Respiratory Care and Suctioning
Setting Oxygen Flow Rates
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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 contraindications 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.
- When using a plastic face mask with a reservoir bag, inspect it frequently to make sure it is fully inflated. If it is not, the patient will breathe in large amounts of exhaled carbon dioxide.
- If the oxygen flow rate is greater than 4 L/min, use humidification. If the flow rate is less than 4 L/minute, the body’s own humidification system is sufficient.
Equipment
(Roll cursor over items to see labels)
Humidifier
Pulse oximeter
Nasal cannula and tubing
Reservoir nasal cannula (Oxymizer) and tubing
Venturi mask with adapter and tubing
Partial/nonrebreathing mask and tubing
Face tent and tubing
Stethoscope
PrintableDelegation
The skill of setting oxygen flow rates cannot be delegated to nursing assistive personnel (NAP). Before delegating related skills, be sure to inform NAP of the following:
- Review the procedure for safely adjusting the device, such as loosening the strap on an oxygen cannula or mask.
- Instruct NAP to inform you immediately of any change in vital signs or level of consciousness; any skin irritation from the cannula, mask, or straps; or any patient complaints of pain or breathlessness.
Preparation
- Review the patient’s medical record for the medical order for oxygen, noting the delivery method, flow rate, and duration of oxygen therapy.
- Explain the procedure to the patient and family.
- Observe the patient for a patent airway, and remove airway secretions by having the patient cough and expectorate mucous or by suctioning.
- Assess the patient’s respiratory status, including the following:
- Symmetry of chest wall expansion
- Chest wall abnormalities, such as kyphosis
- Temporary conditions that affect the patient’s ventilation, such as pregnancy or trauma
- Respiratory rate and depth
- Sputum production
- Lung sounds
- Signs and symptoms associated with hypoxia
Follow-up
- Use pulse oximetry to monitor the patient’s response to changes in the oxygen flow rate. NOTE: Monitor ABGs when ordered; however, ABG measurement is an invasive procedure and is therefore not frequently ordered.
- Observe the patient for decreased anxiety, improved level of consciousness and cognitive abilities, diminished fatigue, absence of dizziness, decreased respiratory rate, improved color, improved oxygen saturation, and a return to the his or her baseline vital signs.
- Once per shift, assess the adequacy of oxygen flow.
- Observe the patient’s external ears, the bridge of the nose, the nares, and the nasal mucous membranes for evidence of skin breakdown.
Documentation
- Record your respiratory assessment findings, including the following:
- Method of oxygen delivery
- Flow rate
- Patient’s response
- Adverse reactions or side effects
- Changes in the health care provider’s orders
- Report any unexpected outcome to the health care provider or to the nurse in charge.
Review Questions
1. Why is it important for the nurse to set the correct flow rate for a patient to whom oxygen is prescribed?
To provide the correct amount of oxygen to the patient
To ensure the therapeutic effects of oxygen therapy- To prevent any adverse reaction to the prescribed oxygen therapy
- To minimize the risk of combustion during oxygen delivery
CORRECT. The role of the flow regulator is to deliver the amount of oxygen indicated on the regulator.
INCORRECT. Although therapeutic effects are an expected outcome of the therapy, such effects cannot be ensured merely by properly setting the prescribed flow rate.
INCORRECT. Although adverse effects are not an expected outcome of the therapy, such effects cannot be prevented merely by properly setting the prescribed flow rate.
INCORRECT. The risk of combustion cannot be averted merely by properly setting the prescribed flow rate.
2. What would be the nurse’s priority in order to minimize a patient’s risk for injury during oxygen therapy?
- Advising the patient to call for assistance before getting out of bed
- Instructing nursing assistive personnel (NAP) to immediately correct the flow rate if the oxygen regulator is not set as prescribed
- Observing the six rights of medication administration
- Monitoring the patient for signs of hypoxia
INCORRECT. Although a patient should call before getting out of bed, since the oxygen tubing may pose a trip hazard, it is more important for the nurse to ensure that the oxygen is administered correctly.
INCORRECT. The skill of setting and adjusting the oxygen flow rate may not be delegated to NAP.
CORRECT. Oxygen is considered a medication and must be administered following the six rights of medication administration.
INCORRECT. This option is directed toward evaluating the patient’s response to oxygen therapy, not toward minimizing his or her risk for injury.
3. What can the nurse do to evaluate a patient’s response to continuous oxygen therapy delivered at 4 L/min by nasal cannula?
- Regularly measure and trend the patient’s pulse oximetry (SpO2) values.
- Evaluate venous blood levels every morning.
- Monitor the patient’s arterial blood gas (ABG) levels hourly.
- Assess the patient for compliance with the prescribed therapy.
CORRECT. Measuring and analyzing the patient’s pulse oximetry values will provide objective information about the patient’s response to oxygen therapy.
INCORRECT. Arterial blood monitors oxygen levels, therefore monitoring venous blood does not evaluate the patient's response to oxygen therapy.
INCORRECT. ABG levels should not be monitored every hour in a patient who is receiving oxygen at a rate of 4 L/min.
INCORRECT. Assessing the patient’s compliance does not provide data regarding his or her response to oxygen therapy.
4. What should the nurse do when a patient is ordered to receive 4 L/min oxygen by nasal cannula?
- Encourage oral fluids.
- Restrict fluids.
- Ensure that humidification is present.
- Measure blood pressure every hour.
INCORRECT. Fluids need not be encouraged in the patient receiving 4 L/min oxygen by nasal cannula.
INCORRECT. Fluids need not be restricted in the patient receiving 4 L/min oxygen by nasal cannula.
CORRECT. If the oxygen flow rate is 4 L/min or higher, add humidification and verify that water is bubbling in the humidifier.
INCORRECT. Blood pressure need not be measured every hour in a patient receiving 4 L/min oxygen by nasal cannula.
5. What would the nurse monitor frequently to ensure that the prescribed amount of oxygen is being delivered to a patient?
INCORRECT. ABG levels would indicate the patient’s response to oxygen therapy.
CORRECT. The oxygen flow meter setting is directly related to the rate of oxygen delivery.
INCORRECT. Respiratory rate would indicate the patient’s response to oxygen therapy.
INCORRECT. Oxygen delivery has little effect on body temperature.
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