Care of Client With Oxygenation Problem: SEPTEMBER 9-10,2021

CARE OF CLIENT WITH
OXYGENATION
PROBLEM
SEPTEMBER 9-10,2021
CARE OF CLIENT WITH OXYGENATION PROBLEM
Oxygen is required by all tissues to support

cell metabolism; in acute illness, low tissue
oxygenation (hypoxia) can occur due to a
failure in any of the systems that deliver and
circulate oxygen
CARE OF CLIENT WITH OXYGENATION
PROBLEM
• Hypoxia is an indication to start oxygen therapy; this can be a life-
saving intervention, but given without appropriate assessment
and ongoing evaluation, it can also be detrimental to patients’ health
(Ridler et al, 2014).
Oxygen treatment
• When used as a medical treatment, oxygen is regarded as a drug and must

be prescribed. In 2008, the British Thoracic Society produced guidelines for
its use with acutely unwell adult patients (O’Driscoll et al, 2008). This was
endorsed by 21 professional groups across a wide range of professions and
specialties.
• The guidelines recommend:
• Administering oxygen to treat hypoxaemia (low blood oxygen levels);
• Prescribing a target oxygen saturation range to guide therapeutic treatment.
• Oxygen does not treat breathlessness in the absence of hypoxaemia
(O’Driscoll et al, 2008).
Oxygen treatment
• In an emergency situation, immediate assessment of airway patency,
breathing and circulation is essential, and in critical illness such as
peri-arrest, high-concentration oxygen should be commenced via
reservoir mask at 10-15L/min if the patient is hypoxic, with
continuous monitoring of pulse oximetry and prescription of an
appropriate target range once the patient’s condition is stabilized
(Resuscitation Council (UK), 2015).
Oxygen treatment
• The target saturation range is prescribed according to the risk of type
2 (hypercapnic) respiratory failure pending arterial blood gas
measurement. For most patients, a target of 94-98% is appropriate.
For those at risk of carbon dioxide retention (hypercapnia), a target of
88-92% ensures safe levels of oxygenation and minimizes risk of
respiratory acidosis.
Oxygen treatment
• Those at risk include patients with:
• Chronic obstructive pulmonary disease (emphysema);
• Neuromuscular and chest wall disorders;
• Cystic fibrosis;
• Morbid obesity.
• Pulse oximetry must be available in all settings where emergency
oxygen is used.
Oxygen treatment
• It is essential to:
• Record inspired oxygen (FiO2 -fractional inspired oxygen), delivery
device and oxygen saturations;
• Monitor and document the effect of any changes to administered
oxygen therapy
Delivery devices
• Oxygen is delivered via variable-performance or fixed-performance

devices
Variable-performance devices
• The amount of oxygen delivered by variable-performance devices
(also known as uncontrolled oxygen systems) is dependent on the:
• Oxygen flow rate;
• Patient’s inspiratory volumes;
• Respiratory rate;
• Proportion of room air added during breathing
SIMPLE MASK
• The simple, or “low flow”, face mask is intended for short-term use,
such as post-operative recovery. Oxygen is delivered at 2-10L/min and
supplemented with air drawn into the mask during breathing.
• The FiO2 achieved cannot be predicted as it depends on the rate and
depth of the patient’s breathing. Oxygen flow rates of <5L/min may
result in the patient rebreathing exhaled carbon dioxide, which may
build up in the mask. Simple face masks should not be used for
patients at risk of type 2 respiratory failure
Nasal cannula
• Nasal cannula (Fig 1, attached) are comfortable and well tolerated by most patients.
They do not need to be removed when the patient is talking or eating. Oxygen is
inhaled even when breathing through the mouth. Nasal cannula are useful:
• For patients who are stable;
• To provide supplemental oxygen therapy during meals;
• To provide air-driven nebulised therapy for those requiring controlled oxygen therapy.
• They are commonly used to deliver oxygen in the home setting.
• Flow rates above 4L/min can cause considerable drying of nasal mucosa and are more
difficult to tolerate. The FiO2 achieved varies with the rate and depth of breathing
and, therefore, nasal cannulae should not be used in patients with unstable type 2
respiratory failure.
Fixed-performance devices
• Fixed-performance devices (also known as controlled oxygen delivery systems) deliver a

fixed proportion of air and oxygen via a Venturi valve, ensuring an accurate
concentration of oxygen is delivered, regardless of inspiratory volumes and respiratory
rate (Fig 2, attached).
• Fixed-performance devices should be used in acute illness in patients who are at risk of
carbon dioxide retention.
• Venturi valves (Fig 3, attached) are colour-coded to denote the fixed percentage of
oxygen delivered; these range from 24% (blue) to 60% (green), provided that the
minimum oxygen flow rate on the barrel of the device is given.
• The minimum flow rate varies between oxygen-mask manufacturers, so it is important
to check the minimum rate that is recommended on the device in use.
• If patients are extremely breathless but achieving adequate oxygen saturation rates,
increasing the oxygen flow rate by 50% (for example, increasing from 2L/min to 3L/min)
will increase the gas flow into the mask without increasing the percentage of oxygen
delivered, and may be more comfortable for them
Fixed-
performance
device
Non-rebreather masks are designed to
deliver a lot of extra oxygen to your
airway. The normal fraction of inspired
oxygen (FIO2), or concentration of
oxygen in the air, in any room is about
21%. Non-rebreather masks provide you
with 60% to 91% FIO2. To do this, they
form a seal around your nose and
mouth.
What's the purpose of a non rebreather oxygen mask?
Non-rebreather masks are designed to deliver a lot of
extra oxygen to your airway. The normal fraction of
inspired oxygen (FIO2), or concentration of oxygen in the
air, in any room is about 21%. Non-rebreather masks
provide you with 60% to 91% FIO2. To do this, they form a
seal around your nose and mouth.
• Starting oxygen therapy
• The reservoir bag must be filled with oxygen before use and the mask
posit
• The reservoir bag must be filled with oxygen before use and the mask
positioned to ensure a close fit on the patient’s face. A one-way valve
prevents exhaled air entering the bag.
• Oxygen via a reservoir mask cannot be humidified, and patients will
be more comfortable if they can be maintained within target range on
a humidified system once they are more stable.
Oxygen therapy
• Simple face mask
• The simple, or “low flow”, face mask is intended for short-term use,
such as post-operative recovery. Oxygen is delivered at 2-10L/min and
supplemented with air drawn into the mask during breathing.
• The FiO2 achieved cannot be predicted as it depends on the rate and
depth of the patient’s breathing. Oxygen flow rates of <5L/min may
result in the patient rebreathing exhaled carbon dioxide, which may
build up in the mask. Simple face masks should not be used for
patients at risk of type 2 respiratory failure
Oxygen therapy cont.
• Nasal cannulae
• Nasal cannulae (Fig 1, attached) are comfortable and well tolerated by most patients.
They do not need to be removed when the patient is talking or eating. Oxygen is inhaled
even when breathing through the mouth. Nasal cannulae are useful:
• For patients who are stable;
• To provide supplemental oxygen therapy during meals;
• To provide air-driven nebulised therapy for those requiring controlled oxygen therapy.
• They are commonly used to deliver oxygen in the home setting.
• Flow rates above 4L/min can cause considerable drying of nasal mucosa and are more
difficult to tolerate. The FiO2 achieved varies with the rate and depth of breathing and,
therefore, nasal cannulae should not be used in patients with unstable type 2 respiratory
failure.
Oxygen therapy cont.
• Fixed-performance devices
• Fixed-performance devices (also known as controlled oxygen delivery systems) deliver
a fixed proportion of air and oxygen via a Venturi valve, ensuring an accurate
concentration of oxygen is delivered, regardless of inspiratory volumes and
respiratory rate (Fig 2, attached).
• Fixed-performance devices should be used in acute illness in patients who are at risk
of carbon dioxide retention.
• Venturi valves (Fig 3, attached) are colour-coded to denote the fixed percentage of
oxygen delivered; these range from 24% (blue) to 60% (green), provided that the
minimum oxygen flow rate on the barrel of the device is given.
• The minimum flow rate varies between oxygen-mask manufacturers, so it is
important to check the minimum rate that is recommended on the device in use.

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CARE OF CLIENT WITH

Oxygen is required by all tissues to support

• When used as a medical treatment, oxygen is regarded as a drug and must

• Oxygen is delivered via variable-performance or fixed-performance

• Fixed-performance devices (also known as controlled oxygen delivery systems) deliver a

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