Oxygen Therapy

Definition
● It is the administration of Oxygen that is used as a drug at a concentration
greater than that found in the environment atmosphere and can be dispensed in
different devices to deliver oxygen concentrations that the patient needs.
● It is a medical treatment to supply oxygen to the patients who lack oxygen in their
system. It is done to achieve normal measures of oxygen levels in the body and
to relieve patient discomforts such as shortness of breath etc.

PURPOSES
1. It is used to prevent Hypoxia and Hypoxemia
2. Give comfort to patient who struggles to breathe
3. Relieve dyspnea

Oxygen therapy is usually Prescribed by Physicians but nurses may initiate if a patient
is in critical condition.
INDICATIONS
● Increased work for breathing
● Increased myocardial work/ myocardial infarction
● Pulmonary hypertension
● Anemic hypoxia: It’s benefit is limited due to circulatory deficit
● Postoperative oxygenation in abdominal and chest surgery

GUIDELINES:
● Identify patients normal range of (VS) Vital Signs
● Know patients ABG current and past.
● Observe patients behavior (anxiety, agitation, drowsiness,and headache which
may lead to confusion.)
● Know patients hemoglobin values.
● Know patient cardiac output
 ● Mind environmental conditions
DIAGNOSIS
Pulse oximetry
- It is a noninvasive test to measure the patient’s saturation and expressed in
percentage (%). This test is used to measure oxygen levels of the blood. Normal
range is 95% to 100%.
SpO2
- Arterial oxygen saturation measured by pulse oximetry
SaO2
- Arterial oxygen saturation measured by pulse oximetry
ABG
- A blood test that determines the adequacy of alveolar gas exchange and
measures acidity pH, levels of oxygen and carbon dioxide from arteries.
PaCO2
- Partial pressure of carbon dioxide one of several measures calculated by ABG
test It evaluates carbon dioxide levels in the blood. Normal range is 35-45
mmHg.
PaO2
- Partial pressure of oxygen. Measurement of oxygen pressure in arterial blood. It
reflects how well oxygen can move from lungs to the circulatory system. Normal
range is 80-100 mmHg.

OXYGEN DELIVERY SYSTEM

Devices that are used to administer, regulate, and supplement oxygen to a
subject to increase arterial oxygenation.
Nasal Most common type of oxygen delivery
Cannula
because it is easy to apply. It delivers low
flow of oxygen through 2 prongs inserted
to 1cm in each nostril. It is set to deliver
oxygen at flows between 2-6 L/min (24-
25% FiO2) oxygen concentration. Oxygen
Concentrations: 24% at 1L/min and 44% at
6 L/min

Oxygen A mask that covers the nose and mouth

mask part to deliver moderate flow rate for a
short period of time. It has the ability to
deliver oxygen concentration of 40-60 %
with flow of 6 to 10L/min.

Simple A face mask is used to deliver Oxygen

Face Mask concentrations of 40% to 60% for short-
term O2 therapy or to deliver O2 in an
emergency.
Fraction of Inspired O2 via simple face
mask
○ 40% to 50% at 6 L/min
○ 55% to 60% at 8 L/min
Non- This device is used to deliver high flow
rebreather rates and high concentration of oxygen in
mask fact it delivers the highest O2
concentration possible (80%-100%) with
the flow of 10-15 L/min. The mask also has
a reservoir bag that is inflated with pure
oxygen. Between the mask and the bag is
another one-way Valve that allows the
patient to breathe in the oxygen supplied
by the sources as well as the oxygen
reservoir and the reservoir bag must not
completely collapse during inspiration. This
provides patients with oxygen
concentration close to 100%.

Partial It delivers oxygen gas to the patient

rebreather concentration of 35-60% with a flow rate of
mask 6-10L/min. With a partial rebreather mask,
when the patient inhales, they inhale some
of the exhaled air which contains carbon
dioxide. When carbon dioxide enters the
lungs it stimulates breathing and during
inspiration and expiration, the reservoir
bag must remain inflated.
Venturi Venturi mask is often used for critical ill
Mask patients that require specific concentration
of O2. It delivered oxygen concentration of
24-60% with flow rate of 4-10L/min and
has a wide bore tubing and color coded
adaptor that correspond to precise oxygen
concentration and liter flow.
● Blue= 24% FiO2 at 2-4 L/min
● White= 28% FiO2 at 4-6
L/min
● Orange= 31% FiO2 at 6-8
L/min
● Yellow= 35% FiO2 at 8-10
L/min
● Red= 40% FiO2 at 10-12
L/min
● Green= 60% FiO2 at 12-15
L/min

Face tent An aerosol device that is often used to

replace oxygen masks when masks are
poorly tolerated by the client. Delivers
oxygen concentration 30-50% at 4-5L/min
flow rate.
PROCEDURE

Device Action

Nasal Catheter 1. Determine the need for oxygen treatment by

performing respiratory assessment verifying the
order for treatment.
2. Wash your hands.Handwashing deters the spread of
microorganisms.
3. Identify and explain the procedure to the client and
review safety precautions necessary when oxygen is
in use. An explanation relieves apprehension and
promotes cooperation. The nurse promotes the safety of
the client and others by providing pertinent information.
4. Assist the client to a semi- fowler’s position if
possible. Permits easier chest expansion to enhance
easier breathing.
5. Open the oxygen valve to ensure proper functioning.
Check that the oxygen is flowing freely through the tubing
and feel the oxygen at the tip of the cath.
6. Regulate the liter gauge as prescribed.
7. Measure from the tip of the nose to the lobe of the ear
and insert gently. An insertion of the correct length of
catheter facilitates oxygen administration and comfort for
the client.
8. Fasten the bridge of the nose and forehead or cheek
with adhesive tape. Correct placement of fastener
facilitates oxygen administration and comfort for the
client.
9. Encourage the client to the breath through his nose
with his mouth closed. Keeping the mouth closed
provides optimal delivery of oxygen to the client’s lungs.
10. Record the time therapy was started, rate of oxygen
flow per minute, and client’s response to therapy. The
client’s respiration, color and so on indicate the
effectiveness of the oxygen therapy.
11. If oxygen therapy is to be discontinued, close oxygen
valve and oxygen liter gauge. Withdraw catheter very
gently. Cleanse client’s nostril after. Liter gauge will
have more pressure to contend with and ruin the
equipment. When performing these tasks the nurse
demonstrates a conscientious concern for the client’s
comfort.
12. Do after care of equipment.
Nasal Cannula 1. Determine the need for oxygen treatment by
performing respiratory assessment verifying the
orders for treatment.
2. Wash your hands.Handwashing deters the spread of
microorganisms.
3. Identify and explain the procedure to the client and
review safety precautions necessary when oxygen is
in use. An explanation relieves apprehension and
promotes cooperation. The nurse promotes the safety of
the client and others by providing pertinent information.
4. Connect the nasal cannula to the oxygen set-up with
a humidifier. If using a wall outlet as an oxygen
source plug flow meter into outlet by pushing until it
snaps into place. If a lock release button is present,
depress it as you place the flowmeter. Oxygen forced
through a water reservoir is humidified before it is
delivered to the client, thus preventing dehydration of the
mucous membranes.
5. Assist the client to a semi- fowler’s position if
possible. Permits easier chest expansion to enhance
easier breathing.
6. Place the prongs in the client’s nostrils.
a. Around the client’s head.
b. Over and behind each ear with the adjuster
comfortable under the chin
Correct placement of prongs and fastener facilitates oxygen
administration and comfort for the client
7. Open oxygen valve to ensure proper functioning.
Permits easier chest expansion to enhance easier
breathing.
8. Use gauze pads at the ear beneath the tubing as
necessary. Pads reduce the irritation and pressure and
protect the skin.
9. Encourage the client to breath through his nose with
his mouth closed. Keeping the mouth closed provides
optimum delivery of oxygen to the lungs.
10. Encourage the client to breath through his nose with
his mouth closed. Keeping the mouth closed provides
optimum delivery of oxygen to the lungs.
11. Wash your hands. It deters the spread of the
microorganisms.
12. Assess and chart the client’s response to therapy.
The client’s respirations, color and so on indicate the
effectiveness of the oxygen therapy.
13. Inspect the equipment on a regular basis. Check the
liter flow, humidifier and safety precautions.
14. Remove and clean the cannula and nares at least
every 8 hours or according to agency
recommendation. Check the nares for evidence of
irritation or bleeding. The continued presence of the
cannula causes irritation and dryness of the mucous
membranes. Humidification counteracts the drying effects
of oxygen.
Oxygen 1. Determine the need for oxygen treatment by
mask/Venturi Mask performing respiratory assessment verifying the
order of the treatment.
2. Do hand washing. Deters spread of microorganisms.
3. Identify and explain the procedure to the client and
review safety precautions necessary when oxygen is
in use. An explanation relieves apprehension and
promotes cooperation. The nurse promotes the safety of
the patient and others by providing pertinent information.
4. Attach the face mason to the oxygen set up with
humidification. Start the flow of oxygen at the
specified rate. Oxygen force through the water reservoir
is humidified before it is delivered to the client, thus
preventing dehydration of the mucous membranes.
5. Position the face mask over the client’s nose and
mouth. Adjust it with the elastic strap so that the
mask fits snugly but comfortably on the face. A loose
poorly fitting mask will result in oxygen loss and
decreased therapeutic value. Masks may cause a feeling
of suffocation, and the client may need frequent attention
and reassurance.
6. Use gauze pads to reduce irritation on the client's
ears and scalp. Pads reduce irritation and pressure and
protect the skin.
7. Wash your hands. Deters spread of microorganisms.
8. Remove the mask and dry the skin every 2 to 3 hours
if the oxygen is running continuously. Do not powder
around the mask. The tight-fitting mask and the moisture
from condensation can irritate the skin on the face. There
is danger of inhaling powder if it is placed on the mask.
9. Assess the client at frequent intervals (vital signs,
color , response to therapy). Monitor the equipment
on a frequent basis. Oxygen toxicity may develop in
response to exposure to a high concentration of oxygen.
10. Record the type of therapy and the client’s response.
A written summary provides an accurate documentation
of the care and response of the client to treatment.
Non rebreather 1.Ensure the patient is in an upright position to
mask/partial maximise breathing.
rebreather Mask 2.Request that pulse oximetry is commenced.
3.Check the oxygen prescription.
4.Explain the procedure to the patient and gain
informed consent.
5.Attach the oxygen tubing to the oxygen source.
6.Set the oxygen flow rate to 12-15l/minute Occlude
the valve between the mask and the oxygen reservoir
bag and check that the reservoir bag is filling up.
7.Squeeze the oxygen reservoir bag to check the
patency of the valve between the mask and the
reservoir bag. If the valve is working correctly it will
be possible to empty the reservoir bag. If the
reservoir bag does not empty, discard it and select
another mask (Smith, 2003).
8. Again, occlude the valve between the mask and the
oxygen reservoir bag , and allow the reservoir bag to
fill up.
9. Place the mask with a filled oxygen reservoir bag
on the patient’s face, ensuring a tight fit.
10.Adjust the oxygen flow rate until it is sufficient to
ensure that the reservoir bag deflates by
approximately one-third with each breath.
11.Reassure the patient, who may need time to
become accustomed to the mask.
12.Monitor the patient’s vital signs closely. In
particular, assess the response to the oxygen
therapy.checking respiratory rate, mechanics of
breathing, colour, oxygen saturation levels and
consciousness. Usually, arterial blood gas will also
be monitored.
13.Document the procedure.

Simple face mask 1. Perform hand hygiene and put on gloves if available.
To prevent the spread of infection.
2. Explain the procedure and the need for oxygen to the
client. The client has a right to know what is happening
and why. Providing explanations alley his/her anxiety
3. Prepare the oxygen equipment:
a. Attach the humidifier to the threaded outlet of
the flowmeter or regulator.
b. Connect the tubing from the simple mask to the
nipple outlet on the humidifier.
c. Set the oxygen at the prescribed flow rate.
To maintain the proper setting. The oxygen must be flowing
 before you apply the mask to the client.
4. To apply the mask, guide the elastic strap over the
top of the client’s head. Bring the strap down to just
below the client’s ears. This position will hold the mask
most firmly.
5. Gently, but firmly, pull the strap extensions to center
the mask on the client’s face with a tight seal. The
seal prevents leaks as much as possible.
6. Make sure that the client is comfortable. Comfort helps
relieve apprehension, and lowers oxygen need.
7. Remove and properly dispose of gloves. Wash your
hands. Respiratory secretions are considered
contaminated.
8. Document the procedure and record the client’s
reactions. Documentation provides for coordination of
care.
9. Sign the chart and report the senior staff. To maintain
professional accountability.
10. Check periodically for depressed respirations or
increased pulse. To assess the respiratory condition and
fiend out any abnormalities as soon as possible.
11. Check for reddened pressure areas under the straps.
The straps, when snug, place pressure on the underlying
skin areas.

Face tent 1. Prior to performing the procedure, introduce self and

verify the client’s identity using agency protocol.
Explain to the client what you are going to do, why it
is necessary, and how he or she can cooperate.
Discuss how effects of the oxygen therapy will be
used in planning further care or treatments.

2. Perform hand hygiene and observe appropriate

infection control procedures.

3. Provide for client privacy, if appropriate.

4. Set up the oxygen equipment and the humidifier.

Equipments:
● Oxygen supply with a flow meter and adapter
● Humidifier with distilled water or tap water according
to agency protocol
● Face tent of appropriate size
Setup:
• Attach the flow meter to the wall outlet or tank. The
 flow meter should be in the off position.

• If needed, fill the humidifier bottle

• Attach a humidifier bottle to the base of the flow meter.

• Attach the prescribed oxygen tubing and delivery

device to the humidifier.

5. Turn on the oxygen at the prescribed rate and ensure

proper functioning.

• Check that the oxygen is flowing freely through the

tubing. There should be no kinks in the tubing and
the connections should be airtight. There should be
bubbles in the humidifier as the oxygen flows
through. You should feel the oxygen at the outlets of
the cannula, mask or tent.

• Set the oxygen at the flow rate ordered.

6. Apply the appropriate oxygen delivery device.

• Place the tent over the client’s face and secure the ties
around the head.

7. Assess the client regularly.

• Assess client’s vital signs, level of anxiety, color and

ease of respiration and provide support while the
client adjusts to the device.

• Assess the client regularly for clinical signs of hypoxia,

tachycardia, confusion, dyspnea, restlessness and
cyanosis. Review oxygen saturation or arterial blood
gas results if they are available.

• Inspect the facial skin frequently for dampness or

chafing and dry and treat it as needed

8. Inspect the equipment on a regular basis.

• Check the liter flow and the level of water in the

humidifier in 30 minutes and whenever providing care
to the client.
 • Be sure that water is not collecting in dependent loops
of the tubing.

• Make sure that safety precautions are being followed.

9. Document findings in the client record using forms or

checklist supplemented by narrative notes when
appropriate.

OBSERVE FOR PROPERLY FUNCTION OF OXYGEN DELIVERY DEVICE

A. Nasal cannula- cannula is positioned properly in the nares
B. Breathing mask- reservoir bag shoulder fill on exhalation and not collapse on
inhalation.
C. Face tent- mist should always be present

EVALUATION
1. Observe for breathing pattern improvement
2. Observe for decrease anxiety, improved LOC, cognitive abilities, and decrease
fatigue
3. ABG Monitoring
4. Assess adequacy of oxygen flow each shift
5. Observed for evidence of skin breakdown specially on external ears, nares and
nasal mucous membranes .

SAFETY PRECAUTIONS
- Oxygen supports fire so no smoking sign must be in place when oxygen is used.
- Electrical devices must be in good condition for good working order
- Avoid material that can generate station electricity
- Avoid using flammable devices or substances such as lighter and candles when
near O2 therapy
- Fire extinguisher locations must be close in case of a disaster.
EXPECTED OUTCOMES
● Patient maintains optimal gas exchange as evidenced by usual mental status,
unlabored respiration at 12-20 per minute.
● Oximetry result within normal range
● Patients signs of hypoxia will reduced/eliminated
● VS will return to baseline
● ABG values will be at normal range
● Patients manifest resolutions or absence of symptoms of respiratory distress.

Sample Documentation

Date Time Nurse’s Notes

11/12/202 1:50 AM Restless during sleep; R- 32, P-118, BP- 148/90; Slightly
cyanotic; Placed in high Fowler’s position; O2 via nasal
cannula administered @ 4L/min, as ordered; VS
rechecked; RR- 25, P-100. BP- 130/80; Verbalized “wala
nako naglisod ug ginhawa”

Janice Tan, St. N