A client is receiving home oxygen. what teaching points

Place cautionary signs reading “No Smoking: Oxygen in Use” on the client’s door, at the foot or head of the bed, and on the oxygen equipment.
Handle and store oxygen cylinders with caution, and strap them securely in wheeled transport devices or stands to prevent possible falls and outlet breakages. Place them away from traffic areas and heaters.
Instruct the client and visitors about the hazard of smoking with oxygen in use. Teach family members and roommates to smoke only outside or in provided smoking rooms away from the client.
Make sure that electric devices (e.g., razors, hearing aids, radios, televisions, and heating pads) are in good working order to prevent the occurrence of short-circuit sparks.
Avoid materials that generate static electricity, such as woolen blankets and synthetic fabrics. Advise clients and caregivers to wear cotton fabrics and use cotton blanket.
Avoid the use of volatile, flammable materials, such as oils, greases, alcohol, ether, and acetone (e.g., nail polish remover), near clients receiving oxygen.

Hold nasal cannula in proper position with prongs curving downward.

Fig. 7: Properly position nasal cannula with prongs curving downward.

Place cannula prongs into nares.

Fig. 8: Place cannula prongs into nares.

Wrap tubing over and behind ears .

Fig. 9: Wrap tubing around ears.

Adjust plastic slide under chin until cannula fits snugly.

Fig. 10: Adjust plastic slide under chin until cannula fits snugly.

Place gauze at ear beneath tubing as necessary (Fig. 11).

Rationale: Proper placement in nares ensures accurate administration. Note: The cannula permits some freedom of movement and does not interfere with the client’s ability to eat or talk.

Fig. 11: Place gauze at ear to reduce irritation and promote comfort.

If prongs dislodge from nares, replace promptly.

Rationale: To ensure correct oxygen delivery and prevent hypoxemia.

Assess for proper functioning of equipment and observe client’s initial response to therapy.

ASSISTING WITH THE USE OF THE OXYGEN CONCENTRATOR

Explain procedure to client.
Wash hands.
Assemble equipment.
Clean air filter.
Wash humidifying bottle, if used.
Check the humidifying bottle to make sure it has an adequate amount of distilled water in it, and the bottle is screwed on tightly, if used.
Attach the air tube, if not on, to the humidifying bottle or oxygen concentrator.
Take and records the client’s pulse and respiratory rate.
Turn on the switch to the oxygen concentrator.
Check that air is bubbling through the humidifying bottle.
Check that air is flowing through the nasal cannula.
Ensure that flow meter is set to appropriate level as noted in the care plan. (REGULATION OF FLOW METER DONE BY AIDE UNDER SPECIAL CIRCUMSTANCES ONLY.)
Assist the client in applying the nasal cannula.
Take and records the client’s pulse and respiratory rate.
Turn off the oxygen concentrator.
Assist the client in removing the nasal cannula.
Wash hands.
Observe for difficulty breathing; rapid pulse and respirations; cold, clammy skin; blue or darkened lips, fingernails, eyelids; client unable to sit still; client does not respond when you call client’s name, has headaches; or complains of no energy.

ASSISTING WITH THE USE OF THE OXYGEN TANK AND LIQUID OXYGEN RESERVOIR

Explain procedure to the client.
Wash hands.
Assemble equipment.
Put on gloves, as necessary.
Check oxygen tank or reservoir gauge to see if there is enough oxygen. Call supplier if not.
Wash humidifying bottle.
Check the humidifying bottle to make sure it has an adequate amount of distilled water in it, and the bottle is screwed on tightly.
Take and record the client’s pulse and respiratory rate.
Turn on the oxygen tank.
Ensure that flow meter is set to appropriate level as noted in the care plan. (REGULATION OF FLOW METER DONE BY AIDE UNDER SPECIAL CIRCUMSTANCES ONLY.)
Check that water in humidifying bottle is bubbling.
Check that air is flowing from the mask or nasal cannula.
Assist the client in applying mask or nasal cannula.
Cannula: prongs go into nose.
Mask: should fit close to face, but not pinch it.
Take and record the client’s pulse and respiratory rate.
Turn oxygen tank off
Turn the flow meter off.
Assist the client in removing the oxygen mask or nasal cannula.
Wash hands.
Observe for difficulty breathing; rapid pulse and respirations; cold, clammy skin; blue or darkened lips, fingernails, eyelids; client unable to sit still, client does not respond when you call his/her name; has headaches; or complains of no energy.
Record the use of the oxygen tank or liquid oxygen reservoir and observations of the client.
Report to supervisor IMMEDIATELY if client has difficulty breathing; has rapid pulse and respirations; has cold, clammy skin; has blue or darkened lips, fingernails, and eyelids; is unable to sit still; does not respond when you call his/her name; has headaches; complains of no energy

Chapter 5. Oxygen Therapy

Oxygen therapy supports life and supports combustion. While there are many benefits to inhaled oxygen, there are also hazards and side effects. Anyone involved in the administration of oxygen should be aware of potential hazards and side effects of this medication. Oxygen should be administered cautiously and according to the safety guidelines listed in Table 5.4.

Table 5.4 Oxygen Safety Guidelines for Home and Hospital

Guideline	Additional Information
Oxygen is a medication.	Remind patient that oxygen is a medication and should not be adjusted without consultation with a physician or respiratory therapist.
Storage of oxygen cylinders	When using oxygen cylinders, store them upright, chained, or in appropriate holders so that they will not fall over.
No smoking	Oxygen supports combustion. No smoking is permitted around any oxygen delivery devices in the hospital or home environment.
Keep oxygen cylinders away from heat sources.	Keep oxygen delivery systems at least 1.5 metres from any heat source.
Check for electrical hazards in the home or hospital prior to use.	Determine that electrical equipment in the room or home is in safe working condition. A small electrical spark in the presence of oxygen will result in a serious fire. The use of a gas stove, kerosene space heater, or smoker is unsafe in the presence of oxygen. Avoid items that may create a spark (e.g., electrical razor, hair dryer, synthetic fabrics that cause static electricity, or mechanical toys) with nasal cannula in use.
Check levels of oxygen in portable tanks.	Check oxygen levels of portable tanks before transporting a patient to ensure that there is enough oxygen in the tank.
ABGs should be ordered for all critically ill patients on oxygen therapy.	High concentrations of oxygen therapy should be closely monitored with formal assessments (pulse oximetry and ABGs).
Data source: British Thoracic Society, 2008; Perry et al., 2014

Precautions and Complications of Oxygen Therapy

Oxygen is essential to life, but as a drug it has both a maximum positive benefit and an accompanying toxicity effect. The toxic effects from oxygen therapy can occur based on the condition of the patient and the duration and intensity of the oxygen therapy. For example, with normal lung function, a stimulation to take another breath occurs when a patient has a slight rise in PaCO2. The slight rise in PaCO2 stimulates the respiratory centre in the brain, creating the impulse to take another breath. In some patients with a chronically high level of PaCO2, such as those with chronic obstructive pulmonary disease (COPD), the stimulus and drive to breathe is caused by a decrease in PaO2. This is called a hypoxic drive. When administering oxygen to patients with known CO2 retention, watch for signs of hypoventilation, a decreased level of consciousness, and apnea.

Oxygen therapy can have harmful effects, which are dependent on the duration and intensity of the oxygen therapy. See Table 5.5 for precautions and complications of oxygen therapy.

Table 5.5 Precautions and Complications of Oxygen Therapy

Complications	Precautions
Oxygen-induced hypoventilation/ hypoxic drive	If patients with a hypoxic drive are given a high concentration of oxygen, their primary urge to breathe is removed and hypoventilation or apnea may occur. It is important to note that not all COPD patients have chronic retention of CO2, and not all patients with CO2 retention have a hypoxic drive. It is not commonly seen in clinical practice. Never deprive any patient of oxygen if it is clinically indicated. It is usually acceptable to administer whatever concentration of oxygen is needed to maintain the SpO2 between 88% and 92% in patients with known chronic CO2 retention verified by an ABG.
Absorption actelectasis	About 80% of the gas in the alveoli is nitrogen. If high concentrations of oxygen are provided, the nitrogen is displaced. When the oxygen diffuses across the alveolar-capillary membrane into the bloodstream, the nitrogen is no longer present to distend the alveoli (called a nitrogen washout). This reduction in alveolar volume results in a form of collapse called absorption atelectasis. This situation also causes an increase in the physiologic shunt and resulting hypoxemia.
Oxygen toxicity	Oxygen toxicity, caused by excessive or inappropriate supplemental oxygen, can cause severe damage to the lungs and other organ systems. High concentrations of oxygen, over a long period of time, can increase free radical formation, leading to damaged membranes, proteins, and cell structures in the lungs. It can cause a spectrum of lung injuries ranging from mild tracheobronchitis to diffuse alveolar damage. For this reason, oxygen should be administered so that appropriate target saturation levels are maintained. Supplemental oxygen should be administered cautiously to patients with herbicide poisoning and to patients receiving bleomycin. These agents have the ability to increase the rate of development of oxygen toxicity.
Data source: British Thoracic Society, 2008; Perry et al., 2014.

A patient is being discharged with low oxygen levels and will receive home oxygen. Name four vital safety components to review with the patient prior to discharge.
COPD patients are at risk for developing a complication called oxygen-induced hypoventilation. What is the cause of this complication and how can it be prevented?