VII.
INTRAVENOUS FLUIDS (IVF)
Types:
Isotonic
● 0.9% NaCl (NSS)
● D5W
● Lactated Ringer’s
● ringer's solution
Hypotonic
● 0.45% NaCl
● 0.33% NaCl
● 0.225% NaCl
● 2.5% Dextrose in Water
Hypertonic
● 3% or 5% NaCl
● D10W, D20W, D50W
● D5NSS, D5LRS
Oxygen Therapy - process of administering supplemental oxygen with high concentration than that of
atmospheric air
Purpose:
● To relieve dyspnea
● To prevent hypoxemia and hypoxia
● To increase oxygenation in tissues
Indication for oxygen administration
● Severe respiratory distress
● Intra and post operatively
● Hypoxia and hypoxemia
● Shock
● Severe trauma
● Acute myocardial infarction
Different types or routes of oxygen administration
● Nasal
● Mask
● Cannul
● Tent
Parts of an oxygen tank:
1. Oxygen tank
2. Oxygen gauge
3. Flow control valve
4. Flow rate
5. Humidifier bottle
6. Cannula tubing
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Wall Outlet Oxygen
Nasal Catheter
● Also known as oropharyngeal catheter
● Another efficient means for administering oxygen but is not frequently used because
it is uncomfortable for patient and may cause trauma to respiratory mucous
membrane
● It is the introduction of oxygen through oropharynx by the means of a soft rubber
tube with hole at the end
● Inserted into the nose through one nostril, with the end of the catheter resting in the
oropharynx
Nasal Cannula
● Also called nasal prongs
● The most common oxygen delivery device
● Introduction of oxygen through the oropharynx by means of a soft rubber tube with hole at
the end
● Consist of rubber or plastic tube that extends around the face
○ 0.6-1.3cm 91/4-½ inch curved prongs that fit into the nostril
Face Masks
● Covers the client's nose and mouth for oxygen inhalation
● The mask is fitted carefully to the patient's face to avoid leakage of oxygen and should be
comfortably snug but not tight against the face
● Some have metal clip that can be bent over the bridge of the nose to snug fit
● There are several holes in the sides of the mask (exhalation ports) to allow escape of
exhaled carbon dioxide
OBJECTIVES
1. To administer oxygen to treat dyspnea by means of nasal catheter
2. To deliver a relatively low flow concentration of oxygen when only minimal oxygen support is
required.
3. To allow uninteresting delivery of oxygen while the client ingests food or fluid
4. To provide moderate oxygen support and a higher concentration of oxygen and or humidity
than is provided by cannula.
Equipment needed:
● Oxygen supply
● No smoking sign
● Humidifier - with sterile distilled water or according to agency protocol
ADDITIONAL EQUIPMENT:
a. CATHETER
i. Nasal Catheter
■ CHILDREN - FRENCH NO. 8-10
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■ ADULT - FRENCH 12-14
ii. Tounge depressor
iii. Flashlight
iv. Safety pin
v. Plaster
b. CANNULA
i. Nasal Cannula and Tubing
ii. Tape
iii. Gauze
c. FACE MASK
i. Prescribed face mask fit for patient
ii. Padding for the elastic band
METHOD Amount dlivered FiO2
Low flow
Simple mask 6-10L/min = 35%-60%
(5L/min setting)
Partial Rebreather Mask low flow 6-15 L/min= 70%- 90%
Non Rebreather Mask low flow 6-15 L/min= 60%-100%
High flow
Venturi 4-10 L/min= 24%- 55%
Additionall information:
OXYGEN TENTS
● commonly used for children
● consist of rectangular clear, plastic canopy with outlets that connect to an oxygen or
compressed air source and to a humidifier that moisturize the air or oxygen
CROUPETTE
● Consists of a nebulizer with attached tubing that connects with a canopy to enclose the
patient and contain the humidifying mist.
STEPS RATIONALE
1. Determine the need for oxygen -respiratory assessment is done to
therapy and verify the order of determine the need for oxygen therapy and
therapy to develop baseline data if not already
available
-oxygen may be administered without the
doctor's order in cases of emergency
2.Prepare the client and support persons
by:
a. Assisting the client to a
semi-fowler's position if possible
b. Explaining that the oxygen is not -The position permits easier chest
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dangerous when safety expansion, hence, easier breathing
precautions are observed and it
will ease the discomfort of dyspnea -Inform client and support persons about the
safety precautions connected with oxygen
use.
3. Set up the oxygen equipment and
humidifier:
a. Attach the flow meter to the
oxygen outlet, exerting firm -The humidifier is filled with distilled water up
pressure. The flow meter should to the level mark.
be in off position
b. Fill the humidifier bottle with -If there is no level mark, fill the humidifier
distilled/tap water in accordance half full.
with agency protocol. (This can be
done before coming to the
bedside.)
c. Attach the humidifier bottle to the
base of the flow meter.
d. Attach the prescribed oxygen
tubing and deliver the device to the
humidifier.
4. Turn on the oxygen at the prescribed
rate and ensure proper functioning.
a. Check that oxygen is flowing freely -This can be done by placing the catheters,
through the tubing. There should near your face or on the dorsum of the hand
be no kinks in the tubing and to check flow of oxygen.
connection should be airtight.
There should be bubbles in the
humidifier as the oxygen flows
through the water. You should feel
the oxygen at the outlets of the
cannula
b. Set the oxygen at the flow rate -Excessive administration of oxygen can
ordered, for example 2-6 LPM cause oxygen narcosis
(respiratory alkalosis)
5. Apply the appropriate oxygen delivery
device:
a. Nasal catheter
i. Measure the length of the
catheter to be inserted by
holding it horizontally from
the tip of the nose to the
earlobe.
ii. Moisten the tip of the
catheter with water to
facilitate easy passage of
the catheter.
iii. Elevate the tip of the nose
gently until the mark on
the catheter is reached.
iv. Check if the catheter is in -The catheter should be behind the uvula.
the right position by
depressing the tongue.
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Use the flashlight for better
visualization.
v. Fasten the catheter to the -Pin the connecting tube on the pillowcase
side of the patient's face or back of the mattress. Some models have
and drape it over his ear. a strap to adjust under the chin.
b. Nasal Cannula
i. Put the cannula over the
client's face, with the outlet
prongs fitting into the
nares and the elastic band
around the head.
ii. If the cannula will not stay
in place, tape it at the
sides of the face.
iii. Slip gauze pads under the
tubing over the
checkbones
c. Face Mask
i. Place the mask toward the -to prevent skin irritation
client's face and apply it
from the nose downward.
ii. Apply the mask making -The mask should mold to the face, so that
sure that it fits the contour very little oxygen escapes into the eyes and
of the client's face around the cheeks.
iii. Secure the elastic band
around the client's head so
that the mask is
comfortable but snug.
iv. Pad the band behind the
ears and over the bony
prominences
6. Make the client comfortable
7. Fill out oxygen slip taped to oxygen
tank
8. Assess the client regularly
a. Assess the client's level of anxiety,
color and ease respirations ans
provide support while the client
adjusts to the cannula -Assess vital signs, color, breathing patterns
b. Assess the client in 15-30 and chest movements
minutes, depending on the client's
condition and regularly thereafter
c. Assess the client regularly for -Obtain arterial blood gas results, if they are
signs of hypoxia, tachycardia, available
confusion, dyspnea restlessness
and cyanosis
Nasal Catheter
d. Assess the client's nares for
encrustations and irritations. NOTE:
Change the catheter every 8 hours as
Apply a water-soluble lubricant as required. necessary. Water soothes the mucous
membrane.
Face Mask
e. Inspect the facial skin frequently
for dampness or chafing, dryness
and treat it as needed.
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9. Inspect the equipment on a regular
basis
a. Check the liter flow and the level of
water in the humidifier in 30
minutes and whenever providing
care to the client.
b. Maintain the level of water in the -empty humidifier, rinse and fill with distilled
humidifier or tap water every 24 hours
c. Make sure that safety precautions
are being followed
10. Document relevant data. Record tge
initiation of the therapy and all nursing
assessments.
PULSE OXIMETRY
● A non invasive technique that measures the oxygen saturation (SpO2) of arterial blood
● Useful for monitoring patient receiving oxygen therapy, those at risk for hypoxia, and
post-operative patients
● Normal range: 95% - 100%
● If there is lack of oxygen in the blood, that means your body tissues will not be oxygenated
properly and can be hazardous to your health.
Equipments:
1. Oximeter
2. Oximeter probe appropriate for client
3. Acetone or nail polish remover
4. Gloves (optional)
Procedure:
● Check doctor's order
● Explain the procedure to the client
● Obtain equipment
● Assess potential sensor for quality or circulation, edema, tremor, restlessness, nail polish or
artificial nails
● Review the medical history for data indicating vascular or other pathology, such as anemia or
carbon monoxide inhalation
● Checked prescribed medications for vasoconstrictive effects.
● Determine how much the client understands about pulse oximetry,
● Wash hands or perform hand antisepsis with alcohol.
● Position the sensor so that the light emission is directly opposite the sensor.
● Attach the sensor cable to the machine. Observe the numeric display, audible sounds &
waveform on the machine.
● Set the alarms for saturation level and pulse rate according to the manufacturer’s directions.
● Move an adhesive finger sensor if the finger becomes pale, swollen, or cold: remove and
reapply a spring-tension every 2 hours.
● Document the following:
a. Abnormal oxygen saturation measurements when they are sustained.
b. Nursing measures to improve oxygenation if oxygen saturation levels fall below 90%
& are prolonged.
c. Removal & relocation of sensor.
d. Condition of skin at sensor site.
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NOTE:
Sites where sensor is best applied:
1. Finger
2. Toe
3. Earlobe
4. Bridge of the nose
Normal Value of SpO2: 95% - 100%
PAI - PULMONARY AID INHALATION
Inhalation - any drug or solutions of drug administered by nasal or oral respiratory route.
Nebulizers - is used to deliver a fine spray (fog or mist) of medication or moisture to a client. There
are two kinds of nebulization: atomization and aerosolization.
Nebulization - is the process of medication administration via inhalation. It utilizes a nebulizer which
transports medications to the lungs by means of mist inhalation.
INDICATION:
Nebulization therapy is used to deliver medications along the respiratory
tract and is indicated to various respiratory problems and diseases such
as:
1. Bronchospasms
2. Chest tightness
3. Excessive and thick mucus secretions
4. Respiratory congestions
5. Pneumonia
6. Atelectasis
7. Asthma
CONTRAINDICATION:
In some cases, nebulization is restricted or avoided due to possible untoward results or rather
decreased effectiveness such as:
1. Patients with unstable and increased blood pressure
2. Individuals with cardiac irritability (may result to dysrhythmias)
3. Persons with increased pulses
4. Unconscious patients (inhalation may be done via mask but the therapeutic effect may
be significantly low)
EQUIPMENT:
● Nebulizer and nebulizer connecting tubes
● Compressor oxygen tank
● Mouthpiece/mask
● Respiratory medication to be administered
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● Normal saline solution
PROCEDURE
1. Position the patient appropriately, allowing optimal ventilation.
2. Assess and record breath sounds, respiratory status, pulse rate and other significant
respiratory functions.
3. Teach patient the proper way of inhalation:
a. Slow inhalation through the mouth via the mouthpiece
b. Short pause after the inspiration
c. Slow and complete exhalation
d. Some resting breaths before another deep inhalation
4. Prepare equipments at hand
5. Check doctor’s orders for the medication, prepare thereafter.
6. Place the medication in the nebulizer while adding the amount of saline solution ordered.
7. Attach the nebulizer to the compressed gas source
8. Attach the connecting tubes and mouthpiece to the nebulizer
9. Turn the machine on (notice the mist produced by the nebulizer)
10. Offer the nebulizer to the patient, offer assistance until he is able to perform proper inhalation
(if unable to hold the nebulizer [pediatric/geriatric/special cases] replace the mouthpiece with
mask
11. Continue until medication is consumed
12. Reassess patient status from breath sounds, respiratory status, pulse rate and other
significant respiratory functions needed. Compare and record significant changes and
improvements. Refer if necessary
13. Attend to possible side effects and inhalation reactions
NURSING RESPONSIBILITY
As nurses, it is important that we teach the patients the proper way
of doing the therapy to facilitate effective results and prevent
complications (demonstration is very useful). Emphasize compliance
to therapy and to report untoward symptoms immediately for
opposite intervention.
Suctioning
● Aspirating secretions through a catheter connected to a suction machine or wall suction
outlet.
● Even though the upper airways (the oropharynx and nasopharynx) are not sterile, sterile
technique is recommended for all suctioning to avoid introducing pathogens into the airway.
Purpose
● To remove secretions that obstruct the airway
● To facilitate ventilation
● To obtain secretions for diagnostic purposes
● To prevent infection that may result from accumulated secretions
Indication
a. Patient feels/ indicates the presence of secretions in his / her airway
b. Deteriorating arterial blood gas values
c. Altered chest movements
d. Restlessness
e. Decreased oxygen saturation levels
f. Diminished air entry
g. Change of color
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h. Tachypnea
i. Suction is indicated for visible or audible airway secretion,
