Respiratory: Oxygen therapy (for nursing assistant training)

Oxygen therapy is the delivery of extra oxygen to those with conditions that cause hypoxia, which is when there is not enough oxygen to meet the needs of the body.This includes clients with various diseases that interfere with the lungs’ ability to properly absorb oxygen from the inhaled air like pneumonia, chronic bronchitis, emphysema, and sleep apnea as well as blood problems like anemia where the blood doesn't carry enough oxygen and heart problems like heart failure where the heart has trouble pumping blood around the body.Now, oxygen is considered a medication so, as a nursing assistant, you will provide care for clients receiving oxygen therapy.However, it’s a nurse’s or respiratory therapist’s task to start and maintain the oxygen therapy, and a healthcare provider will be the one to order when and how to administer supplemental oxygen.Okay, now, an oxygen setup consists of an oxygen source and a delivery device.

There are several sources for oxygen therapy, including a wall outlet, an oxygen tank, a liquid oxygen system, and an oxygen concentrator.With a wall outlet, oxygen is delivered into each client’s room from a central supply.

Next, an oxygen tank is filled with oxygen under pressure and is typically portable, so it can be carried along as the client moves.However, this should be moved very carefully; if the tank tips over and the valve breaks open, pressurized oxygen can burst out forcefully and result in severe trauma.Oxygen tanks also have a gauge that shows how much oxygen is left.

There are also liquid oxygen systems that consist of a portable component which can be worn over the shoulder.The portable component needs to be filled by a large reservoir that is kept at home.

Finally, oxygen concentrators pull in air from the atmosphere and selectively remove nitrogen to deliver 100% oxygen.These devices need a power supply and are very easy to use because they have an on-off switch.They are usually preferred at home or in healthcare facilities for clients who only need oxygen therapy every now and then rather than on a regular basis.All oxygen sources are attached to a flow meter that indicates the flow rate, or the liters of oxygen administered per minute.

This usually falls somewhere between 1 and 15 liters per minute.Now, oxygen delivery, especially at high flow rates, can have a drying effect on mucous membranes which may cause discomfort to the client.To prevent that from happening, the oxygen also passes through a humidifier bottle before reaching the delivery device.

This bottle contains distilled water which turns into water vapor.Water vapor is then picked up by the oxygen, creating bubbles.

And if bubbling occurs, vapor is being produced and humidified oxygen is being delivered to the client.Now, various delivery devices can be applied to administer supplemental oxygen.

The most common choice is the nasal cannula.This consists of two prongs that are placed into the nostrils and a band of tubing which wraps around the cheeks and behind the ears to keep it in place.A nasal cannula is simple to apply and is less intrusive, so it lets the client eat, drink, and talk freely.

However, high flow rates can cause the nasal passages to dry out and sometimes bleed.If the bands are too tight, they might also irritate the skin around the nose, cheekbones, and ears and potentially lead to open sores.Bear in mind that nasal cannulas are typically not preferred for clients who breathe through their mouths or those in serious conditions who require high oxygen concentrations.In these cases, face masks which cover the client’s nose and mouth are usually used.

There’s a variety of face masks, ranging from simple ones to face masks connected with reservoir bags.These include partial-rebreather masks which consist of a simple face mask and a bag storing exhaled air and pure oxygen.Every time the client inhales, they breathe in oxygen and exhale air from the bag as well as an amount of room air.With non-rebreather masks, only oxygen from the bag is breathed in, while exhaled air escapes through holes on the sides of the mask.Venturi masks are another variety and can be used when a precise amount of oxygen needs to be administered.Compared to nasal cannula, face masks are more complicated, they might be more uncomfortable for the client, and they make it harder to eat, drink, and talk.In some cases, when the client is comatose or has received sedative drugs, accessory devices can be used along with the nasal cannula or face mask in order to secure an open airway, by keeping the tongue off the back of the throat.These are flexible tubes that go through the nose and up to the throat, known as nasopharyngeal airways, or into the mouth and back to the throat, called oropharyngeal airways.Now, when providing care to a client who is receiving oxygen therapy, there are some general considerations.First, make sure they wear their nasal cannula or face mask at all times and never take it off, unless it is outlined differently in their plan of care.It’s also important to use and store oxygen in well-ventilated areas rather than behind curtains, in cabinets, closets, or other confined spaces.Keep in mind that, although oxygen is not flammable itself, it supports the feeding of combustion, so it can lead to a fire.For this reason, it’s important to keep oxygen at least five feet away from flames or heat sources.In home and long-term care settings, be sure to hang a “No smoking” sign and make it clear both to the client and their visitors that smoking, lighting matches, or using anything flammable, like alcohol-containing sprays, where oxygen is used or stored is extremely dangerous.Clients should also know that they should not use electric razors, hair dryers, or any heat-producing and electrical appliances that have a motor while using oxygen.Water-based products, rather than oil-based lotions or ointments, should be applied in or around the nose.Anything that causes static electricity should also be avoided which is why cotton bedding is usually preferred.Ask the nurse to inform you about the ordered flow rate and check the flow meter regularly to make sure it’s not too high or too low.Remember to also check the humidity bottle to see that there’s enough water and that bubbles are produced.Ensure there are no kinks in the tubing and that the client is not lying on top of it.

If they are using a nasal cannula, also check to make sure that it is comfortable for the client, that the prongs are facing up, and that there isn't any mucus on the prongs that could interfere with oxygen delivery.For a face mask with a storage bag, be sure to observe the bag to make sure it remains inflated; this is how you will know enough oxygen is flowing into the bag.Finally, regular oral care is important to alleviate some of the dryness of the nasal and oral mucosa, while skin care is essential to protect areas where the delivery devices press against the skin.Although you will not apply oxygen to the client or set or change flow rates, you can be responsible for setting it up to be used.So first, gather the equipment you’ll need, including an oxygen delivery device with the appropriate tubing, a flow meter, a humidifier bottle if ordered, and distilled water for the humidifier.Connect the flow meter with the oxygen source.

Then pour the distilled water in the humidifier bottle and attach the humidifier to the flow meter as well as to the delivery device.You can now inform the nurse that the system is set up, so that they can turn it on, set the flow rate, and apply the oxygen to the client.Now, when assisting a client receiving oxygen therapy, there are a few things you should report to the nurse right away such as the client complaining of an abrupt onset of chest discomfort, shortness of breath or if you notice problems such as coughing up white, foamy, green, yellow, or brown phlegm.Also, observe for any changes in vital signs or in the level of consciousness; unusual respiratory sounds; bluish discoloration of the skin or mucous membrane; irritation; or breakdown around the nose, cheeks, or ears.Finally, remember to document the date, time, and any observations you made while caring for a client receiving oxygen therapy.Alright, as a quick recap...

Oxygen therapy is used for clients with conditions that put them at risk for hypoxia.Sources for oxygen therapy include a wall outlet, an oxygen tank, a liquid oxygen system, and an oxygen concentrator.The flow rate of oxygen is measured in liters per minute and is regulated via a flow meter.

A humidifier bottle is also used to prevent the oxygen from drying out the mucous membranes lining the nose and mouth.Face masks can be simple, partial-rebreather, non-rebreather, or Venturi.

Nasopharyngeal or oropharyngeal airways should also be applied in sedated and unconscious clients to keep the airway open.It’s highly important to be aware of safety considerations, like never taking the oxygen off and keeping it in well-ventilated areas and at least five feet away from flames or heat sources.Also, check the flow meter to see that the flow rate matches the ordered one, the gauge on the oxygen tank to ensure there’s enough oxygen left, and the humidity bottle to see there’s enough water and bubbles are produced.

The flow rate of oxygen is measured in liters per minute and is regulated. Via a flowmeter.

A humidifier bottle is also used to prevent the oxygen from drying out the mucous. Membranes lining the nose and mouth face masks can be simple, partial, rebreather non-rebreather or Venturi nasopharyngeal or oropharyngeal Airways.

Should also be applied in sedated and unconscious clients to keep the airway open. It's highly important to be aware of safety considerations, like never taking the oxygen off and keeping it in well-ventilated areas and at least five feet away from Flames or heat sources.

Also check the flow meter to see that the flow rate matches. The ordered 12 gauge on the oxygen tank to ensure there's enough oxygen left and the humidity bottle to see there's enough water and Bubbles