Module 12 – Health Conditions -

Assignment

General Direction:

A. The assignment will count for 20% of your final mark in Module 12.

Name: ________________________________________________________

Date: _________________________________________________________

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Oxygen Therapy

Many of the clients you encounter will require the use of oxygen (O2) as part of their treatment.
Oxygen is a gas that is vital to life— without it, tissue cells can die in four to six minutes. With
proper handling and storage techniques, it is a safe and effective therapy.

How is it decided that a client requires oxygen?

Oxygen must be prescribed by a physician and is therefore treated like a drug: the PSW may not
administer Oxygen; however, they may assist clients with their therapy. If the PSW should have
any questions or concerns, they should immediately notify their supervisor.

In order to decide whether or not a client will require Oxygen therapy, several factors must be
considered. The first thing is the client’s oxygen saturation (you might hear this called the “O2
sat”). A special monitor is attached to a client’s finger or toe, and a sensor measures how much
oxygen is in the blood (how much oxygen has saturated the blood). This measurement is read
as a percentage. Most healthy people have an O2 sat in the high nineties to 100 range. Anything
consistently below 90% is usually a sign that the client will need O2 therapy.

Chronic breathing illnesses causing lung damage, like Bronchitis, or COPD (chronic obstructive
pulmonary disease), as well as cigarette smoking, are major causes of low O2 sats. These clients
are usually placed on long-term, continuous O2 therapy.

Sometimes people are admitted to hospital with a breathing crisis, such as pneumonia or
another respiratory infection. Their O2 sat would be low and O2 immediately given. This is not
considered long term therapy because once the crisis is over, their O2 sat should recover and,
therefore, the need for oxygen will be gone.

It is important to remember that every client is different and will be prescribed oxygen therapy
on an individual basis. The PSW’s observations and input regarding the client’s status and how
well they manage their treatment are key factors in the successful use of O2 therapy.

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What is the difference between intermittent and continuous therapy?

Intermittent therapy is used only when the client’s symptoms require it. An example of this
might be when a client becomes short of breath after activity. At rest, they don’t require O2.
However, the activity will increase their need for it.

Continuous therapy is used when clients require O2 24 hours a day. Usually, these clients have
a chronic type of respiratory illness that results in a low O2 saturation. They will generally feel
tired, sluggish, and have a low activity tolerance— all of these should stabilize as treatment
progresses.

Always remember that the client with breathing difficulties may have a tendency to be
somewhat anxious, which can, in turn, increase shortness of breath! Many state they feel like
they’re “suffocating,” or that something bad is going to happen to them. Oxygen therapy can be
very reassuring to them. Support from the PSW is a vital part of the therapy. Helping to keep
calm, staying with them, and making sure they are using the equipment safely are part of the
PSW role.

Who decides how much oxygen a client receives?

Again, because oxygen is considered a drug, the physician not only decides what type of
therapy the client receives, but also how much.

Oxygen is delivered at a specific flow rate. This flow rate is measured in liters per minute
(L/min). All oxygen is turned on, and then the flow meter is dialed to the appropriate number
(e.g. a client is prescribed 2L/min per NP). Clients and family members are instructed on how to
use and regulate the flow meter.

It is important to understand that the PSW’s role is only to assist with this aspect of oxygen
therapy. The PSW should never adjust or prescribe a different flow rate. Many clients and
family members will ask the PSW to do this for a good number of reasons. They might say, “but
I’m so short of breath. If the 2L isn’t helping me, shouldn’t I try the 3L? It’s not much more!” If
the family or PSW has concerns regarding the client’s breathing status, they should notify the
doctor and nursing supervisor immediately.

How is oxygen supplied to the client?

Several different methods are used. In some facilities, there will be a central storage area for
oxygen, and the users simply plug their O2 tubing into a wall outlet. This is not practical in a
smaller facility or in a private home.

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Portable oxygen tanks (cylinders) are an option when your client is mobile. Large tanks are
available for use inside the home/facility. Long, extendable tubing is attached so that the client
may freely move about the area. Caution should be used to avoid tripping over the tubing!

When clients wish to venture to another location outside of the home/facility, smaller, portable
cylinders are available. These cylinders may be moved on a cart or carried in a special carrying
device. They don’t last as long as the larger cylinders, but do give clients the freedom to travel,
keep appointments, and escape the four walls of their home! These small cylinders are also
handy in an emergency situation, or whenever a client is being moved from one area to
another.

It is important to note that the oxygen we have been discussing has been in the form of gas.
Liquid oxygen is also available. Large canisters (similar to tanks) are used to store the cold (-294
degrees F) liquid oxygen. The client and family may be trained to fill smaller, portable canisters
from a larger, main unit. The O2 supplier would be scheduled to refill the main unit on a regular
basis.

Perhaps the most cost-efficient and commonly used system in the community is the oxygen
concentrator. It is an electrical device that takes room air, extracts the oxygen, and delivers it
to the patient. Since it is powered by electricity and is not portable, the client should have an
alternate source of O2 available (such as a canister of O2). The “backup” system could be used in
the event of a power failure, or if they wish to leave the home and must keep their oxygen on.
Lengthy O2 tubing could be attached to the concentrator to allow the client mobility within
their home.

Some clients may be concerned about the added cost of electricity on their monthly hydro bill.
Using the current rate, the cost for one client on 24hr/day O2 concentrator therapy would
amount to approximately $260.00 per year, or approximately $21.60 per month. This can be a
burden to someone who is living on a fixed income. The Assistive Devices Program is designed
to help clients cope with the added financial burden by providing partial or full financial
assistance.

How does the oxygen get from the source to the client?

Before the oxygen reaches the client a couple of things must happen first. Think about the
respiratory system: what happens to the air you breathe before it gets in your lungs? First, the
little hairs in your nose and bronchus filter out many of the microscopic particles of dirt and
other materials. Second, the air is warmed and moistened by passing over the mucous
membranes that line the structures of the respiratory system.

Since we are not using “room air” in most cases, the oxygen the client receives has no real need
to be filtered, because the oxygen concentrator will filter the room air before delivering it to

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the client. However, the oxygen remains very dry and needs to have some humidity added to it.
This procedure is usually done by attaching a humidifier (“water bottle”) to the oxygen source
before the oxygen is sent through the tubing. This way, the client receives oxygen that has
already been moistened.

Note: It is important to remember that even though this “humidity” has been added, O2 can
still be very drying to the client’s mucous membranes. This may result in complaining of a dry
nose, sore nose, nosebleeds, or a dry mouth. It is important that these complaints be listened
to: if we ignore them, the client is less likely to be compliant with their treatment. Dealing with
these problems will be discussed later on in this assignment.

There are two main ways to get the oxygen to the client. The first method is by using a face
mask. This mask should cover both the nose and mouth. Small holes on the sides of the mask
allow CO2 (Carbon dioxide – a waste material from breathing) to escape when the client
breathes out, and room air to enter when the client breathes in.

The face mask has a tendency to be uncomfortable for some clients. Some people find the
pressure from the mask constantly on their skin very bothersome. Others find that having the
mask on their face feels as if they are going to suffocate. The mask will also interfere with a
person’s eating, drinking, and conversation. It is beneficial for clients who are on a high-flow
rate of O2.

In some cases, a special colour-coded plastic device at the base of the tubing will determine the
percentage of O2 that the client receives. This will be ordered by the physician and is not to be
determined by the PSW. The PSW’s role is to follow the client’s normal routine for oxygen use.
If this routine changes, they should notify their supervisor.

The second method used in nasal cannula: these are often referred to as nasal prongs, NP for
short. This is the most widely used method. This device will look like a very long piece of oxygen
tubing with two little “prongs” sticking out. These two prongs will curve slightly and should be
placed in the nostrils (nares) so that the prongs point downward— otherwise, it will be very
uncomfortable and irritating for your client and may hamper the flow of oxygen. The tubing is
then placed behind the ears to hold the prongs in place. A small, sliding plastic “holder” can be
slid up the neck portion of the tubing to secure the prongs in place, much like a hat that fits
under the chin. Some clients prefer the tubing to be placed behind their head, going down their
back: this would be most comfortable for clients who are immobile.

Nasal cannulas allow a great deal more freedom than a mask. A client would be free to wander,
eat, drink, talk, and complete their ADLs. By attaching one or more pieces of extension tubing
to the cannula, you can allow the client to go further distance. Caution should be used with the
use of canes and walkers— you don’t want them to get tangles in the tubing! Tubing may be
pinned or taped to the client’s clothing to keep it free of kinks and from getting in the way.
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Although cannulas are used with lower flow rates of O2, clients may still complain of the drying
effects. They may also complain of irritation from the tubing on the face or behind the ears.
This can be dealt with by gently padding the area with some gauze.

It is important to understand that although clients are prescribed continuous O2 therapy, they
will not die if they go without it for a short while. Many clients will have their face mask or nasal
prongs fall off while they are asleep and not notice until a couple of hours later. Removing the
oxygen while they dress, or bathe is generally not a problem either. Just remember that some
clients get extremely anxious, and the PSW should be there to support and reassure them.

What do I need to know to handle oxygen safely?

The greatest risk that O2 use presents is that of fire. Although O2 itself will not burn, it will help
or accelerate other materials to do so. In fact, a fire will generally not continue without the
presence of oxygen. Listed below are some of the safety measures that can be used by the
client/family/PSW:

1. Any flammable materials and/or heating sources should be kept a minimum of 5-10
feet away from O2 equipment. Such items may include curling irons, heating pads, hair
dryers, electric blankets, and electric razors.

2. Do not attempt to lubricate equipment. Leave this for the professionals! Oil and grease-
based lubricants easily explode. Also, aerosolized sprays often contain particles that can
be dangerous if inhaled by a client with breathing difficulties.

3. Avoid the use of aerosol sprays around oxygen equipment. These cans are under
pressure and can easily explode. Also, aerosolized sprays often contain particles that can
be dangerous if inhaled by a client with breathing difficulties.

4. Petroleum based products should be avoided. These include Vaseline (petroleum jelly),
Nivea cream, or any combination cream that contains petroleum. Clients may wish to
use these products to moisturize areas left dry and irritated by the use of O 2 equipment.
Water based products can be used as safe alternatives: Muko, KY Jelly, or Secaris can be
used inside a dry nose instead of Vaseline. Vaseline Intensive Care Lotion or a similar
product may be used on other areas.

5. Keep all equipment in a well-ventilated area. Doing this will prevent an accumulation of
O2 that could be a fire hazard

6. Liquid oxygen units should always be kept airtight. This will prevent an accumulation of
O2 that could be a fire hazard.

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 7. Oxygen tubing should never be obstructed or “kinked.” Never place the tubing
underneath carpeting, furniture, blankets, or clothing as this may allow O2 to
accumulate, causing a fire hazard.

8. Use caution when transporting O2. The oxygen supply company should be consulted on
how to safely “move” O2 cylinders and tanks: this should be reviewed when the O2
therapy is initiated. The tanks/cylinders should not be stored in an area without
ventilation, such as the trunk of the car.

9. Avoid smoking in the area where the oxygen is being used. Smoking near O2 poses an
EXTREME risk for fire, explosion, or injury. The following are some situations you may
encounter:

a. Client smokes well away from O2 equipment that has been turned off. There is
no real immediate hazard with this, but it is possible that the client may forget to
turn off the O2 at some point. Be sure to notify your supervisor and document
carefully.

b. Client smokes with O2 on. This is EXTREMELY dangerous! If the client is doing
this when you arrive for your visit, you MUST ask them to put out their cigarette,
etc. If they refused your request, you must leave the premises for your own
safety. Your supervisor must be notified IMMEDIATELY!

c. Client who is cognitively impaired and states that they still smoke while they
are on O2 therapy. As long as the client is not doing this while you are visiting, it
is safe for you to stay. However, safety rules should be reviewed with the client
and their family as well as notifying your supervisor.

These guidelines also apply to family members and visitors in the home. It is suggested that if
family or visitors wish to smoke, they do so at least 10 feet from the oxygen— even better
would be to go outside. A warning sign may be obtained from the oxygen supply company and
posted on the door to warn all visitors that oxygen is in use.

When it comes right down to it, oxygen safety is mostly about common sense. If you are ever in
doubt about how to handle a situation, contact your supervisor or even the oxygen supply
company and ask its advice. Educate yourself about safe handling practices and you will be able
to pass their knowledge along to your clients.

This learning package was designed to help you become familiar with the basics of oxygen
therapy. If possible, you should try to get some “hands-on” experience while completing your
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clinical rotation. Be certain to let your instructor and the clinical staff know that you are
interested so they will be on the lookout for learning opportunities for you.

The following pages contain your oxygen therapy assignment and are to be completed outside
of classroom time and handed in on the due date given by your instructor. Please keep this
reading assignment in your notes for future reference.

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Oxygen Therapy Hand-in Assignment /30

1. Define the term oxygen saturation. (1 Mark)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

2. List two causes that can contribute to a low O2 sat reading. (2 Marks)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

3. Define the term “continuous oxygen therapy” and explain why it is beneficial for people
with chronic breathing difficulties. (2 Marks)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

4. Why is humidity added to the oxygen source before it is breathed by the client? (1 Mark)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

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5. You are assigned to Mr. Cy Hendriks to provide assistance with ADLs. This client has
emphysema and there is oxygen equipment in the home. While preparing to assist him
with his morning bath, you notice that he smells of cigarette smoke, although you don’t
notice any cigarettes or ashtrays nearby. How would you proceed with this situation? (3
Marks)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

6. List two possible hazards that occur when clients/family members smoke near oxygen.
Describe two actions the PSW could take to avoid these hazards in the workplace and
ensure their safety as well as the client’s. (4 Marks)

Hazard one______________________________________________________

_______________________________________________________________

Hazard two______________________________________________________

_______________________________________________________________

Actions_________________________________________________________

_______________________________________________________________

7. What is the PSW’s role regarding the client’s use of oxygen therapy? (1 Mark)

_____________________________________________________________________

_____________________________________________________________________

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8. During your home visit with Mrs. Emma Rock, she complains that the nasal cannula she has
been wearing is irritating her cheeks and behind her ears. What are two ways the PSW
could assist her? (2 Marks)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

9. Name two products that should be avoided when a client is using oxygen. For each product
name a safer alternative. (4 Marks)

Product to be avoided Alternative product

10. List three ways that oxygen may be supplied to the client. (3 Marks)

______________________, ____________________, ____________________

11. When clients have dyspnea (difficult or painful breathing), they are often anxious and
upset. What are two interventions the PSW could do to help reduce their anxiety? (2
Marks)

________________________________, _______________________________

12. Name three breathing illnesses that may require the client to use oxygen on either a
temporary or continuous basis. (3 Marks)

____________________, ____________________, _____________________

13. Your client complains he is SOB and asks you, his PSW, to turn their oxygen up “just a bit.”
The oxygen is currently running at the prescribed amount of 3L per minute. How do you
respond to your client? (2 Marks)
_______________________________________________________________

________________________________________________________________

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