Supplemental Oxygen: Fundamentals (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 Hi. Welcome to our video series on the respiratory system. Now on this one, we're going to look at what supplemental oxygen is and who needs oxygen therapy. Okay, so what is supplemental oxygen? Now you see in the picture there you have a patient who's got a mask and the healthcare professional using an ambu bag to deliver breaths. We're not going to get that intense right off the bat, but let's talk about supplemental oxygen or oxygen therapy. It's the use of oxygen as a medical treatment. So don't forget that it's not just air, it's actually a medical treatment.

    00:36 Supplemental oxygen is considered a drug and you have to have it ordered by a healthcare provider. So, it's not just air, it's actually treated as a drug, it must have a specific order.

    00:48 So, why do we use it. Oh you're thinking "duh" because we have to breathe. Right? But some people with breathing disorders just can't get enough oxygen by breathing room air. That's about 21%. So they need some supplemental or additional oxygen. So, oxygen therapy is to help a patient to have adequate oxygen in their bloodstream to be delivered to their tissues.

    01:13 So we've talked about what supplemental oxygen is, why we use it, now we're going to talk about the types of patients who use oxygen. Well someone with a low PaO₂, that's a partial pressure of oxygen in their bloodstream. We get this result from an ABG, an arterial blood gas.

    01:30 So if that PaO₂ is too low, then we'll start the patient on supplemental oxygen. Now if I have a patient who has spontaneous breathing, that means what they do on their own just isn't strong enough, fast enough, or deep enough to supply enough oxygen to their bodies' needs, we'll use supplemental oxygen for them. Now, supplemental oxygen might be for a short period of time like during a hospitalization or while the patient is sedated or until they can recover or someone may need to be on oxygen continuously for life. Now, luckily we have much more portable equipment so a patient can still get pretty mobile and active having to wear oxygen, but if you have to be on it for life it definitely requires some planning. So, overall if I'm thinking about what types of patients use oxygen, anyone with lung disease, somebody who's had trauma to the respiratory system, chronic obstructive pulmonary disease, COPD, pneumonia, asthma, heart failure, cystic fibrosis, or even sleep apnea. So those are just a few of the examples of patients who might require supplemental oxygen. Now I want you to be aware of just some major science of significant respiratory problems. All nurses need to recognize these.

    02:49 If they see these signs, they know they need to take the next step because the patient is heading toward possibly pretty severe respiratory problems. The first one is flaring of the nostrils with breathing. That means their body is really working hard. So if you see nasal flaring or their nostril is flaring, getting bigger that's not a good sign. If you notice their respiratory rate is going up, it's pretty high, it's greater than 24 breaths a minute we call that tachypnea.

    03:19 So for an adult, we're generally looking for rate over 24 a minute. Now why is it a sign of problems. That's the brain telling the body "Whoah not enough oxygen, you need to breathe faster, breathe faster, breathe faster." So that's why a high respiratory rate is a sign of having some respiratory problems. Now unless you just step off a Stairmaster or you got down for a run, if we don't know what the reason is that wasn't for significant exertion, that's when tachypnea becomes a problem. Now, noisy breathing. That's what a patient would call it but you and I would use words like wheezing, stridor, like some moaning (moaning sound) that would tell you "Wow, let's really explore and see if something is not significantly wrong with this patient. Notice the patient using all their accessory muscles for breathing, or using their neck muscles and their arm muscles, just using every muscle they can recreate to breathe. Not a good sign. Do you see them doing pursed lip breathing (sound). Sometimes we teach patients this strategy, other times they just do it naturally particularly with severe COPD patients.

    04:32 Because they have that crazy air trapping, the one that makes our lung tissues so big and guess we'll not barrel chest. We're just as wide as they are deep. Those patients will often purse lip breathe because it helps them get rid of that air that's trapped in their lungs. So, pursed lip breathing allows the patient a longer period of time on the exhale. So their exhale is like twice as long as their inhale or breath in. When they have that extra pressure with pursing their lips like they're blowing out a candle, that will help them empty out their lungs and minimize that extra air hyperinflation. So, Cheyne-Stokes breathing, this one is really an odd one to see because they have experienced back and forth of apnea and then (sound) nothing and then (sound) really really ominous sign. So it's called Cheyne-Stokes breathing. When you see that, periods of apnea may last up to 30 seconds and then they'll kick in and start breathing really rapidly. These are 6 signs that every nurse should know that this patient is having respiratory problems.

    About the Lecture

    The lecture Supplemental Oxygen: Fundamentals (Nursing) by Rhonda Lawes, PhD, RN is from the course Supplemental Oxygen (Nursing).

    Included Quiz Questions

    1. Flaring of nostrils with breathing
    2. Tachypnea
    3. Wheezing, stridor, and moaning
    4. Pursed-lip breathing
    5. Partial pressure of oxygen (PaO2) 80–100 mm Hg
    1. It is a drug and must be ordered by a health care provider.
    2. All clients can benefit from supplemental oxygen.
    3. Supplemental oxygen is not indicated in clients with chronic obstructive pulmonary disease (COPD).
    4. Supplemental oxygen needs to be administered with anesthetics.
    1. Arterial blood gas (ABG)
    2. Hemoglobin
    3. Blood cultures
    4. Complete metabolic panel (CMP)

    Author of lecture Supplemental Oxygen: Fundamentals (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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