Ns. RENI SULUNG UTAMI, M.

Sc
ADULT NURSING DEPARTMENT
 Setelah mempelajari materi ini diharapkan
mahasiswa mampu:
 Memahami macam-macam terapi oksigen
 Memahami prinsip pemberian oksigen
 Mendemonstrasikan pemberian oksigen
 Hyperventilation
Condition in which more than the normal amount of air is entering
and leaving the lungs as a result of an increase in rate or depth of
respiration or both
 Hypoventilation
Decreased rate or depth of air movement into the lungs
 Hypoxia
Inadequate amount of oxygen available to the cells
 Hypoxaemia
Reduction of the oxygen concentration in the arterial blood
 Tachypnea
Rapid breathing
 Cyanosis
a bluish discoloration of the skin and mucous membranes
resulting from an inadequate oxygen in the blood
 To correct alveolar and tissue hypoxia, aiming
for a PaO2 of at least 8.0 kPa (60 mmHg) or
oxygen saturations of at least 93%
 Hypoxia/hypoxemia.
 Decreased cardiac output
 Increased oxygen demand
 Decreased oxygen carrying capacity
 Increased myocardial workload
 Procedures that may cause hypoxemia (mis: surgery)
 Respiratory distress
 An acute situation where hypoxaemia is suspected
 LOW FLOW MASKS HIGH FLOW MASKS

 Nasal cannulae  Venturi masks.

 Hudson (or MC) masks
 Reservoir bag masks.
 Convenient and comfortable.
 Patients can easily speak, eat and drink
wearing nasal cannulae.
 Oxygen flow rate does not usually exceed 5
l/min
 Can be easily dislodged
 May cause dryness and pressure sores in
nares
Oxygen Flow Rate (ml/mnt) Inspired Oxygen Concentration (%)
1 24
2 28
3 32
4 36
5 40

The concentration of oxygen delivered by nasal cannulae is

variable both between patients and in the same patient at
different times. The concentration is affected by factors
such as the size of the anatomical reservoir and the peak
inspiratory flow rate.
 Deliver 40-60% oxygen when set to 10–15 l/min (6-10 l/min)
 The mask provides an additional 100–200 ml oxygen reservoir and
that is why a higher concentration of oxygen is delivered
compared with nasal cannulae.
 The concentration of oxygen delivered varies depending on the
peak inspiratory flow rate as well as the fit of the mask.
 Significant rebreathing of CO2 can occur if the oxygen flow rate is
set to less than 5 l/min because exhaled air may not be adequately
flushed from the mask.
 Mask may be uncomfortable
 Produce pressure necrosis of the skin
 Must be removed during eating, drinking
and talking
 Similar in design to Hudson masks, with the
addition of a 600–1000-ml reservoir bag which
increases the oxygen concentration still further
 Reservoir bag masks deliver around 80% oxygen
at 10–15 l/min, but this varies depending on the
peak inspiratory flow rate as well as the fit of the
mask.
 There are two types of reservoir bag mask:
partial rebreathing masks and non-rebreathing
masks.
PARTIAL REBREATHING MASK NON REBREATHING MASK

 The first one-third of the  Exhaled air exits the side of

patient’s exhaled gas fills the mask through one-way
the reservoir bag, but as valves and is prevented
this is primarily from the from entering the reservoir
anatomical deadspace, it bag by another one-way
contains little CO2. valve.
 The patient then inspires a  The patient therefore only
mixture of exhaled gas and inspires fresh gas (mainly
fresh gas (mainly oxygen). oxygen).
PARTIAL REBREATHING MASK NON REBREATHING MASK

 6–10 L/min delivers 35% to  6–10 L/min delivers 60% to

60% oxygen. 100% oxygen.
 Never let bag totally  Places pressure on bridge
deflate because this may of nose and ears—pad with
cause CO2 retention. gauze pads to prevent
 Places pressure on bridge pressure sores and necrosis
of nose and ears—pad with
gauze pads to prevent
pressure sores and
necrosis.
 The reservoir should be filled with oxygen before the
mask is placed on the patient and the bag should not
deflate by more than two-thirds with each breath in
order to be effective.
 If the oxygen flow rate and oxygen reservoir are
insufficient to meet the inspiratory demands of a
patient with a particularly high inspiratory flow rate,
the bag may collapse and the patient’s oxygenation
could be compromised  To prevent this, reservoir
bag masks must be used with a minimum of 10 l/min
of oxygen
 It is important to realise that low flow does not
necessarily mean low concentration.
 The Venturi valve utilises the Bernoulli principle
and has the effect of increasing the gas flow to
above the patient’s peak inspiratory flow rate
 A changing inspiratory pattern does not affect
the oxygen concentration delivered, because the
gas flow is high enough to meet the patient’s
peak inspiratory demands.
 There are two types of venturi systems: colour-
coded valve masks and a variable model
 Each colour-coded valve masks is designed to
deliver a fixed percentage of oxygen when set to
the appropriate flow rate.
 To change the oxygen concentration, both the valve and
flow have to be changed.
 The size of the orifice and the oxygen flow rate are
different for each type of valve, because they have been
calculated accordingly.
 The orifice is adjustable and the oxygen flow rate is set
depending on what oxygen concentration is desired.
 Increasing the oxygen flow rate will increase total gas
flow, but not the inspired oxygen concentration
 Normally, inspired air is warmed and humidified to
almost 90% by the nasopharynx.
 Administering dry oxygen lowers the water content of
inspired air  result in ciliary dysfunction, impaired
mucous transport, retention of secretions, atelectasis,
and even bacterial infiltration of the pulmonary
mucosa and pneumonia.
 Humidified oxygen is given to avoid this, and is
particularly important when prolonged high-
concentration oxygen is administered and in
pneumonia or post-operative respiratory failure
where the expectoration of secretions is important.
 Oxygen mask Clinical situation
Nasal cannulae (2–5 l/min) Patients with otherwise normal vital signs
(e.g. post-operative, slightly low SpO2,
long-term oxygen therapy).

Hudson masks (more than 5 l/min) or Higher concentrations required and

reservoir bag masks (more than 10 l/min) controlled oxygen not necessary (e.g.
severe asthma, acute left ventricular
failure, pneumonia, trauma, severe
sepsis)
Venturi masks Controlled oxygen therapy required (e.g.
patients with exacerbation of COPD).
 Prolonged exposure to high concentrations of oxygen (above 50%)
can lead to atelectasis and acute lung injury
 Absorption atelectasis occurs as nitrogen is washed out of the alveoli
and oxygen is readily absorbed into the bloodstream, leaving the
alveoli to collapse.
 Acute lung injury is thought to be due to oxygen free radicals
 Oxygen is also combustible.
 High concentrations of oxygen could inactivated pulmonary
surfactant
 O2 toxicity  reduced vital capacity, cough, substernal chest pain,
nausea and vomiting, paresthesias in extremities, dry cough,
dyspnea, anorexia, nausea, vomiting, fatigue, lethargy, malaise,
restlessness, progressive ventilatory difficulty and in the end cause
lung fibrosis.
 Flow is not the same as concentration!
 Low flow masks can deliver high concentrations
of oxygen and high flow masks can deliver low
concentrations of oxygen.
 A fixed concentration of oxygen is important for
many patients, as is humidified oxygen.
 When giving instructions or prescribing oxygen
therapy, two parts are required: the type of
mask and the flow rate.
 The right patient should receive the right
amount of oxygen for the right length of time.
EQUIPMENT/SUPPLIES
 Oxygen source
 Oxygen flowmeter
 Humidifier
 Specific type of oxygen delivery system
(nasal cannula, simple face mask, partial
rebreather mask, nonrebreather mask,
Venturi mask)
 Wash hands. (Reduces transmission of microorganisms)
 Organize equipment (Organizing equipment before beginning
procedure enhances efficiency and patient safety)
 Explain procedure to patient. (Ensures that patient is informed, and
decreases patient anxiety.)
 Prepare humidifier: Add distilled water if needed (Delivers
humidified oxygen to mucous membranes of airway)
 Connect humidifier to flow meter, and connect humidifier to
tubing attached to cannula. (Controls flow of oxygen and connects
humidification to oxygen delivery system)
 Turn oxygen flowmeter on until bubbling is noted in
humidifier. (Ensures connections are
intact and that oxygen delivered will
be humidified)
 Check order.
 Adjust flow of oxygen via flowmeter. (Regulates
oxygen flow delivery)
 Put on gloves (Reduces transmission of
microorganisms)
 Place tips of cannula in patient’s nares; fit tubing
over ears, tighten tubing under chin, and adjust
to proper fit. (Ensures proper fit of nasal cannula)
 Position patient for comfort and ease of
breathing with head of bed elevated (Facilitates
lung expansion for adequate gas exchange)
 Evaluate patient’s respirations and oxygen
saturation (Determines adequacy of oxygen
delivery system for patient)
 Wash hands. Reduces transmission of microorganisms.
 Organize equipment. Organizing equipment before
beginning procedure enhances efficiency and patient safety.
 Explain procedure to patient. Ensures that patient is
informed and decreases patient anxiety.
 Prepare humidifier Delivers humidified oxygen to mucous
membranes of airway.
 Connect humidifier to flowmeter, and then connect
humidifier to mask tubing. Controls flow of oxygen and
connects humidification to oxygen delivery system.
 Turn oxygen flow meter on until bubbling is noted in
humidifier. Ensures connections are intact and that oxygen
delivered will be humidified.
 Adjust flow of oxygen via flowmeter (with Venturi mask,
attach oxygen percentage regulator to oxygen mask and
regulate flow as indicated) Regulates oxygen flow delivery.
 Put on gloves. Reduces transmission of microorganisms.
 Place mask over nose, mouth, and chin; adjust metal strip
over bridge of nose to fit securely; and pull elastic band
around back of head and tighten to fit. Ensures proper fit of
mask.
 Position patient for comfort and ease of breathing with
head of bed elevated. Facilitates lung expansion for
adequate gas exchange.
 Evaluate patient’s respirations and oxygen saturation.
Determines adequacy of oxygen-delivery system for patient.
Assess the patient’s:
 Oxygen saturation, and compare to baseline
 Quality of and rate of respirations, and
compare to baseline
 Vital signs, and compare to baseline
 Comfort level
 Assessment of the patient’s respiratory status
prior to initiation of oxygen therapy, including
oxygen saturation and a description of
respirations including rate.
 Type of oxygen-delivery method initiated.
 Time of initiation of oxygen-delivery method.
 Percentage of oxygen currently being given.
 Assessment of patient’s respiratory status after
initiation of oxygen therapy to include oxygen
saturation and a description of respirations,
including rate.