NURSING FOUNDATION
OXYGENATION
• oxygenation
• physiology of oxygenation
• factors affecting oxygenation
• Oxygen administration
• purposes
• Indications
• Source of oxygen adminiatration
• Methods Of Oxygen Administration
• Nursing Care
PURPOSE :
.
To increase Oxygen saturation in tissues where the
saturation levels are too low due to illness or injury.
. If this process is inadequate , Oxygen level in the blood
decreases, and the patient may need supplemental Oxygen .
Indications:
• Acute Respiratory Failure
• Acute Myocardial Infarction
• Cardiac Failure
• Shock
• Hypermetabolic state induced by trauma , burns or sepsis
• During CPR
• During Anaesthesia for Surgery.
• Severe Anaemia
SOURCES OF OXYGEN ADMINISTRATION:
OXYGEN CYLINDERS
OXYGEN WALL OUTLETS
USING OXYGEN CYLINDERS:
1. The Oxygen cylinder is delivered with a
protective cap to prevent accidental force
against the cylinder outlet.
2. To release the Oxygen safely and at
desirable rate , a Regulator is used.
3. A Reduction gauge that show the amount of
Oxygen in the tank .
4. A Flow Meter that regulates the control of
Oxygen in Liters Per Minutes.
5. Oxygen is moistened by passing it through a
humidifier to prevent the mucous membranes of
respiratory tract free from becoming dry .
OXYGEN WALL OUTLETS :
The Oxygen is supplied from a central
source through a pipeline .
Only a Flowmeter and a humidifier are
required.
METHODS OF OXYGEN ADMINISTRATION:
1. Nasal Cannula.
2. Simple Face Mask.
3. Partial Re- Breather Mask
4 . Non Re- Breather Mask
5. Venturi Mask
6. Oxygen Hood
7. Oxygen Tent
8. AMBU Bag
9. Tracheostomy Collar
10. T- Piece
NASAL CANNULA / PRONGS:
It is a disposable plastic device with two protruding
prongs for insertion into the nostrils , connected to an
Oxygen source .
It is used for low concerntration of oxygen (24% to
44%)
Fraction Inspired Oxygen
Low flow (24-44%)
1 l/mt – 24%
2 l/mt – 28%
3 l/mt – 32%
4 l/ mt – 36%
5 l/ mt – 40%
6 l/ mt – 44%
[ l /mt = (liters/minute)]
ADVANTAGES:
• Client able to talk and eat with Oxygen in place.
• Easily used in home setting.
• Safe and Simple method.
• Easily tolerated.
• Delivers low concerntrations.
DISADVANTAGES:
• Unable to use with nasal obstruction.
• Drying of mucous membranes, so greater than 4 l/ mt
needs to be humidified.
• Can dislodge from nares easily.
causes skin irritation or breakdown over ears
or at nares.
Not good for mouth breathers.
Patient’s breathing pattern affects
FiO2(Fraction Inspired Oxygen).
NURSING CARE:
• Be alert for skin breakdown over the ears and in the
nostrils from too tight an application.
• Observe for mucosal dryness.
• Check frequently that both prongs are in nares.
FACE MASK:
Simple Oxygen Mask
The Partial Re-breather Mask
The Non Re- breather Mask
The Venturi Mask
SIMPLE OXYGEN MASK:
• It 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.
- It delivers 35% to 60% of Oxygen.
- A flowrate of 6 to 10 litres per minute.
- It has vents on its sides which allow room air to leak in
at many places, there by diluting the source oxygen.
- Often it is used when an increased delivery of oxygen
is needed for short periods.(ie less than 12 hours.)
ADVANTAGES:
• To provide increased delivery of Oxygen for short
period of time.
• DISADVANTAGES:
* Tight seal requiredto deliver higher
concerntration.
* Difficult to keep mask in position over mouth
and nose.
* Potential for skin breakdown (pressure ,
moisture ).
* Uncomfortable for patient while eating or
talking
* Expensive with nasal tube.
NURSING CARE :
》Monitor client frequently to check placement of
mask .
》 Ensure physician’s order to replace mask with
nasal cannula during meal time.
THE PARTIAL RE- BREATHER MASK :
- The mask is with a reservoir bag that must remain
inflatedduring both inspiration and expiration .
- It collects of part of the patient’s exhaled air .
- It is used to deliver oxygen concerntration upto 80%.
- The oxygen flowrate must be maintained at a
minimum of 6 l/ mt to ensure that the patient does
not re- breath large amounts of exhaled air.
- The remaining exhaled air exists through the
vents.
ADVANTAGES:
client can inhale room air through opening in mask if
oxygen supply is briefly interrupted.
DISADVANTAGES :
Requires tight seal .( eating and talking is difficult ,
uncomfortable).
NURSING CARE :
* Set flowrate , so mask remains two thirds full
during inspiration.
* Keep Reservoir bag free of twists or kinks.
THE NON RE- BREATHER MASK :
● This mask provides the highest concerntration of Oxygen
(95- 100%) at a flowrate 6 – 15 l/ mt.
● It is similar to the partial re- breather mask except two one
way valves prevent conservation of exhaled air.
● The bag has an Oxygen reservoir, when the patient exhales
air the one way valve closes and all of the expired air is deposited
into the atmosphere, not the reservoir bag .
● In this way, the patient is not rebreathing the any of
expired gas.
ADVANTAGES:
■ Delivers the highest possible Oxygen concerntration.
■ Suitable for patient breathing spontaneous with severe hypoxemia.
DISADVANTAGES:
¤ Impractical for long term therapy .
¤ Malfunction can cause CO2 buildup.
¤ Suffocation.
¤ Expensive .
¤ Uncomfortable.
NURSING CARE :
● Maintain flowrate ,so reservoir bag collapses only
slightly during inspiration.
● Check the valves and rubber flaps are function
properly .( open during expiration).
● Monitor SaO2 with pulseoximeter.
VENTURI MASK:
☆ It is high flow oxygen delivery device .
☆ Oxygen from 40 – 50 % . At litres flow of 4 l to 15 l /
mt.
☆ The mask is constructed so that there is a constant
flow of room air blended with a fixed concerntration of
oxygen.
● Designed with wide – bore tubing and various colour
– coded jet adaptors.
● Each colour code corresponds to a precise oxygen
concerntration and a specific litre flow.
● It is used primarily for patients with Chronic
Obstructive Pulmonary Disease.
Blue colour - 24% ( 2 litre/ mt)
White colour - 28% ( 4 litres/ mt)
Orange colour – 31% ( 6 litres/ mt )
Yellow colour – 35 % (8 litres / mt)
Red colour - 40 % ( 10 litres /mt)
Green colour - 60% ( 15 litres /mt)
ADVANTAGES :
■ Delivers most precise Oxygen concerntration.
■ Doesn’t dry mucous membranes.
DISADVANTAGES :
☆ Uncomfortable.
☆ Risk for Skin irritation.
☆ Produce respiratory depression in COPD patient with
High oxygen concerntration 50%.
NURSING CARE :
● Requires careful monitoring to verify
FiO2 at flowrates ordered.
● Check that air intake valves are not
blocked.
OXYGEN HOOD :
◇ An oxygen hood is used for babies who can breathe
on their own but still need extra oxygen .
◇ A hood is a plastic dome or box with warm moist
oxygen inside.
◇ The hood is placed over the baby’s head.
OXYGEN TENT :
¤ An oxygen tent consists of a canopy laced over the
head and shoulder or over the entire body of a patient to
provide oxygen at a higher level than normal.
¤ It is made of see through plastic material.
¤ It can envelope the patient ‘s bed with the end
sections held in place by a mattress to ensure that the tent
is air tight. The enclosure often has a side opening with a
zipper.
AMBU BAG:
AMBU - ARTIFICIAL MANUAL BREATHING UNIT or
Bag Valve Mask Ventilation
is a hand – held device commonly used
to provide positive pressure ventilation to patients who are
not breathing or not breathing adequately .
TRACHEOSTOMY COLLAR / MASK :
☆ Inserted directly into trachea.
☆ It is indicated for chronic O2 therapy.
☆ Oxygen flowrate is 8 to 10 litres.
☆ Provides accurate FiO2.
☆ Provides good humidity.
☆ Comfortable , more efficient.
T- PIECE :
■ Used on end of ET (Endotracheal) tube
when weaning from ventilator.
■ Provides accurate FiO2.
■ Provides good humidity.
SIDEEFFECTS AND COMPLICATIONS OF
OXYGEN ADMINISTRATION :
♧ Oxygen Toxicity.
♧ Retro- lental Fibroplasia.
♧ Absorption atelectasis.
OXYGEN TOXICITY :
》It is a condition which occurs due to
inspiration of a higher concerntrationof oxygen for
a prolonged period of time.
》Oxygen concerntration greater than 50%
over 24 – 48 hours can cause pathological changes
in the lungs .
RETROLENTAL FIBROPLASIA :
Blindness due to vasoconstriction and ischemia (premature
infants)
ABSORPTION ATELECTASIS :
During 100% O2 delivery , nitrogen in alveoli is
washed out and replaced by oxygen.
In contrast to nitrogen , oxygen is extremely soluble
in blood and diffuses very quickly into the pulmonary
vasculature , so that not enough gas is left in the alveoli
to maintain the patency and the alveols collapses ; this is
known as atelectasis .
EVALUATION:
☆ Breathing pattern , regular and at normal rate .
☆ Pink colour in nail buds , lips, conjunctiva of eyes.
☆ No confusion , disorientation, difficulty with cognition.
☆ Arterial oxygen concerntration or haemoglobin.
☆ Oxygen saturation with in normal limits.
DOCUMENTATION :
♧ Date and time oxygen started.
♧ Method of delivery.
♧ Oxygen concerntration and flowrate.
♧ Patient Observation
♧ Oronasal care to the nursing care.
THANK YOU
