Safety

• Treat oxygen therapy as a medication. Do not substitute oxygen for any other treatment. 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.
• Do not interrupt oxygen therapy during patient transport.
• A plastic face mask with a reservoir bag and a Venturi mask will deliver 60% to 90% oxygen at appropriate flow rates. The reservoir bag of this oxygen mask maintains a high-concentration oxygen supply. Frequently inspect the bag to make sure it is fully inflated. If it is not fully inflated, the patient breathes in large amounts of exhaled carbon dioxide.

Equipment

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Stethoscope

Pulse oximeter

Nasal cannula and tubing

Nonrebreathing mask and tubing

Venturi mask

Face tent

Humidifier set-up for oxygen

Delegation

The skills of initiating and adjusting oxygen flow may not be delegated to nursing assistive personnel (NAP); the nurse is responsible for assessing the patient’s respiratory system and response to oxygen therapy, and for setting up the oxygen delivery device and adjusting the oxygen delivery rate. The skill of applying a nasal cannula or oxygen mask may be delegated to NAP. Be sure to inform NAP of the following:

• Review the procedure for safely adjusting the device, such as loosening the strap on the oxygen cannula or mask.
• Instruct NAP to inform you immediately about any changes in vital signs; changes in level of consciousness; skin irritation from the cannula, mask, or straps; or patient complaints of pain or breathlessness.

Preparation

• Assess the patient’s respiratory status, including the following:
  • Symmetry of chest wall expansion
  • Chest wall abnormalities, such as kyphosis
  • Temporary conditions that can affect ventilation, such as pregnancy or trauma
  • Respiratory rate and depth
  • Sputum production
  • Lung sounds
  • Signs and symptoms associated with hypoxia
• Observe the patient for a patent airway, and remove airway secretions by having the patient cough and expectorate mucous, or by suctioning.
• If available, note the patient’s most recent ABG results or SpO₂ value.
• 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.

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.
• Assess the adequacy of oxygen flow each shift.
• Observe the patient’s external ears, the bridge of the nose, nares, and nasal mucous membranes for evidence of skin breakdown.
• If oxygen therapy continues after discharge, teach the patient and family the importance of and rationale for oxygen therapy, safety precautions for oxygen use, how to use the oxygen delivery device, how to contact the supplier of medical equipment, and when to contact the health care provider.
• Discuss signs of oxygen toxicity that the patient must report to the health care provider, such as confusion, headache, decreased level of consciousness, somnolence, carbon dioxide narcosis, and respiratory arrest.

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 nurse in charge.