Oxygen inhalation for nursing care .pptx

0xygen inhalation

1. Prepared by Ms shiwani sah lecturer Oxygen therapy

2. INTRODUCTION Oxygen therapy is the administration of oxygen at a concentration greater than that found in the environmental atmosphere through the different devices. Concentration of oxygen in room is 21% . Normal oxygen level in blood:- an oxygen level of 95-100% is considered to be normal. When the level of oxygen is within this range, it is considered to be optimum for smooth functioning of the cell.

3. definition Method by which oxygen is supplemented at higher percentages than what is available in atmospheric air. It is also called supplemental oxygen. It is only available through a prescription from health care provider.

4. INHALATION Inhalation is the act of drawing in air, vapour or gas into the lungs. It may be for local effect eg . Steam inhalation Dry inhalation Moist inhalation Dry inhalation : It is the inhalation of gases, fumes from volatile drugs or burning drugs. Eg . Oxygen inhalation Moist inhalation : Breathing warm and moist air produced by a vaporizer is called steam moist inhalation.

5. Sources of Oxygen: Therapeutic oxygen is available from two sources 1. Wall Outlets (Central supply) 2. Oxygen cylinders

6. Oxygen cylinder description It is never kept near inflammable material Avoid using oil (or) grease around oxygen connections Post ‘ No smoking’ sign on the patients door and in view of the patients visitors Avoid electric pads Turn off flow valve when cylinder valve is being opened and always check for leakage

7. EMPTY mark should be placed when the cylinder is empty The ordinary nasal catheter should have 3 or 4 holes in the sides of the tip Humidifies should be half fill

8. Equipment Oxygen cylinder after testing it is working efficiently A tray with cover Nasal catheter (or) cannula (or) a mask Bowl with water Plaster & scissors Half filled humidifier with sterile distilled water Flow meter Rubber tubing

9. Procedure Assemble the equipment Explain the procedure Post ‘No smoking’ sign on the patient door (or) at the patients head end Hold the catheter and measure the distance between the nostrils and ear lobe Test the apparatus before hand by opening the valve Immense the end of the catheter into a bowl of water .

10. Lubricate the catheter before passing into nose, with water soluble lubricant. Make sure that the humidifier is filled to the appropriate mark. Attach the connecting tube Set the flow rate at prescribed litres /minute Feel to determine if oxygen is flowing through the tips of the cannula Open the cylinder and adjust the flow before introducing the catheter into the nose. Never open the cylinder after introducing into the nose. Place the tip of the cylinder (or) nasal catheter in the patients nose.

11. Observe the position of the catheter through the patients mouth. Fix the catheter in position on the or the forehead with adhesive tap Before leaving the patient ,make sure that the patient is comfortable Patient should be checked at frequent intervals Catheter should be changed every 12 hours or every 24 hours, if it is continued for a long time Always record in the patients record time. No. of lit/ mt given to the patient Always check the amount of oxygen in the cylinder when you come on duty and at intervals throughout your duty time

12. OXYGEN INHALATION Oxygen administration treats the effects of oxygen deficiency but it does not correct the underlying causes Indication : Cyanosis Dyspnea or labored breathing An environment low in oxygen content eg . High altitude Anaemia : Definiency of quality or quantity of red corpuscle in the blood giving rise to anoxaemia Disease of condition in the alveoli of lungs that interfere with the exchange of oxygen

13. 6. Patient whose respiratory capacity is diminished by some disease (or) condition eg . Atelectasis, pneumonia, CCF etc. 7. Poison with chemicals that alter tissue ability to utilize oxygen eg . Cyanide poisoning 8. Shock and circulatory failure 9. Haemorrhage and air hunger 10. Patient under anaesthesia 11. Patients who are critically ill, CVA, Cardiac thrombosis 12. Patients with psychologically induced dyspnea 13. Asphysia by foreign body obstruction of the air passage-drowning etc.

14. Procedure

15. Nasal prongs It is a disposable plastic device with two protruding prongs for insertion into the nostrils connecting to an oxygen source. Used for low medium concentration of oxygen (24 to 44 %)

16. Nasal prong

17. Nasal prong Advantages Client can able to talk and eat with oxygen in place Easily used in home setting Safe and simple Easily tolerated Delivers low concentration Disadvantages Unable to use with nasal obstruction Can dislodge from nasal easily Not good for mouth breathers Drying to mucous membrane, so flow greater than 4L/min needs to be humidified.

18. Face mask The simple oxygen mask The partial re breather mask The non re-breather mask The venture mask

19. The simple oxygen mask Simple mask 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.

20. The simple oxygen mask Advantages Can provide increased delivery of oxygen for short period of time Disadvantages Tight seal require to deliver high concentration Difficult to keep mask in position over nose and mouth Potential for skin breakdown Uncomfortable for patient while talking or eating

21. Partial re-breather mask The mask is with a reservoir bag that must remain inflated during both inspiration and expiration It collects of part of the patients exhaled air It is used to deliver oxygen It is used to deliver oxygen concentration upto 80% The oxygen flow rate must be maintained at a minimum of 6L/min to ensure that the patient does not re breath large amount of exhaled air.

22. Partial re-breath mask Advantages Client can inhale room air through opening in mask if oxygen supply is briefly interrupted Disadvantages Requires tight seal (eating and talking difficult, uncomfortable)

23. Non re-breather mask This mask provides the highest concentration of oxygen (95 to 100%) at flow rate 6 to 15 L/min 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 re-breathing any of the expired gas.

24. Non re-breather mask

25. Non re-breather mask Advantages Delivers the highest possible oxygen concentration Suitable for patient breathing spontaneously with severe hypoxemia. Disadvantages Impractical for long term therapy Malfunction can cause CO2 build up Suffocation Expensive Uncomfortable

26. Venturi mask It is high flow oxygen delivery device Oxygen from 40 to 50 %At liters flow of 4 to 15 L/min The mask is constructed so that there is a constant flow of room air blended with a fixed concentration of oxygen

27. Venturi mask Advantages Delivers most precise oxygen concentration Does not dry mucous membrane Disadvantages Uncomfortable Risk for skin irritation Produces respiratory depression in COPD patients with high oxygen concentration 50%

28. Oxygen hood The oxygen hood is used for babies who can breath on their own but still need extra oxygen The hood is a plastic dome or box with warm, moist oxygen inside The hood is placed over babies head

29. Oxygen tent An oxygen tent consist of a canopy placed over the head and shoulder or over the entire body of a patient to provide oxygen at a high level than normal Typically tent is made of see- through plastic materials It can envelop patient bed with the end section held in place by a mattress to ensure that the tent is air tight The enclosure often has a side opening with a zipper

30. Oxygen tent

31. AMBU bag AMBU- Artificial manual breathing unit (or) Bag valve mask ventilation is a hand held device commonly used to provide positive pressure ventilations to patients who not breathing or not breathing adequately

32. Tracheostomy collar/ mask Inserted directed into trachea Is indicated for chronic oxygen therapy need oxygen flow rate 8 to 10 L Provides good humidity Comfortable, more efficient

33. T - Piece Used on end of ET tube when weaning from ventilator Provides accurate FIO2 Provides good humidity

34. Preparation of articles Oxygen cylinder with stand and accessories, humidifier regulator, flow meter, connecting tube etc. A tray containing Nasal catheter Water soluable lubricating jelly Adhesive tapes Bowl of water Flash light & tongue depressor Cotton applicators and normal saline in a container

35. Kidney tray and paper bag Mackintosh and towel Rag piece or gauze piece

36. Preparation of patient Explain the procedure to the patient to win his confidence. Instruct the patients family members about the safety precautions required during the oxygen therapy Put up the instruction regarding the fire precautions in the unit Remove cigars, matches etc. Assemble the equipment and arrange them conveniently in the unit Clean the nostrils Protect the bed and garments

37. Applying a nasal catheter Wash hands Measure the length of nasal catheter from the tip of the nose to the ear lobe and mark the length with ink Check the apparatus for the working condition. Open the flow meter on regulator and adjust the flow as required. When it is opened the oxygen will start bubbling through the water/ in the wolfs bottle. Attach the catheter to the connecting tube and check the flow of oxygen through the catheter by submerging it under the water in the bowl

38. Lubricate the tip of the catheter with water soluable jelly and then check the flow by immersing it in the water. Introduce catheter slowly into one of the nostrils to the previous marked distance. Check the position of the catheter in the or oropharynx at the level of the uvula. Fix the catheter either over the forehead (or) at the cheek with adhesive tape. Secure the connecting tube to the bed clothes or patients gown using an elastic band and a safety pin.

39. Applying a nasal cannula Inspect the patient for signs and symptoms of hypoxia and presence of airway obstruction Explain to client and family , the procedure details and purpose of oxygen therapy Assemble needed supplies and equipments Check the cylinder for working condition. Wash hands Attach nasal cannula to oxygen tubing and attach to humidified oxygen source adjusted to prescribed flow, check the flow by introducing it in the water.

40. Place tips of nasal cannula into clients nares Adjust elastic head band or plastic slide until cannula fits snugly and comfortably Maintain sufficient slack of oxygen tubing and secure to client clothes Check the cannula every 8 hours Keep humidification jar filled at all time Observe clients nares and superior surface of both ear for skin breakdown Wash hands Record in nurses record , method of oxygen delivery, flow rate, patency of oxygen cannula.

41. Applying a face mask After the litre flow is turned on the mask is applied to the patients face. Oxygen mask selected should rest comfortably on the patients face. After care : Stay with the patient till he is at ease Keep the patient warm and comfortable Evaluate the patients progress by observing the vital signs Record the procedure with date and time. Check the apparatus for its working condition

42. Arrange for blood gas analysis at specified interval to make sure the status of anoxemia is treated When the oxygen is to be stopped, do it gradually. Reduce the volume of oxygen supply then give it intermittently To discontinue the oxygen inhalation loosen the adhesives take out the catheter from the nostrils close the main valve, disconnect catheter and put it in kidney tray Replace all the articles Watch the patient for any deteriorating symptoms after the removal of oxygen inhalation.

43. Complication of oxygen therapy Oxygen toxicity : It is a condition which occur due to inspiration of high concentration of oxygen for a prolonged period of time. Oxygen concentration more than 50% over 24 to 48 hours can cause pathological changes in the lungs Retrolental fibroplasia : Blindness due to vasoconstriction & ischemia Absorption atelectasis : During 100% oxygen 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, the alveolus collapses.

44. Moist Inhalation The inhalation of plane steam or with a drug is known as steam inhalation Method : Jug method (Nelsons inhaler is used) Steam tent Electric steam inhaler Drugs used: Plain water Tr.Benzoin , Eucalyptus, Methyl salicylate, Menthol, Camphor.

45. General uses The spout of the inhaler must be placed in such a way that the patient cannot touch it or put his face too near Fill the jug only 2/3 with boiling water. Water should remain below the spout level Have the water in the jug at a moderate temperature (120-160 f) (or) 54.4 to 76.7 c) Keep the patient warm and prevent drought before , during and after the inhalation When voltage group like menthols are used keep his eyes closed to prevent the drug irritating the conjunctiva

46. Watch the patient closely through out the procedure Place sputum cup within the reach of the patient Explain the procedure to the patient Preliminary assessment : Check patients name, bed no, and other identification Check the diagnosis and general condition of the patient Check the physicians order Assess the patients ability for self care Assess the level of consciousness Check the articles available

47. Articles Nelsons inhaler with a mouth piece fitted to the neck of the inhaler Bowl or basin large enough to hold the inhaler A towel Tr , Benzoin or any other inhalant ordered Kettle with boiling water, Gauze piece Cotton swab, kidney tray Acetone or milk of magnesia in a container

48. Preparation of the patient Explain the procedure to the patient Ask the patient to empty bowel and bladder if needed so that he will not be disturbed during the procedure and he will remain on the bed for several hours after the inhalation Place the patient in a fowlers position with a cardiac table Close the door and window and put off the fan to prevent draft Place the sputum cup in a convenient place within the easy reach of the patient Mouth piece should be boiled and cooled before use.

49. Procedure Explain the procedure to the patient Measure the capacity of the inhaler with cold water Warm the inhaler by pouring a little hot water into the jug and emptying it. Pour the required amount of inhalant into the inhaler and fill the jug 2/3 with hot water. The water should remain just below the spout Cover the mouth piece and close the jug tightly see that the mouth piece is in the opposite direction to the spout

50. Cover the jug with towel Cover the mouth piece with a gauze piece and plug the spout with a cotton ball Place the inhaler in the basin and take it to the bedside quickly Place the apparatus conveniently in front of the patient with the spout opposite to the patient . Remove the cotton plug and discard it into the paper bag. Instruct the patient to place the lips on the mouth piece and breath in the vapour . After removing the lips from the mouth piece, breath out the air.

51. After care Continue the treatment for 15-20 min as long as the patients gets vapour Remove the inhaler from the patient after the stated time Remove the backrest and cardiac table. Adjust the position of the patient in bed Instruct hi to remain in bed for 1-2 hours to avoid drafts Replace the articles and record the procedure with date and time Return to the patient to assess his comfort . Offer hot drinks if needed

52. Steam inhalations (or) Aerosol therapy It is the procedure to prevent (or) treat condition of the respiratory tract by adding airborne water particles and possibly by medications Types of medication used for the inhalation Mucolytes Decongestant Bronchodilators Antimicrobial agents moist – Intermittent and continuous Dry – Smelling salts

53. Procedure Check doctor’s prescription including date, time, flow liter/minute and methods. Perform hand hygiene and wear gloves if available. Explain the purpose and procedures to the patient. Assemble equipments .

54. Procedure Prepare the oxygen equipment: 1)Attach the flow meter into the wall outlet or oxygen cylinder 2)Fill humidifier about 1/3 with sterile water or boiled water 3)Blow out dusts from the oxygen cylinder 4)Attach the cannula with the connecting tubing to the adapter on the humidifier

55. Procedure Test flow by setting flow meter at 2-3L/ minute and check the flow on the hand. Adjust the flow meter’s setting to the ordered flow rate. Insert the nasal cannula into client’s nostrils, adjust the tubing behinds the client’s ears and slide the plastic adapter under the client’s chin until he or she is comfortable . Maintain sufficient slack in oxygen tubing

56. Procedure Encourage the client to breathe through the nose rather than the mouth and expire from the mouth Initiate oxygen flow ’s response to oxygen and comfort level. Dispose of gloves if you wore and perform hand hygiene Place “No Smoking” signboard at entry into the room. Document the following: Date, time, method, flow rate, respiratory condition and response to oxygen Sign the chart

57. Nursing Alert After used the nasal cannula, you should cleanse it as follows: 1. Soak the cannula in salvon water for an hour 2. Dry it properly 3. Cleanse the tip of cannula by spirit swab before applying to client

58. Nebulizer Therapy Nebulizer Therapy is to liquefy and remove retained secretions from the respiratory tract. A nebulizer is a device that a stable aerosol of fluid and /or drug particles. Most aerosol medication have broncho dilating effects and are administered by respiratory therapy personnel.

59. Nebulizer Therapy Purpose: 1. To relieve respiratory insufficiency due to bronchospasm 2. To correct the underlying respiratory disorders responsible for bronchospasm

60. ❖ Nursing Alert  Teach the client how to use personnel device. (Rationale: To ensure appropriate self-care after discharge) Avoid treatment immediately before and after meals . ( Rationale: To decrease the chance of vomiting or appetite suppression, especially with medication that cause the client to cough or expectorate or those that are done in conjunction with percussion/ bronchial drainage).

61. Nebulizer Therapy

62. Oxygen toxicity Oxygen toxicity is  lung damage that happens from breathing in too much extra (supplemental) oxygen . It's also called oxygen poisoning. It can cause coughing and trouble breathing. In severe cases it can even cause death.

63. Thank you