A nurse is caring for a client who is receiving oxygen therapy via a nasal cannula

• PMID: 10670374

Clinical Trial

Oxygen therapy for children. Need-based preparation and evaluation of a self-instructional module for staff nurses on care of a child receiving oxygen therapy

A Machado et al. Nurs J India. 1998 Jun.

Abstract

The present study was carried out with the objectives of determining the learning needs of Staff Nurses regarding care of children receiving Oxygen Therapy; finding association between learning needs and selected variables: age, total years of experience, experience in Paediatric Ward, married with or without children; determining validity of self-instructional module, on "care of child receiving Oxygen Therapy", and evaluating the effectiveness of the self-instructional module or SIM. The study was conducted in two phases. A survey approach was used for Phase-I and one group pre-test post-test design was adopted for Phase-II. The total sample of the study was 30 Staff Nurses, of 6 months experience in Paediatric Ward. The findings of the study showed high learning need status in most of the areas and the Staff Nurses also expressed the desirable need for learning in detail. It was found that age, total years of experience, experience in Paediatric Ward and married with or without children were independent of their learning need. SIM was effective in terms of gain in knowledge score as well as acceptability and utility scores of Staff Nurses.

Similar articles

• The effects of specific educational preparation on emergency nurses' clinical decisions regarding supplemental oxygen administration.

  Considine J, Botti M, Thomas S. Considine J, et al. Nurs Health Sci. 2006 Jun;8(2):73-80. doi: 10.1111/j.1442-2018.2006.00252.x. Nurs Health Sci. 2006. PMID: 16764558

• Developing an E-learning education programme for staff nurses: processes and outcomes.

  Chang WY, Hsiao Sheen ST, Chang PC, Lee PH. Chang WY, et al. Nurse Educ Today. 2008 Oct;28(7):822-8. doi: 10.1016/j.nedt.2008.02.003. Epub 2008 Apr 1. Nurse Educ Today. 2008. PMID: 18384917

• Effect of a self-directed learning package on emergency nurses' knowledge of assessment of oxygenation and use of supplemental oxygen.

  Considine J, Botti M, Thomas S. Considine J, et al. Nurs Health Sci. 2005 Sep;7(3):199-208. doi: 10.1111/j.1442-2018.2005.00236.x. Nurs Health Sci. 2005. PMID: 16083483

• The design of a hemodialysis nursing orientation program.

  Ludlow V, Gaudine A, Jacobs M. Ludlow V, et al. CANNT J. 2007 Apr-Jun;17(2):44-7. CANNT J. 2007. PMID: 17691710 Review.

• The educational preparation of nursing staff undertaking pre-assessment of surgical patients--a discussion of the issues.

  Ormrod G, Casey D. Ormrod G, et al. Nurse Educ Today. 2004 May;24(4):256-62. doi: 10.1016/j.nedt.2004.01.005. Nurse Educ Today. 2004. PMID: 15110434 Review.

Publication types

MeSH terms

LinkOut - more resources

• Medical

  • MedlinePlus Health Information

Purpose

1. Deliver low to moderate levels of oxygen to relieve hypoxia.

Assessment/Preparation

• Assess respiratory status (i.e., breath sounds, respiratory rate and depth, presence of sputum, arterial blood gases if available).
• Assess past medical history, noting chronic obstructive pulmonary disease (COPD). For clients with COPD, hypoxemia is often the stimulus to breathe because they chronically have high blood levels of carbon dioxide. If additional oxygen is needed, a low-flow system is essential to maintain slight hypoxemia so breathing is stimulated.
• Assess for clinical signs and symptoms of hypoxia: anxiety, decreased level of consciousness, inability to concentrate, fatigue, dizziness, cardiac dysrhythmias, pallor or cyanosis, dyspnea.

Equipment

• Oxygen source
• Flowmeter
• "No smoking" sign
• Humidifier and distilled water (for high-flow O2 therapy)

Procedure

1. Review chart for physician's order for oxygen to ensure that it includes method of delivery, flow rate, titration orders; identify client.

   Rationale: Prevents potential errors.

2. Wash your hands.

   Rationale: Handwashing reduces transmission of microorganisms.

3. Identify client and proceed with 5 rights of medication administration (Fig. 1). Explain procedure to client. Explain that oxygen will ease dyspnea or discomfort, and inform client concerning safety precautions associated with oxygen use. Encourage him or her to breathe through the nose.

   Rationale: Oxygen is a drug and administering using the 5 rights avoids potential errors. Teaching helps ensure compliance with therapy.

Fig. 1: Check client's identification against physician's order.

4. Assist client to semi- or high Fowler's position, if tolerated.

   Rationale: These positions facilitate optimal lung expansion.

5. Insert flowmeter into wall outlet (Fig. 2). Attach oxygen tubing to nozzle on flowmeter. If using a high O2 flow, attach humidifier (Fig. 3). Attach oxygen tubing to humidifier (Fig. 4).

   Rationale: Oxygen in high concentrations can be drying to the mucosa.

Fig. 2: Insert flow meter into wall unit.

Fig. 3: Attach humidifier to flow meter.

Fig. 4: Attach oxygen tubing to humidifier.

6. Turn on the oxygen at the prescribed rate (Fig. 5). Check that oxygen is flowing through tubing (Fig. 6).

   Rationale: Oxygen must be administered as prescribed.

Fig. 5: Set oxygen to prescribed rate.

Fig. 6: Ensure the oxygen is flowing through the tubing.

7. Hold nasal cannula in proper position with prongs curving downward (Fig. 7).

Fig. 7: Properly position nasal cannula with prongs curving downward.

8. Place cannula prongs into nares (Fig. 8).

Fig. 8: Place cannula prongs into nares.

9. Wrap tubing over and behind ears (Fig. 9).

Fig. 9: Wrap tubing around ears.

10. Adjust plastic slide under chin until cannula fits snugly (Fig. 10).

Fig. 10: Adjust plastic slide under chin until cannula fits snugly.

11. Place gauze at ear beneath tubing as necessary (Fig. 11).

    Rationale: Proper placement in nares ensures accurate administration. Note: The cannula permits some freedom of movement and does not interfere with the client's ability to eat or talk.

Fig. 11: Place gauze at ear to reduce irritation and promote comfort.

12. If prongs dislodge from nares, replace promptly.

    Rationale: To ensure correct oxygen delivery and prevent hypoxemia.

13. Assess for proper functioning of equipment and observe client's initial response to therapy.

    Rationale: Assessment of vital signs, oxygen saturation, color, breathing pattern, and orientation helps the nurse evaluate effectiveness of therapy and detect clinical evidence of hypoxia.

14. Monitor continuous therapy by assessing for pressure areas on the skin and nares every 2 hours and rechecking flow rate every 4 to 8 hours.

    Rationale: Permit early detection of skin breakdown or inadequate flow rate.

Lifespan Considerations

Infant and Child

• Isolettes (incubators) and tents may be used for administering oxygen and humidity to infants and newborns. It is difficult to maintain high concentrations of oxygen in an isolette or tent, but it is nonintrusive and nonirritating.
• Plan nursing care so tent or isolette is entered as little as possible to prevent oxygen levels from dropping.
• Children frightened by the oxygen tent may feel more secure with their favorite toy or blanket.

Home Care Modifications

• In-home oxygen supply is delivered by cylinders, liquid oxygen, or oxygen concentrators. Portable oxygen systems are available to increase independence and social activities.
• Equipment vendor and home care nurse should instruct client on how to use home oxygen equipment and how often the equipment must be filled.
• Instruct the client and family about the importance of not smoking in the area of oxygen use.
• The client should be informed about using an oxygen vendor whose services include:
  • Trained personnel to instruct the client in use and maintenance of the equipment
  • 24-hour emergency service
  • Monthly follow-up visits for equipment maintenance and client instruction
  • Vendor insurance billing
• Needing oxygen at home can be stressful for the client. Clients should be encouraged to share their fears and concerns. A local support group of clients using home oxygen may help them to discuss their feelings.
• For insurance to cover home oxygen, clients must have oxygen saturation below 88% to 90% on room air.

How often should the nurse assess oxygen settings and connections?

What nursing considerations should be made when delivering oxygen?

Which factors should be taken into consideration when determining the type of oxygen delivery system to be used for a patient?

When should you not give oxygen therapy?