Respiratory Care and Suctioning
Ensuring Oxygen Safety
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Take the Review Test:
Safety
- Treat oxygen therapy as a medication. Use it only when indicated, at the flow rate ordered.
- Ensure that the patient has no contraindication to oxygen therapy, such as elevated PaCO2 (hypercarbia), which puts the patient at increased risk for respiratory failure.
- Check all oxygen equipment for safety and function at least once per shift, and monitor more frequently under circumstances in which oxygen concentration can vary, such as when using a hood or a high-flow device.
- Do not interrupt oxygen therapy during patient transport.
- Oxygen is highly combustible; reinforce education regarding the risk of flammability.
Equipment
(Roll cursor over items to see labels)
Oxygen nasal cannula and tubing (oxygen delivery device)
Oxygen flow meter
Oxygen source
"Oxygen in Use" room sign
"No Smoking" room sign
Holder for oxygen cylinder
PrintableDelegation
The skills of respiratory assessment and evaluation of the patient’s response to oxygen therapy cannot be delegated to nursing assistive personnel (NAP). Oxygen is a medication, and medication administration cannot be delegated to NAP. Before delegating related skills, be sure to inform NAP of the following:
- Emphasize the need to follow all safety guidelines.
- Discuss how the oxygen therapy system is set up and the need to report any differences to you.
- Instruct NAP to immediately correct or report any safety hazards.
Preparation
- Review the patient’s medical record for the health care provider’s order for oxygen. Note the delivery method, flow rate, and duration of oxygen therapy.
- Assess the patient’s and family’s or caregiver’s knowledge and understanding of safe oxygen therapy at home.
Follow-up
- Provide education to the patient and family about home oxygen therapy, proper use of the equipment, and the importance of complying with safety measures.
- Teach the patient and family to place an “Oxygen in Use” sign on the door at home and to keep oxygen delivery systems at least 10 feet away from any open flames.
- Evaluate the connection of the tubing to the oxygen device to make sure it is secure.
- Observe the patient for signs of hypoxia or adverse reactions, and report such signs to the physician so that oxygen therapy can be adjusted as needed.
Documentation
- Record the method of oxygen delivery and flow rate.
- Document the patient’s response to oxygen therapy.
- Record the dates of your patient teaching sessions about safe home oxygen therapy. Describe the content covered, and note the patient’s understanding of the safety guidelines presented.
- Document your notification of the health care provider about any signs of hypoxia or adverse reactions. Note any change to oxygen therapy, if prescribed.
Review Questions
1. What would the nurse do first when preparing to begin oxygen therapy for a patient?
Educate the NAP about the oxygen orders.
Review the medical prescription for delivery method and flow rate.- Place a “No Smoking” sign outside of the hospital room.
- Ensure that suction equipment is present in the room.
INCORRECT. The NAP is not able to complete oxygen orders.
CORRECT. The nurse’s initial action when preparing to begin oxygen therapy would be to review the delivery method and flow rate specified on the medical order.
INCORRECT. Smoking is not permitted inside hospitals. This sign would need to be put up at the patient’s home.
INCORRECT. Suction equipment is not needed for oxygen therapy.
2. When preparing the patient’s environment for safe oxygen therapy, which intervention is a priority to minimize the patient’s risk for injury?
- Place appropriate signage to alert staff and visitors to the presence of oxygen in the patient’s room.
- Instruct nursing assistive personnel (NAP) to immediately correct or report safety hazards.
- Inspect all electrical equipment in the patient’s room for the presence of safety-check tags.
- Ensure that the patient receives the prescribed amount of oxygen via the appropriate method.
INCORRECT. Another answer is directly related to environmental safety.
INCORRECT. Another answer has priority regarding environmental safety.
CORRECT. Inspecting electrical equipment would take priority among the other interventions in providing environmental safety.
INCORRECT. This answer does not pertain to environmental safety.
3. When a patient is receiving oxygen at home, which instruction to the family would help them understand how to use the oxygen safely?
- Increase the oxygen level as needed for the patient’s comfort.
- Store extra oxygen cylinders horizontally.
- Place a “No Smoking” sign at the entrance to the house.
- Keep oxygen 5 feet (about 1.5 meters) away from anything that could generate a spark.
INCORRECT. Oxygen may not be increased based on the patient’s comfort.
INCORRECT. Extra cylinders should be stored vertically.
CORRECT. “No Smoking” signs should be placed throughout the house as well as at the entrance.
INCORRECT. Keep oxygen at least 10 feet (about 3 meters) away from anything that could generate a spark.
4. What would the nurse do first when preparing to educate the patient about safe administration of oxygen therapy at home?
- Evaluate the patient’s understanding of the combustible nature of oxygen.
- Arrange for a capable family member to be present during the initial discussion.
- Collect written information to present to the patient as supplemental instructional materials.
- Assess the patients emotional readiness and physical ability to provide autonomous care.
INCORRECT. Information about oxygen’s combustibility will be provided during patient education.
INCORRECT. The nurse might or might not need to arrange for a capable family member to be present during the initial discussion. The patient may be entirely capable of handling the oxygen equipment himself or herself.
INCORRECT. Although written information is a part of patient education, the nurse must first assess the patient’s emotional readiness and physical ability to provide self-care.
CORRECT. The nurse would first assess the patient’s emotional readiness and physical ability to provide self-care, since these attributes are necessary in order to teach a patient effectively about oxygen administration.
5. Which statement by the patient would indicate that he or she understands the safe use of oxygen?
- “The nurse told me that my oxygen saturation must be maintained at 85% or above.”
- “I know that oxygen is a medication I can adjust whenever I need to.”
- “I’ll alert the nurse immediately if I have any increased difficulty breathing.”
- “I often experience difficulty breathing for no apparent reason, but that is expected.”
INCORRECT. Oxygen saturation should be 90% or higher in a patient on oxygen, although the level may vary depending on the patient’s situation and medical history.
INCORRECT. Oxygen is considered to be a medication, but the patient may not adjust it himself or herself. A health care provider must write an order for initiation of oxygen therapy and for any change in oxygen administration thereafter.
CORRECT. The patient should let the nurse know without delay if he or she has increased difficulty breathing.
INCORRECT. The patient should not experience difficulty breathing for no reason; this complaint would need to be reported to the nurse or to the provider.
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