Oxygen Therapy

Presented by: BSN 2B

Members:
Agripo, Kenje Kate Alegado, Hazel Mae Alenton, Henzel Marish Alnaser, Waleed Amolato, Isaiah Apa, Roschelle Kathryn Aquino, Melissa Mae

Objectives:
After 4 hours of lecture-discussion and demonstration, the Level II students will be able to: 1. Define the following terms: - Anoxia - Apnea - Biots Breathing - Bradypnea - Cheyne-stokes-respiration - Cyanosis - Dyspnea - Eupnea - Expiration - Inspiration - Hypercapnia 2. Discuss on the physiology of respiration 3. Enumerate the importance of oxygen therapy 4. Identify the factors affecting oxygenation 5. Cite the indications and contraindications of oxygen therapy 6. Explain the scientific principles involved in oxygen therapy 7. Discuss the following: - Types of oxygen source - Types of oxygen regulators - Types of oxygen delivery system 8. Cite the different methods of administration of oxygen therapy according to its percentage of oxygen delivered and its advantages and disadvantages: - hypocapnia - hyperventilation - hypoventilation - hypoxemia - Kussmauls Breathing - orthopnea - oxygen therapy - oxygen system - respiration - tachypnea

8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9

nasal cannulae nasal catheter oxygen hood oxygen tent croupette mask with reservoir bag venturi mask simple face mask face tent

8.10 ventilator 9. Identify the guidelines including safety precautions in administration of oxygen therapy. 10. Discuss the possible complications that may arise during oxygen therapy 11. Enumerate the nursing responsibilities before, during, and after oxygen therapy. 12. Cite materials in the oxygen set up. 13. Demonstrate beginning skills on oxygen therapy.

I. Definition of Terms
Anoxia Deficiency of oxygen. Apnea Temporary cessation of breathing Biots Breathing rapid, short breathing with pauses of several seconds, indicating increased intracranial pressure. Bradypnea abnormally slow breathing rate. Cheyne - stokes breathing with rhythmic waxing and wanning of depth of breaths and regularly recurring apneic periods. Cyanosis a bluish coloration of the mucous membranes and skin caused by deficient oxygenation of the blood. Dyspnea labored, difficulty in breathing. Eupnea normal breathing. Expiration the act of expelling air from the lungs. Inspiration the act of inhaling air from the lungs. Hypercapnea a condition marked by an unusually high concentration of carbon dioxide in the blood as a result of hyperventilation. Hypocapnea also called acopnia, is a state of reduced carbon dioxide. Hyperventilation an increased depth and rate of breathing greater than demanded by the body needs, can cause dizziness, light headedness, a sense of unsteadiness and tingling around the mouth and fingertips. Hypoventilation breathing at an abnormally slow rate, resulting in an increased amout of carbon dioxide in the blood.

Hypoxemia an abnormally low concentration of oxygen in the blood. Kussulmauls Breathing deep rapid breathing as seen in respiratory acidosis. Orthopnea a form of dyspnea in which the person can breathe comfortably only when standing or sitting erect. Oxygen System - A device that delivers oxygen through the upper airways to the lungs at concentrations above that of ambient air. Tachypnea abnormally rapid breathing.

Abnormal Breathing Patterns

II.

Physiology of Respiration

Respiratory System:

Primary function is to obtain oxygen for use by body's cells & eliminate carbon dioxide that cells produce Pathway of air: nasal cavities (or oral cavity) pharynx trachea primary bronchi (right & left) secondary bronchi tertiary bronchi bronchioles alveoli (site of gas exchange)

Breathing is an active process requiring the contraction of The of the external (located and of the

skeletal

muscles.

primary muscles respiration include intercostal between diaphragm the (a

muscles ribs) sheet

muscle

located between the thoracic & abdominal cavities).

THE MECHANICS OF BREATHING:

When we INHALE - The diaphragm flattens and moves downwards and the
intercostal muscles move the rib cage upwards and out. This increase in size

decreases the internal air pressure and so air from the outside (at a now higher pressure that inside the thorax) rushes into the lungs to equalize the pressures. When we EXHALE - the diaphragm and intercostal muscles relax and return to their resting positions. This reduces the size of the thoracic cavity, thereby increasing the pressure and forcing air out of the lungs.

III.

Importance of Oxygen Therapy

1. To relieve or prevent hypoxia. 2. To keep a healthy level of tissue oxygenation. 3. To reduce or correct arterial hypoxemia and tissue hypoxia. 4. To produce sufficient amount of oxygen to the tissue so that normal metabolism can occur. 5. To regulate rate and depths of respiration 6. To ensure adequate lung expansion 7. Decreases the heart work in pumping 8. Decreases the work of respiratory system

IV. FACTORS OF OXYGEN THERAPHY

1.) Physiological Factors * decreased oxygen * decreased cardiac output * hypovolemia * increased metabolic rate * pregnancy * obesity 2.) Developmental Stage * Premature infant * Infant/ toddler * School Age child & Adolescent * Older Adult
3.) Lifestyle * Nutrition * Excercise *Smoking * Substance Abuse 4.) Environment * Toxic Inhalants * Allergens * Pollution

V.

Indications and Contraindications

Indications:
- Use in patients with chronic obstructive pulmonary disease (COPD) , a common long term effect of smoking, who may require additional oxygen to breathe either during a temporary worsening of their condition or throughout the day and night. - Used in pre-hospital environment. High flow is definitely indicated for use of resuscitation, major trauma, major hemorrhage and hypothermia. - For personal use, high concentration oxygen is used as home therapy to abort cluster headache attacks, due to its vaso constriction. - Severe respiratory distress (e.g., acute asthma or pneumonia) - Severe trauma - COPD - Acute myocardial infarction (heart attack) - Pulmonary hypertension - Short term therapy such as post-anesthesia recovery

Contraindications:
- Should never be use in explosive environments - Smoking during oxygen therapy is fire hazard and a danger to life and limbs - Not recommended for patients who have suffered pulmonary fibrosis or other lung damage resulting from bleomycin treatment. - Contraindicated in all patients with unfavourable ventilation response to oxygen treatment

VI. Scientific Principles

Anatomy and Physiology

- The nurse administering the O2 therapy should know the anatomy and physiology of the respiration. - Respiratory tract is composed of the nose, pharynx, larynx, trachea, bronchi and lungs. Microbiology - Oxygen devices should be sterilized to avoid infection and transmission of microorganisms from the device to the patients body. (e.g., nasal catheter and face masks) Chemistry
- Our body is composed of 59% oxygen. The average person consumes 6 to 8 lbs. of oxygen, 4 lbs. of food and 2 lbs. of water per day. - The chemistry of our life is dominated by the chemistry of oxygen. Our body is a composition of chemicals, oxygen (59%) being the most important.

Pharmacology - Oxygen is considered a drug - O2 therapy is prescribed when there is a need/deficiency of oxygen
in the body

Physics - The exchange of gases takes place by a process of simple diffusion depending on the partial pressure of the gases, the character of the membrane, and the solubility of the gases. Psychology - In order to develop a healthy relationship, it's vital that a nurse
understands human emotional reactions, and psychology is the key to understand this fully.

- A nurse must recognize when a patient is angry, depressed, confused

or afraid, and take the necessary steps to deal with these emotions so as not to aggravate a patient's health condition.

Sociology - Establish rapport, introduce ones self - Explain procedure well before proceeding to any other examinations

VII. Discuss the following:

The main types sources for oxygen therapy are:

1. Liquid storage Liquid oxygen is stored in chilled tanks until required, and then allowed to boil (at a temperature of 90.188 K (182.96 C)) to release oxygen as a gas. This is widely used at hospitals due to their high usage requirements, but can also be used in other settings.

2. Compressed gas storage The oxygen gas is compressed in a gas cylinder, which provides a convenient storage, without the requirement for refrigeration found with liquid storage. These tanks can last 46 hours when used with a conserving regulator, which senses the patient's breathing rate and sends pulses of oxygen. Conserving regulators may not be usable by patients who breathe through their mouths. 3. Instant usage The use of an electrically powered oxygen concentrator or a chemical reaction based unit can create sufficient oxygen for a patient to use immediately, and these units (especially the electrically powered versions) are in widespread usage for home oxygen therapy and portable personal oxygen, with the advantage of being continuous supply without the need for additional deliveries of bulky cylinders. 4. Wall Outlet - these are oxygen piped in a wall outlet in hospital

rooms 5. Hyperbaric chamber - Hyperbaric oxygen therapy allows you will breathe 100% pure oxygen under increased pressure. This level is much higher than the 21% oxygen found in room air. The air inside the hyperbaric chamber can be compressed up to three times the pressure found at sea level.

Types of Oxygen Regulators

Definition Oxygen regulators are defined as a device that allows for a specific amount of oxygen to flow to a patient.

Thorpe tube flowmeter is an instrument used to directly measure the flow rate of a gas. It consists of a connection that may be fitted to a gas source, a needle valve opened and closed by turning an attached dial for control of flow rate, a float resting in a clear tapered tube, and an outlet port. It is primarily used in health care institutions during delivery of medical gases, often in conjunction with other devices such as pressure gauges or pressure reducing valves. Bourdon Gauge A Bourdon Gauge is a pressure indicator, it works with a "C" shaped tube oval in cross section that tries to straighten under pressure. When the tube tries to straighten it pulls on a connecting arm which turns a needle that is against a card that states the pressure.
Parts of a regulator: Flow meter The flow meter is located on the regulator. The flow meter measures the oxygen leaving the

tank by liters per minute. Regulatory bulb The regulator is positioned at the top of the cylinder tank. The regulator controls the amount of oxygen leaving the tank. Cyclinder contents gauge It is a glass covered dial gauge that shows how much oxygen is in the tank. Complete O2 Set-up: Tube Humidifier Oxygen Regulator/Analyzer Oxygen Tank with outlet

TYPES OF OXYGEN DELIVERY SYSTEMS.

The types of oxygen delivery systems include:

Compressed oxygen oxygen that is stored as a gas in a tank. A flow meter and regulator are attached to the oxygen tank to adjust oxygen flow. Tanks vary in size from very large to smaller, portable tanks. This system is generally prescribed when oxygen is not needed constantly (e.g., when it is only needed when performing physical activity).

Liquid oxygen oxygen that is stored in a large stationary tank that stays in the home. A portable tank is available that can be filled from the stationary tank for trips outside the home. Oxygen is liquid at very cold temperatures. When warmed, liquid oxygen changes to a gas for delivery to the patient.

Oxygen concentrator electric oxygen delivery system approximately the size of a large suitcase. The concentrator extracts some of the air from the room, separates the oxygen, and delivers it to the patient via a nasal cannula. A cylinder of oxygen is provided as a backup in the event of a power failure, and a portable tank is available for trips outside the home. This system is generally prescribed for patients who require constant supplemental oxygen or who must use it when sleeping.

Oxygen conserving device, such as a demand inspiratory flow system or

pulsed-dose oxygen delivery systemuses a sensor to detect when inspiration (inhalation) begins. Oxygen is delivered only upon inspiration, thereby conserving oxygen during exhalation. Low Flow Low-flow systems can be defined as those which do not provide the patient's entire ventilatory requirements through the delivery device. Air is entrained to meet the patient's ventilatory requirement. They include: Simple Face Mask (without entrainment device) Non re-breather face mask (mask with reservoir bag and one-way valves which prevent air entrainment) Nasal prongs Tracheostomy mask (without entrainment device) Tracheostomy HME connector Isolette - neonates (for use in the Neonatal Unit only) High Flow High flow systems are those defined as able to deliver the patient's entire ventilatory demand through the delivery device. Air entrainment devices allow titration of inspired oxygen concentration (%) or FiO2 by altering the amount of room air entrained through the device. They include: Ventilators CPAP/BiPaP drivers Face mask or tracheostomy mask used in conjunction with an entrainment device VIII.

Different methods of administration of oxygen therapy

8.1Nasal cannula a device used to deliver supplemental oxygen or airflow to a patient or

person in need of respiratory help. This device consists of a plastic tube which fits behind the ears, and a set of two prongs which are placed in the nostrils. low flow system, oxygen concentration will vary, depending on the patients respiratory rate and tidal volume Approximate concentrations delivered are: 1L= 24%-25% 3L= 30%-33% 2L= 27%-29% Room Air = 21% + 4 % in each L/min of O2 concentration Above 6L/mt client tends to swallow air and FiO2 is not increased Advantages Safe & Simple Easily Tolerated Effective for low concentrations Does not impede eating or talking Inexpensive and disposable Disadvantages Less effective in patient who mouth breathes Dries nasal mucosa at higher flows May irritate skin behind ears & at cheeks. Can dislodge easily

8.2

Nasal catheter

A tube inserted into the nose for procedures, oxygen administration, or monitoring purposes

 It is inserted through nostril with the end of the catheter resting in the oropharynx made from flexible materials like rubber and plastic so they can be gently guided into the nose and through the relevant structures while conforming to the shape of the body Flow - 8 l/min FiO2 22% - 45% Advantage Good stability Disposable Low cost Disadvantage Difficult to insert Need regular changing May block insertion May provoke gagging

8.3

Oxygen hood

A device placed over the head of a patient to deliver high concentrations of oxygen Its a plastic dome or box with warmed and humidified oxygen inside Is used for patients who can breathe on their own but still need extra oxygen. Best use :Infants who need supplemental Oxygen Flow

 7 L /minFiO2 21% - 100 %

Advantage Full range of Fio2

Disadvantage Difficult to clean and disinfect

8.4

Oxygen tent

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. 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 Oxygen Flow : 8-15 L/min.FiO2 range :40% - 50% Advantage Supply enough oxygen to the patient Less suffocating Disadvantages limits patient care leakage is common especially while the child is being nursed or monitored fire hazard

8.5

Croupette

A device that provides cool humidification with the administration of oxygen or of compressed air. Consists of a nebulizer with attached tubing that connects with a canopy to enclose the patient and contain the humidifying mist are plastic tents that are large enough to enclose a small child

Advantage Provides cool mist environment to the patient

Disadvantage difficulty in sealing the tent

8.6

Face Mask

Types of Face Masks: 1. Simple Face Mask - Delivers oxygen

concentrations from 40% to 60% at liter flows of 5 to 8 liters per minute, respectively Advantages Provides higher concentrations than possible with N/C. Effective for mouth breathers or patients with nasal disorders Disadvantages Requires humidification Interferes with eating and talking Anxiety in claustrophobic Creates risk of rebreathing

2. Partial Rebreather Mask - Delivers oxygen concentration of 60% to 90% at liter flows of 6 to 10 liters per minute, respectively. Advantages Delivers increased O2 Does not dry mucus membrane Disadvantages Creates a risk for suffocation Requires monitoring to verify that reservoir

3. Non Rebreather Mask - Delivers the highest oxygen concentration possible 95% to 100% by means other than intubation or mechanical ventilation, at liter flows of 10 to 15 liters per minute. Advantages Delivers highest Possible O2 without Intubation Does not dry mucus membranes 4. Venturi Mask Delivers oxygen concentrations varying from 24% to 40% or 50% at liter flows of 4 to 10 liters per minute. Disadvantages Risk of O2 toxicity Requires tight seal Bag should not deflate

Advantages Delivers exact preset O2 despite clients breathing pattern Does not dry mucus membranes Can be used to deliver humidity

Disadvantages O2 Permits condensation to form in tubing which diminishes the flow of O2 COPD use permitted with appropriate low flow regulator

8.9 Face Tent

It can replace oxygen masks when masks are poorly tolerated by clients. The face tent is molded of soft vinyl with the under-the-chin design and clarity offer patient comfort, clear vision and ease of speech. Oxygen delivered: 8 -12 L/M 28 100%

Advantages Provides a comfortable fit Used for facial trauma burns or surgery

Disadvantages Interferes with eating may result in inconsistent O2 due to environmental loss

8.10.1.1 Ventilator Machine designed to mechanically move breathable air into and out of the lungs, to

provide the mechanism of breathing for a patient who is physically unable to breathe, or breathing insufficiently.

Advantages Regulation of Air Quality of air decreases indoor pollution Remove excess heat

Disadvantage Negative pressure caused the chest wall to fall

IX.

Identify guidelines including safety precautions in administration of oxygen therapy.

Oxygen therapy safety precautions Post "Oxygen" and "No Smoking" signs -These signs should be posted on the cylinder in use, in oxygen storage areas, and at entrances to a ward or room where oxygen is in use. The chief danger in using oxygen is

fire. The pressure of oxygen in increased concentrations makes all materials more combustible. Things that burn slowly in ordinary air will burn violently and even explosively in the presence of increased oxygen. Inform the patient and visitors of the requirement for no smoking and no open flames in the room - None of these should be a problem in the modern hospital since smoking is not allowed in any Army hospital or other federal buildings; however, in third world countries, this may not be the case.

Ensure that oil or grease is not used around the oxygen fittings. (Petroleum- based products will burn.) If an oxygen tank is used, secure it away from the door and high traffic areas to reduce potential unauthorized tampering of cylinder gauges and to reduce the possibility of the cylinder being knocked over and the valve being damaged or broken. Use only nonsparking wrenches on tanks

X.

Complications that may arise:

Possible Complications:

Ear barotrauma: This is the most common side effect of HBOT. Ear barotrauma is a condition of discomfort in the ear caused by pressure differences between the inside and the outside of the eardrum. This may be caused by an upper respiratory infection, nasal congestion, or immature or deformed eustation tubes. Usually, the discomfort is temporary and can be resolved by equalizing the pressure in the ears. Children can be taught to clear (pop) their ears by drinking water,

chewing gum, yawning, or simply by blowing pressure into the nose while pinching it shut. Sinus pain: This is the second most common HBOT complication and usually occurs in patients with upper respiratory track infections or allergic rhinitis. Ocular changes: Rarely myopia and vision changes can be caused or worsened by hyperbaric therapy. It is always temporary and resolves after discontinuing treatment. Do not get new prescription glasses while receiving treatment. Oxygen toxicity: Pulmonary and Neuralgic manifestations of excessive oxygen are often cited as major concerns. Oxygen tolerance limits that avoid these manifestations are well defined for continuous exposures in normal people. Toxicity is not produced by daily exposures to oxygen at below 2.0 ATA for up to 2 hours per day. The protocol for most of the diagnoses we address is 1.5 ATA for 1 hour a day. Oxygen seizures: Incidence of seizures is very rare and occurs only about once in over 200,000 treatments. Seizures have never been reported in treatments at less than 2.0 ATA for 1 hour or less. These are usually seen in persons with a known seizure disorder. Fire: Theoretically there is an increased risk of fire due to the enriched oxygen atmosphere inside of a tank. Since this chamber used by this clinic delivers oxygen through a mask system, the risk of fire is greatly reduced. Further, these risks are minimized by eliminating fire causing materials from the tank during treatment. No pocket warmers, lighters, or cell phones should ever be carried inside the chambers. Under certain conditions, battery operated devices may or may not be allowed. Claustrophobia: Due to the confining nature of this treatment, confinement anxiety may occur. If signs of this are seen, therapy may

be discontinued until this problem is resolved. If this is an issue, please keep in mind that in an emergency it takes two minutes to decompress the chamber. The chamber door cannot be opened until it is totally decompressed. Pulmonary barotrauma: Pulmonary barotrauma is a condition that rarely happens at the end of a therapy session, during decompression. This can be caused by the patient holding their breath during decompression or by certain lung diseases. Lung diseases that can cause an increased risk of pulmonary barotrauma include those in which there is obstruction to gas flow, such as asthma that has not responded fully to treatment, and lung scarring or inflammation (such as sarcoidosis, eosinophilic granuloma, or interstitial fibrosis). Retrolental Fibroplasia: A bilateral retinopathy occurring in premature infants treated with excessively high concentrations of oxygen, characterized by vascular dilatation, proliferation, and tortuosity, edema, and retinal detachment, with ultimate conversion of the retina into a fibrous mass that can be seen as a dense retrolental membrane.

XI. Nursing Responsibilities

Before -Inform the patient and explain the nature and procedure of Oxygen Therapy -Prepare the necessary equipment prior for Oxygen Therapy -Adjust the patient's position to promote adequate administration of oxygen -Do medical hand washing and gloving as necessary During -Set oxygen flow to the proper amount as needed by the patient

-Monitor the client throughout the administration -Ensure the mask is worn properly and is not uncomfortable -Attach a "No Smoking" sign to the patients room or to the respective area where the patient is receiving the Oxygen Therapy -Be sure the set up of the Oxygen Therapy is enough to allow movement to the restrooms if the client is able to move about After -Assist the removal of the equipment -do proper after cleaning -evaluate feedback from the patient -do proper documentation

XII. Materials Needed

-humidifier bottle with distilled water -simple face mask with tubing -flow meter -oxygen source