Oxygen Therapy

  1. Most common therapy for clients with respiratory disease
  2. Indications include arterial hypoxemia; COPD; ARDS; tissue, cellular, and circulatory hypoxia
  3. Delivery systems
    1. Low-flow system: delivers oxygen at variable liter flows designed to add to client's inspired air.
      1. Nasal cannula
        1. most common mode of oxygen delivery; consists of delivering 100% oxygen through two prongs inserted 1 cm into each nostril; general flow rates of 1-4 liters/minute are used with desired FiO2 range of 24%-40%.
        2. Nursing care
          1. instruct client to breathe through the nose.
          2. remove cannula and clean nares every 8 hours.
          3. provide mouth care every 2-3 hours.
          4. use gauze pads behind ears to decrease irritation.
          5. assess arterial pO2 frequently.
      2. Standard mask
        1. simple face mask that covers the nose and mouth and provides an additional area for oxygen collection; ranges: 6-12 liters/minute; FiO2: 40%-65%.
        2. Nursing care
          1. instruct client to breathe through the nose.
          2. remove and clean mask every 2-3 hours.
          3. monitor carefully in clients who are prone to develop obstructed airways.
          4. replace mask with nasal cannula during meals and reposition mask immediately after eating.
      3. Nonrebreathing mask
        1. standard mask with a reservoir bag designed to deliver 90%-100% oxygen; a one-way valve between reservoir bag and mask allows the client to inhale only from the reservoir bag and exhale through separate valves on the side of the mask; ranges: 6-15 liters/minute; FiO2: 60%-90%.
        2. Nursing care
          1. instruct client to breathe through the nose.
          2. ensure that bag does not collapse completely with each inspiration.
          3. remove and clean mask every 2-3 hours.
    2. High-flow system: client receives entire inspired gas from the apparatus, flow rates must exceed the volume of air required for a person's minute ventilation; Venturi mask commonly used
      1. Provides precise delivery of oxygen concentrations of 24%-50%.
      2. Nursing care
        1. provide supplemental oxygen by cannula during meals and other activities where mask interferes.
        2. remove and clean mask every 2-3 hours.

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