OXYGEN THERAPY

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OXYGEN THERAPY
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INTRODACTION 

• Oxygen is an odorless, tasteless,
  colorless, and transparent gas .That is slightly
  heavier than air. Because oxygen supports
  combustion, there is always danger of fire, when
  oxygen is being used, oxygen can be dispensed
  from a cylinder, piped in system, liquid oxygen
  reservoir or oxygen concentrated .

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What is oxygen therapy?

• Providing a adequate oxygen in
  the blood , while decreasing the work of
  breathing and reducing stress in the myocardium.

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Indications  Oxygen relievesa-Hypoxemia.b
-Hypoxia.
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 Early use of oxygen therapy

• It may prevent of the development of -
• 1- Cyanosis late sign .
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• 2- Labored breathing indicate
  sever respiratory distress .
•   3- Myocardial stress increase the
  heart rate and stroke volume (cardiac output) is
  the primary mechanism for the compensation for
  hypoxemia and hypoxia .

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Oxygen delivery system

Oxygen may be
administered by nasal cannula, various types of
masks, head box, tent, catheter, T-piece. It also
applied directly to the endotracheal tube via
mechanical ventilator .The method selected
depends on the required concentration of
oxygen.      
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Nursing actions 1-   Determined the current
vital signs ,level of consciousness,and most
recent ABGs 2-   Check the vital signs 3-  
Assess risk for co2 retention with o2
administration 4-   Make sure that the humidifier
that is filled to the appropriate
mark 5-   Set the flow rate at prescribed liter
per minute . 6-   Feel to determine if oxygen is
flowing.    
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  -Assess the patient conditions ABGs or Po2
and the functioning of the equipments at regular
intervals. 8- Determine patient comfort with
oxygen use . 9- Remove mucus or saliva from
the o2 device. 10- Monitor closely to ensure an
accurate floe arte for specific Fio2.  
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  Administering oxygen by CPAP(continuous
positive airway pressure)   1-Nasal
CPAP. 2-Endotracheal CPAP.  
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• Nasal CPAP It consists of a single
  nasopharengeal tube that deliveries 2-8 cm of
  positive pressure with or without o2.
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• Nursing care
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• - Frequent suction .
• - Tube care.
• - Change the nasal tube.

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• Endotracheal CPAP Positive pressure delivering
  via an ETT.
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• Nursing care
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• - Use sterile suctioning techniques
• - Mouth care
• - Change the ETT every seven days .

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  Mechanical ventilation   Objectives To
provide for the safe and efficient care of stable
neonate requiring mechanical ventilation.   Types
of ventilations 1- Pressure cycle
ventilator 2- Time cycle ventilator 3- Volume
cycle ventilator 4- Micro processor ventilator.
 
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Modes of ventilations   1- Controlled 2-
Assist controlled 3- Synchronized intermittent
mandatory ventilation(SIMV)
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• Ventilator controls and settings
• - Tidal volume.
• - Rate .
• - Fraction of inspired oxygen(FIO2)
• - Peak airway inspiratory pressure (PIP)
• - Continuous positive airway pressure (CPAP)
• - positive end expiratory pressure (PEEP).

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• Indications for mechanical ventilations
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•  Pao2 less than 50 mmHg with fio2 more than 0.60.
• Pao2 more than 50 mmHg with ph less than 7.25.
• Vital capacity less than 2 times tidal volume.
• Negative inspiratory force less than 25 cm H2O.
• Respiratory rate more than 35 per minute.

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Complications of Mechanical ventilator   1-
Air way obstruction(thickened secretions,
mechanical problems with artificial airway or
ventilator circutory. 2- Tracheal damage 3-
pulmonary infection 4- Barotrauma (pneumothorax
or tension pneumothorax)
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5- Decrease cardiac output. 6-
Atelectasis. 7- Alteration in
GI(dilation,bleeding). 8- Alteration in renal
function. 9- Alteration in cognitive perceptual
status
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• Nursing actions
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• -Immediately after intubation
• -Check symmetry of chest expansion .
• -Auscultate breath sounds anterior and lateral
  chest bilateral .
• -Obtain order for chest x-ray .

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• Ensure high humidity.
• Administer O2 concentration as prescribed.
• Secure the tube to the patient face with tape and
  mark.
• Use sterile suction technique.
• - positioning every 2 hrs.

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• Extubation
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• - Explain the procedure
• - Ambo bag and mask ready in case ventilatory
  assistance .
• - Suction the tracheobonchial tree and
  oropharynges
• - Give oxygen for few breaths and insert new
  nasal cannula or catheter .

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• Normal blood gas value
• PH 7.35-7.45
• PCO2 35-45 mmHg
• HCO3 22-27meq/liter
• PO2 80-100

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• Analysis Arterial Blood Gas results
• If you can remember the following pyramid points
  and steps, you will be able to analyze any blood
  gas report.
• Pyramid points
• In acidosis, the PH is down.
• In alkalosis, the PH is high.
• The respiratory function indicator is the PCO2.
• The metabolic function indicator is the HCO3

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Pyramid steps Pyramid step 1- look
at the blood gas report. Look at the PH, is it up
or down if it is up it reflects alkalosis. If
it is down it reflects acidosis.
Pyramid step 2- look at the PCO2, is it up
or down if it reflects an opposite response to
the PH, then you know that the condition is a
respiratory imbalance.
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If it does not reflect an opposite response to
the PH then move on to pyramid step 3.
Pyramid step 3- look at the HCO3. Does the
HCO3 reflect a corresponding response with the
PH if it does, then the condition is a metabolic
imbalance. Pyramid step 4-
Remember, compensation has occurred if the PH is
in a normal range of 7.35-7.45. If the PH is not
within normal range, look at the respiratory or
metabolic function indicators.
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• Respiratory Imbalances
• if the condition is a respiratory imbalance
  look at the HCO3 to determine the state of
  compensation.
• if the HCO3 is normal, then the condition is
  uncompensated.
• if the HCO3 is abnormal, then the condition is
  partial compensation.

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• Metabolic Imbalance
• If the condition is metabolic imbalance, look
  at the PCO2 to determine the state of
  compensation.
• If the PCO2 is normal, then the condition is
  uncompensated.
• If the PCO2 is abnormal, then the is partial
  compensation.