ALERTUse caution in the presence of oxygen. Oxygen is a fire hazard because it lowers the temperature at which materials catch fire in the presence of an ignition source, such as a spark or heat from a light source.undefined#ref5">5 Show
The goal of oxygen use in a prehospital setting is to treat hypoxemia, but excess oxygen use can cause hyperoxia, causing worse outcomes.3 OVERVIEWOxygen is a medication used in and out of the hospital setting. Home oxygen therapy may be short-term or long-term for the patient who is hypoxemic, who has respiratory complications, or who is experiencing activity intolerance. Short-term oxygen therapy may be administered via a nasal cannula or a simple face mask. When a patient has a permanent tracheostomy tube, a T-piece or tracheostomy collar is used for oxygen administration. Oxygen administered directly into the trachea via a tracheostomy tube or transtracheal catheter should be humidified.4 Long-term oxygen therapy is usually administered via an oxygen-conserving device (OCD) (i.e., oxygen concentrator). OCDs reduce the amount of oxygen that the patient uses, enabling the use of a smaller and lighter unit and reducing the overall cost of the therapy.1 There are three types of OCDs.
There are three types of oxygen delivery systems available for home use (Table 1): compressed oxygen cylinders, liquid oxygen systems, and oxygen concentrator systems.2
Home oxygen equipment is designated as durable medical equipment (DME) in the home care setting. When initiating and managing ongoing oxygen therapy, the nurse should collaborate with the patient, practitioner, caregiver(s), family, DME supplier, and payer. A patient who requires home oxygen should be given extensive instructions on how to use oxygen therapy efficiently and safely (Box 1). To enhance home safety, an oxygen home risk assessment should be performed, including assessing smoking materials, other fire risks, and the functioning of smoke detectors in the home. EDUCATION
ASSESSMENT AND PREPARATIONAssessment
Preparation
PROCEDURE
MONITORING AND CARE
EXPECTED OUTCOMES
UNEXPECTED OUTCOMES
DOCUMENTATION
PEDIATRIC CONSIDERATIONS
OLDER ADULT CONSIDERATIONS
REFERENCES
ADDITIONAL READINGSAmerican Lung Association. (2020). Oxygen therapy. Retrieved July 22, 2021, from http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/diagnosing-and-treating/supplemental-oxygen.html (Level VII) Adapted from Perry, A.G. and others (Eds.). (2022). Clinical nursing skills & techniques (10th ed.). St. Louis: Elsevier. Elsevier Skills Levels of Evidence
What are the requirements for oxygen administration?Oxygen should be prescribed to achieve a target saturation of 94–98% for most acutely ill patients or 88–92% for those at risk of hypercapnic respiratory failure (tables 1–3). The target saturation should be written (or ringed) on the drug chart (guidance in fig 1).
What would the nurse do first when preparing to begin oxygen therapy for a patient?What would the nurse do first when preparing to begin oxygen therapy for a patient? Review the medical prescription for delivery method and flow rate.
What is the most appropriate method for oxygen delivery?Low Flow Administration
This is the most common method of delivery for home use and provides flow rates of 2 to 6 liters per minute (LPM) comfortably, allowing the delivery of oxygen while maintaining the patient's ability to utilize his or her mouth to talk, eat, etc.
Why do you have to be careful with giving oxygen to a person with COPD?For patients with COPD, insufficient respiratory effort and/or inadequate alveolar ventilation, in a setting of uncontrolled oxygen delivery (where the precise Fio2 is unknown) can result in dangerous levels of both oxygen and carbon dioxide.
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