy by Mask:
1. Review chart for physician’s order for oxygen to ensure that it includes method of delivery, flow rate, titration orders; identify client.
2. Wash your hands.
3. Identify client and proceed with 5 rights of medication administration. Explain procedure to client. Explain that oxygen will ease dyspnea or discomfort, and inform client concerning safety precautions associated with oxygen use.
4. Assist client to semi- or high Fowler’s position, if tolerated.
5. Insert flow meter into wall outlet. Attach oxygen tubing to nozzle on flow meter (Fig. 1). If using a high O₂ flow, attach humidifier. Attach oxygen tubing to humidifier.
Fig. 1: Connect face mask to oxygen source.
6. Turn on the oxygen at the prescribed rate (Fig. 2). For a mask with a reservoir, be sure to allow oxygen to fill bag (Fig. 3).
Fig. 2: Adjust flow rate.
Fig. 3: Allow oxygen to fill the bag.
7. Place mask on face, applying from the nose and over the chin (Fig. 4).
Fig. 4: Oxygen mask applied over nose and mouth.
8. Adjust the metal rim over the nose and contour the mask to the face,
9. Adjust the metal rim over the nose and contour the mask to the face (Fig. 5).
Fig. 5: Adjust elastic strap.
10. Assess for proper functioning of equipment and observe client’s initial response to therapy.
11. Monitor continuous therapy by assessing for pressure areas on the skin and nares every 2 hours and rechecking flow rate every 4 to 8 hours.
General Rules during Oxygenation:
1. Place warning signs reading “No smoking: Oxygen in use” on the patient’s door, at the foot or head of bed, and on the oxygen equipment.
2. Instruct the patient and visitors about the hazards of moking with oxygen in se.
3. Make sure that electrical equipment; such as razors, radios and televisions is in good working condition to prevent the occurrence of short circuit sparks.
4. Avoid materials that generate static electricity, such as woolen blankets and synthetic fabrics.
5. Avoid the use of volatile, inflammable materials, such as oils, alcohol and ether near patients receiving oxygen.
6. Ground electric monitoring equipment, suction machines and portable diagnostic machines.
7. Make known the location of fire extinguishers and make sure personnel are trained in their use.
Read More…