Oxygen

Inhalation

Definition

Method by which oxygen is supplemented at higher percentages

than what is available in atmospheric air.

Purpose

1. To relieve dyspnoea

2. To reduce or prevent hypoxemia and hypoxia

3. To alleviate associated with struggle to breathe

Therapeutic oxygen is available

from two sources

1.Wall Outlets(; Central supply)

2.Oxygen cylinders

Nursing Alert

Explain to the client the dangers of lighting matches or smoking

cigarettes, cigars, pipes.

Be sure the client has no matches, cigarettes, or smoking materials in the

bedside table.

Make sure that warning signs (OXYGEN- NO SMOKING) are posted on the
clients door and above the clients bed.

Do not use oil on oxygen equipment.( Rationale: Oil can ignite if exposed
to oxygen.)

With all oxygen delivery systems, the oxygen is turned on before the
mask is applied to the client.

Make sure the tubing is patent at all times and that the equipment is
working properly.

Maintain a constant oxygen concentration for the client to breathe;

monitor equipment at regular intervals.

Contd..

Give pain medications as needed, prevent chilling and try to ensure

that the client gets needed rest.

Be alert to cues about hunger and elimination.( Rationale: The

clients physical comfort is important.)

Watch for respiratory depression or distress.

Encourage or assist the client to move about in bed. ( Rationale: To

prevent hypostatic pneumonia or circulatory difficulties.) Many
clients are reluctant to move because they are afraid of the oxygen
apparatus.

Contd..

Provide frequent mouth care. Make sure the oxygen contains proper
humidification.( Rationale: Oxygen can be drying to mucous
membrane.)

Discontinue oxygen only after a physician has evaluated the client.

Generally, you should not abruptly discontinue oxygen given in
medium-to-high concentrations( above 30%).

Gradually decrease it in stages, and monitor the clients arterial

blood gases or oxygen saturation level.

( Rationale: These steps determine whether the client needs continued

support.)

Contd..

Always be careful when you give high levels of oxygen to a client

with COPD. The elevated levels of oxygen in the patients body
can depress their stimulus to breathe.

Never use oxygen in the hyperventilation patient.

Wear gloves any time you might come into contact with the
clients respiratory secretions.( Rationale: To prevent the spread
of infection).

Equipment required

Clients chart and Kardex

Oxygen connecting tube (1)

Flow meter (1)

Humidifier filled with sterile water (1)

Oxygen source: Wall Outlets or Oxygen cylinder

Tray with nasal cannula of appropriate size or oxygen mask (1)

Kidney tray (1)

Adhassive tape

Scissors (1)

Oxygen stand (1)

Gauze pieces, Cotton swabs if needed

No smoking sign board

Gloves if available (1)

Indications for oxygen

delivery
The treatment of documented hypoxia/hypoxaemia as determined by
SpO2 or inadequate blood oxygen tensions (PaO2).

Achieving targeted percentage of oxygen saturation (as per normal values

unless a different target range is specified on the observation chart.)

The treatment of an acute or emergency situation where hypoxaemia or

hypoxia is suspected, and if the child is in respiratory distress manifested
by:

dyspnoea, tachypnoea, bradypnoea, apnoea

pallor, cyanosis

lethargy or restlessness

Use of accessory muscles: nasal flaring, intercostal or sternal recession,

tracheal tug

Patient assessment and

documentation

Clinical assessment and documentation including but not limited

to: cardiovascular, respiratory and neurological systems should be
done at the commencement of each shift and with any change in
patient condition.

Check and document oxygen equipment set up at the

commencement of each shift and with any change in patient
condition.

Hourly checks should be made for the following:

oxygen flow rate

patency of tubing

humidifier settings (if being used)

Contd..

Hourly checks should be made and recorded on the patient

observation chart for the following (unless otherwise directed
by the treating medical team):

heart rate

respiratory rate

work of breathing (descriptive assessment - i.e. use of accessory

muscles/nasal flaring)

oxygen saturation

Ensure the individual MET criteria are observed regardless of

oxygen requirements

Oxygen delivery method selected

depends on:

age of the patient

oxygen requirements/therapeutic goals

patient tolerance to selected interface

humidification needs

Note: Oxygen therapy should not be delayed in

the treatment of life threatening hypoxia.

Low flow delivery method

Low-flow systems include:

Simple face mask (without air entrainment device)

Non re-breather face mask (mask with oxygen reservoir bag and oneway valves which aims to prevent/reduce room air entrainment)

Nasal prongs (low flow)

Tracheostomy mask (without air entrainment device)

Tracheostomy HME connector

Isolette - neonates (usually for use in the Neonatal Unit only)

Note: In low flow systems the flow is usually titrated

(on the flow meter) and recorded in litres per minute
(LPM).

High flow delivery method

High flow systems include:
Ventilators
CPAP/BiPaP

drivers

Face

mask or tracheostomy mask used in

conjunction with an entrainment device or
AIRVO 2 Humidifier

High

flow nasal prongs (HFNP)

Preparation of patient

check name, bed no, and other identification mark of patient.

Check diagnosis and need of oxygen therapy

check doctors order for initiation of therapy and dosage.

Assess patient sign of anoxia.

Assess patient's vitals signs and breathing pattern

explain need of oxygen therapy

gain patient confidence

keep patient in fowler's position.

Steps of procedure

STEPS
Wash hands

RATIONALE
Reduce transmission of microorganism.

Attach cannula/catheter mask to oxygen

Prevent drying of nasal and oral mucous
tubing and humidified oxygen source adjusted membrane airway secretion.
to the prescribed flow rate.
Place tip of cannula into the patient's nares.if
mask apply snuggly to face

Direct flow of oxygen into upper respiratory

tract. Prevent loss of oxygen

Check cannula/equipment every 8 hourly.

Ensure patency and safe delivery of prescribed

oxygen.

Keep humidification jar filled at all times.

Prevent drying of mucous membrane.

Observe patient nares and superior surface of

skin and ears breakdown.

To assess dryness of mucous membrane.

Check oxygen flow rate and physician order 8

hourly.

Ensure delivery of prescribed oxygen flow rate

Wash hand before removing oxygen mask or

tube.

Reduce transmission of infection.

Inspect the patient for relief of symptoms

associated with hypoxia.

To assess effect of treatment

Record procedure in nurses notes.

Documents correct use of oxygen therapy and

patient's response.

After care of patient

stay with patient till he/she is at ease.

Keep the patient warm and comfortable.

Evaluate patient progress by observing vital signs.

Watch for any deteriorating signs after removal of oxygen

inhalation. Inform the doctor.

Record procedure date and time.

Request for an arterial blood gas analysis at specified intervals to

make sure hypoxia is treated.

Take all articles to utility room.

Clean nasal catheter with clod water, then warm soap water finally
with clean water.

Note
There

are another high flow devices such as venture

mask, oxygen hood and tracheostomy mask.

You

should choose appropriate method of oxygen

administration with Drs prescription and nursing
assessment.

Nursing Alert
After used the nasal cannula, you should cleanse it as
follows:
1.

Soak the cannula in savlon water for an hour

2.

Dry it properly

3.

Cleanse the tip of cannula by spirit swab before

applying to client

Steam inhalation

Definition
steam

inhalation in an application of moist heat

to respiratory passage and may be plain or
medicated. Inhalation may be for long period or
given for a short time at specific interval.

Purpose

To relieve inflammation of mucous membrane in acute

cold and in sinusitis.

To soften thick, tenacious mucous and help its

expulsion from the respiratory tract.

To warm and moisten air in acute bronchitis, whooping

cough or after tracheostomy.

To relieve the spasm of the mucous membrane of the

larynx and trachea in croup.

To provide antiseptic action on the respiratory tract.

To relieve congestion and edema of the larynx.

Indication
sinusitis
edema
thick

of larynx

mucous of chest

acute

bronchitis

whooping
after

cough

tracheostomy

spasm

of the mucous membrane of the larynx.

Contra-indication
carcinoma

of lung patients

very

young and old patients

high

fever patients

patients

with severe headache

General instruction

Explain the procedure to patient

Ask the patient to empty the bladder

Auscultate the patient before and after the procedure.

Keep the patient warm to prevent draughts before, during

and after inhalation.

When drugs are used for inhalation, instruct the patient to

close his eyes to prevent drug irritating the conjunctiva.

Keep the sputum mug near the patient and face towel to
wipe perspiration.

Articles

A tray containing inhaler to use as a vaporizer.

A bowl with tissue paper or a gauze piece to wipe secretion.

A sputum mug to cough out secretion.

An ounce glass, to measure Tr.Benzoin etc if any medicine to be

added.

Spirit in a bottle and swab sticks to clean the inhaler after use.

A towel to cover the inhaler and a bowl to keep the inhaler, to

prevent burns.

A pint measure to measure water.

An extra blanket to cover the patient, to prevent loss of steam.

A cardiac table, to give comfortable position to patient.

Steps of Procedure

Explain the procedure to patient, to relieve anxiety and gain cooperation.

Screen the patient to provide privacy.

Offer a bed pan to patient, to feel comfort and relaxed.

Auscultate the patient's lung fields , to know the lung condition.

Place patient in sitting position, to comfort patient.

Put off fan and cover the patient with a bed sheet

Bring the inhaler to bed side.

Contd..

Place the inhaler on the cardiac table.

Remove the cotton plug and keep the spout away from the
patients

Instruct the patient to inhale by mouth and exhale through the

nose for 15-20 minutes, to relieve congestion of the mucus
membrane of the nostrils.

Keep a sputum mug and a face towel near the patient and
observe him/her frequently to ease spitting and to wipe face.

Remove inhaler; keep patient in a comfortable position and well

covered for an hour, to prevent chilling.

Contd..

Record the treatment, its effectiveness and condition

of the patient.

Wash the mouth piece of inhaler with a swab and

running water and boil it for the next use, to avoid
infection.

Clean the drug glass with spirit swab sticks, to prevent

cross infection.

Clean all articles and replace properly, to prevent

infection for further use.

Points to remember
Avoid

spilling and prevent scalding the patient.

Never

leave babies or helpless patient along

with an inhaler.

Avoid

draught and chilling the patient.

Check

the inhaler and mouth piece for cracks

and leakage before use.

Clean
Give

tr.Benzoin with spirit if in use only.

treatment regularly as ordered e.g BD,TDS

or SOS.