Oxygen therapy can be lifesaving but nurses must know how it works, when to use it, and how to correctly assess and evaluate a patient’s treatment Show Abstract Citation: Olive S (2016) Practical procedures: oxygen therapy. Nursing Times; 112: 1/2, 12-14. Author: Sandra Olive, respiratory nurse specialist, Norfolk and Norwich University Hospitals Foundation Trust. When administering oxygen therapy, it is important for the nurse to assess the patient before, during, and after the procedure and document the findings. Prior to initiating oxygen therapy, if conditions warrant, the nurse should briefly obtain a history of respiratory conditions and
collect data regarding current symptoms associated with the patient’s feeling of shortness of breath. The duration of this focused assessment should be modified based on the severity of the patient’s dyspnea. See Table \(\PageIndex{1}\) for focused interview questions related to oxygen therapy. This information is used to customize the oxygen delivery device and flow rate for the patient. For example, supplemental oxygen is typically initiated in nonemergency situations with a nasal cannula at
1-2 liters per minute (L/min), but a patient with a history of chronic obstructive pulmonary disease (COPD) may require a different device such as a Venturi mask.
Objective AssessmentPrior to applying supplemental oxygen, objective data regarding patient status should quickly be obtained such as airway clearance, respiratory rate, pulse oximetry, and lung sounds. Signs of cyanosis in the skin or nail bed assessment should also be noted. Within a few minutes after initiating oxygen administration, the nurse should evaluate for improvement of these indicators, and if no improvement is noted, then additional actions should be taken. At any point, if the nurse feels that the patient’s condition is deteriorating, emergency action should be taken such as calling the rapid response team or 911. Depending upon the severity of patient condition, serial ABG results may also be monitored to determine effectiveness of oxygenation interventions. After oxygen therapy is initiated, it is important to closely monitor for skin breakdown at pressure points. For example, nasal cannula tubing often causes skin breakdown in the nares or over the ears, so protective foam dressings may need to be applied. Life Span ConsiderationsChildrenDifferent sized oxygen equipment is used for infants and children. Additionally, oxygen tubing may need to be secured to a child’s face with tape to prevent them from pulling it off. For infants, the pulse oximeter probe is usually attached to the palm or foot. Older AdultsIf a patient is oxygen-dependent, ensure that extension tubing is applied so the patient is able to reach the bathroom with the oxygen device in place. However, be aware of the increased risk for falls due to the excess tubing. Keeping the oxygen tubing coiled up at the head of the bed or on the bedside table closest to the bathroom will decrease the patient’s risk of falling. Advise the patient to ask for assistance when getting up to use the restroom.
What are the signs and symptoms of oxygen toxicity?Symptoms include pleuritic chest pain, substernal heaviness, coughing, and dyspnea secondary to tracheobronchitis and absorptive atelectasis which can lead to pulmonary edema. Pulmonary symptoms typically abate 4 hours after cessation of exposure in the majority of patients.
Which of the following findings is an indication for oxygen therapy?A nurse should recognize that which of the following is an indication for oxygen therapy? Oxygen therapy is indicated for patients who are at risk for or have developed hypoxia. In the early stages of hypoxia, heart rate rises and arterial oxygen saturation (SaO2) falls below 94%.
How to assess Oxygenation status?Oxygenation may be assessed by clinical assessment, pulse oximetry and arterial blood gases. Pulse oximetry is commonly used to obtain a rapid and continuous assessment of oxygenation. Pulse oximetry measures oxygen saturation, which is the percentage of hemoglobin that is saturated with oxygen [2].
What should a nurse do before administering oxygen?Okay, before administering supplemental oxygen to a client, first assess for signs of hypoxia, such as confusion, difficulty speaking, tachycardia, dyspnea, pallor, or cyanosis. In addition, they may also have an increased rate and depth of respirations, accessory muscle use, and an SpO2 less than 92%.
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