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Oxygen Therapy Learning Module Cat.1 and 2, 2015

1. P Patient will be seen by Therapy Assistant 5x a week to continue with above ambulation and exercise program Will be seen by Physical Therapist Monday and Wednesday next week to review and revise exercise and ambulation program B Utiful PT MSc Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 29 Date Time IRole IFocus Content INotes DARP Discipline D Patient arrived in the department on 4 liters per minute lpm 2014 06 22 Occupational Oxygen Kitchen oxygen O2 via nasal prongs on a liquid O2 tank SpO2 90 11 30 Therapist Assessment heart rate HR 95 respiratory rate RR 20 Pt had no complaints of breathlessness A Respiratory assessment completed and oxygen tank checked for adequate oxygen upon arrival and before transportation back to the nursing unit Kitchen assessment initiated but not completed O2 maintained on 4 lpm during assessment O2 saturations checked periodically throughout the testing session R Patient required 4 rest periods during the 45 minute assessment session Patient needed to rest due to dyspnea and leg fatigue SpO2 90 RR 22 HR 110 at each rest period P Complete kitchen assessment tomorrow S Plint MSc OT Date Time IRole Focus Content Notes DARP Discipline D Patient received in the department on 3 liters per minute Ipm 2014 06 22 SLP Oxygen oxygen 02 via nasal prongs on a
2. 10 1 hour 15 0 5 hours The approximate use time will vary depending on the size of your liquid oxygen tank Please refer to the chart at your site for approximate use times To determine oxygen duration using the liquid oxygen tank refer to the chart above For example If the needle is at the far right of the green area the tank is full If your patient is on a flow rate of 2 liters per minute a full tank will last approximately 8 hours If the needle is in the middle of the green area and your patient is on a flow rate of 2 liters per minute the tank will last approximately 4 hours References 4 7 Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 40 Self Test Section Six 1 An oxygen cylinder should be changed when the gauge reads A 800 psi B 500 psi C 1000 psi D 100 psi 2 Why should oxygen cylinders be handled with care A Costly to repair Yes No B Injury to patient staff may occur Yes No C Can become an unguided missile with enormous destructive power Yes No 3 Ifa portable liquid oxygen tank is set at 2 LPM what is the approximate use time for a full tank A 8 hrs B 6 5 hrs C 5 5 hrs D 2 hrs 4 Your patient arrives in the treatment area on 4 LPM and the liquid portable tank is half full Is there sufficient oxygen supply for the patient to receive 30 minutes treatment and 15 minutes travel time A Yes B No 5 The oxy
3. e a significant change from baseline respiratory rate as per clinical judgment e Color Changes A bluish color seen around the mouth on the inside of the lips or on the fingernails may occur when a person is not getting as much oxygen as needed The color of the skin may also appear pale or gray e Evidence of excessive use of accessory muscles of respiration evidence of forced exhalation or increased work of breathing e Grunting A grunting sound can be heard each time the person exhales This grunting is the body s way to try to keep air in the lungs so they will stay open e Nasal Flaring The nostrils spreading open while breathing may indicate that the person has to work harder to breathe e Accessory Muscle Use See illustration below e Paradoxical Breathing Pattern Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 24 e Retractions Indrawing The chest appears to sink in just below the neck and or under the breast bone with each breath in an attempt to bring more air into the lungs e Excessive secretions requiring suction e Sweating There may be increased sweat on the head but the skin does not feel warm to touch More often the skin may feel cold and clammy This may happen when the breathing rate is very fast e Wheezing A tight whistling or musical sound heard with each breath This may indicate that the air passages may be smaller m
4. Swallow Assessment O Respiratory assessment completed and oxygen tank checked for adequate oxygen upon arrival and before transportation back to the nursing unit Patient arrived at rehab on 2 liters per minute lpm oxygen O2 via nasal prongs on a Grab nGo tank SpO2 95 respiratory rate RR 15 heart rate HR 93 The Patient SpO2 RR and HR were maintained during the swallow assessment Patient observed holding food in cheek to catch breath before initiating swallow A Oropharyngeal dysphagia IP Continued follow up re management of modified diet texture S Peach MSc R SLP Date Time Role Discipline Focus Content Notes DARP 2014 06 22 10 45 Physical Therapy Oxygen Mobility D Patient arrived in the department on 2 liters per minute Ipm oxygen O2 by nasal prongs on a liquid portable tank SpO at rest 94 heart rate HR 100 respiratory rate RR 18 Pt had no complaints of breathlessness A Respiratory assessment completed and oxygen tank checked for adequate oxygen upon arrival and before transportation back to the nursing unit Patient ambulated with a 4 wheeled walker 10 meters X 2 repetitions Patient requires one person standby assist to ambulate Exercise program reviewed with patient and repetitions increased R Patient stopped ambulating due to leg fatigue SpO2 on 2 Ipm O2 after exercise 90 HR 110 RR 20 5 minutes post exercise SpO2 95 HR100 RR18
5. No change May be on rate control Monitor Sp0 and patient rest and observe pulse drugs rate control respiratory rate vital signs once stable check pacemaker or cardiac closely d ciment r nt transplant patient Change position Lungs Increased Normal after exercise e Change oxygen level SpO2 Decreased Normal within ran Bel ified i use pulse ng ge COWS PECHE and or delivery system Seter specified by therapist range rest patient dof e Contact Nursing breathing exercises Respiratory and if required 5 increase oxygen Therapist within specified e Contact doctor parameters If e Activate the emergency saturation does not response system at your return to specified site see Section 9 range then call any category 1 staff or RN RT to assess Respiratory Increased Normal with exercise to Above set maximum rate RR set maximum identified stop activity count by the category 1 staff encourage slow deep breaths breaths and check SpO If too fast or distressed call any category 1 staff or RN RT to assess Decreased Normal if taking deeper breaths Exercise will affect one or more systems e Therapists should set restrictions on areas of compromise for the patients e When in doubt ask Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 18 Oxygen titration and weaning Titration of oxygen process of gradually adjusting the dose of oxyge
6. e Asthma e Pneumonia e COPD exacerbation e Pneumothorax e Heart failure e Pulmonary edema e Pleural effusions e Pulmonary emboli Hypoxemia is important as it can lead to Hypoxia Hypoxia Is an inadequate supply of oxygen to the tissue or cells Cellular hypoxia occurs when oxygen transport fails to meet the tissue demand for oxygen This may be due to a problem with the lungs e g airway obstruction including secretions foreign objects or tumors hypoventilation due to disease injury and drugs or blood flow due to the circulatory system Hypoxia secondary to problems with the blood anemia or the circulatory system e g decreased cardiac output responds poorly to oxygen therapy Indications for Oxygen in the Acute Care Setting e Hypoxemia e To decrease the work of breathing e To decrease myocardial work This may be done to target a specific organ in order to prevent ischemic damage and pain e Post operatively oxygen may be ordered for a specific time frame and or flow rate rate Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 14 Dangers Problems and Contraindications for Oxygen Oxygen administration can result in detrimental effects in some cases These include e COPD Patients Some patients with COPD may become increasingly hypercapnic elevated levels of carbon dioxide in the blood when treated with excessive amounts of oxygen In these patients it is rec
7. page 58 amp 59 Submit the checklist to your clinical educator or designate once completed Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff Section One Respiratory Physiology and Anatomy Learning Objectives Upon completion of this section the learner will be able to 1 Differentiate between ventilation internal respiration and external respiration 2 Identify the major muscles of respiration 3 Identify factors affecting external and internal respiration Respiratory Physiology Respiration is the exchange of gases between the atmosphere the blood and the cells These are the three processes involved in this exchange A Ventilation breathing in and out B External Respiration how the lungs exchange oxygen O2 and eliminate carbon dioxide CO3 C Internal Respiration how the cells exchange oxygen and carbon dioxide A Ventilation Air in Air out This is the movement of air in and out of the body during inspiration and expiration During inspiration air is drawn in through the nose mouth and throat through the larynx and down the trachea The trachea then branches into right and left primary bronchus followed by secondary bronchi that enter both the right and left lobes of the lungs The bronchi continue to divide becoming smaller and smaller very much resembling the branches of a tree ending at the smallest air passage called the terminal bronch
8. what is the approximate use time for a full tank A 8 hrs B 6 5 hrs C 5 5 hrs D 2 hrs 14 Your patient arrives in the treatment area on 5 LPM and the liquid portable tank is half full Is there sufficient oxygen supply for the patient to receive 30 minutes treatment and 15 minutes travel time A Yes B No Approximate use time of a FULL portable liquid oxygen tank Flow control knob setting Approx use time 1 15 5 hours 1 5 11 hours 2 8 hours 2 5 6 5 hours 3 5 5 hours 3 5 5 hours 4 4 hours 5 3 hours 6 2 5hours 8 2 hours 10 1 hour 15 0 5 hours 15 The oxygen tank has a choice of 2 or 3 liters flow rate your patient is on 2 5 LPM via nasal prongs what would you set the oxygen flow rate to A 2 liters per minute B 3 liters per minute C 4 liters per minute Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 16 Match the oxygen delivery device to the most appropriate statement photo 57 Answer A B or C Device Statement Photo Regular Nasal Prongs A Used for clients that require higher flows to adequately oxygenate but cannot tolerate a face mask for long periods of time High Concentration Oxygen Mask with Reservoir High Flow Nasal Prongs C Should not exceed 6 LPM 17 You would know the pulse oximeter was reading correctly when A Correlates
9. Assistant do when they are assigned a client on oxygen and have not been given all the information needed A Treat the patient and contact the therapist afterwards B Provide no service and contact the therapist for clarification Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 22 Section Four Physical Assessment Monitoring and Signs of Respiratory Distress Learning Objectives Upon completion of this section the learner will be able to 9 Identify the components required for physical assessment monitoring of patients 10 Identify the normal adult ranges for vital signs 11 Identify the signs of respiratory instability distress and when to obtain assistance Physical assessment and monitoring All staff need to be able to monitor patients and immediately identify values outside the norm as defined for the patient trends in values and signs of respiratory distress Measurement and observation of these parameters is to be completed pre and post rehabilitation intervention on all patients receiving oxygen e Respiratory Rate RR Is usually assessed by observing the movement of the chest wall and or the abdomen It is very important that the patient is unaware that this measure is being taken and that the health professional does not place his or her hand on the patient s chest wall or abdomen to take it If the patient becomes aware he she may alter his her RR and an inacc
10. D L Dean E 2006 Cardiovascular and Pulmonary Physical Therapy Mosby Inc Kisner C Colby L A 1990 Therapeutic Exercise Foundations and Techniques Davis and Co Philadelphia PA Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff Definitions and Abbreviations For the purposes of this learning module Acute care adult inpatient settings include rural and community hospitals regional hospitals metropolitan hospitals and tertiary hospitals Adult 18 years or older Artificial Airway e g tracheostomy tube endotracheal tube or nasotracheal tube Category 1 Staff professionals who work with adult inpatients requiring oxygen therapy The following health care professionals are included in this category Physiotherapists Occupational Therapists and Speech Language Pathologists Category 2 Staff health care providers who work with adult inpatients requiring oxygen therapy The following health care providers are included in this category Therapist Assistants FiO fraction of inspired oxygen Hypoxemia a decreased oxygen tension Pa02 in the blood below the normal range Hypoxia an inadequate supply of oxygen to the tissue or cell Initiate place patients clients on supplemental oxygen who previously were not on supplemental oxygen Most Responsible Health Practitioner means the health practitioner who has responsibility and accountability for
11. Inpatients Guideline the AHS charting guidelines and your service area site standards Timing of the documentation process is best approached from the perspective of two scenarios e The patient s condition is as expected and no changes need to be made e The patient s response is not as anticipated Where the patient s condition and response to treatment are within the expected parameters documentation is completed as soon as possible and no later than the end of the shift The actual time of treatment should be recorded within the note Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 28 Where the patient s condition and response to treatment are outside of the expected parameters documentation should occur as soon as possible ideally immediately Also other health care providers must be informed as required Depending on the zone program and facility documentation may occur on a flow sheet or a multi disciplinary progress note Documentation may be in electronic or paper format Progress notes may be in SOAP DARP and DPARE Examples of paper based multi disciplinary progress notes Date Time Role Discipline Focus Content Notes SOAP 2014 03 24 09 30 SLP Oxygen S Patient received in the rehab department for swallowing assessment Patient had complaints of being short of breath upon eating causing coughing occasionally while eating
12. SpO range e Heart rate range e Respiratory rate range e If flow rate of O can be adjusted up or down to maintain specified SpO2 e Max O flow rate a patient can be raised to before the category 1 staff or RN RT must be called e Indicate if the O is not to be changed e Frequency of treatment e Treatment goals these should be specific and time limited e Treatment activity this needs to be specific with identified ways to progress Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 20 An Example of Information for Therapist Assistant Assignment which may be utilized at your site with adaptions n Alberta Health M Services THERAPIST ASSISTANT ROLE UTILIZATION U PLC O RGH OFMC UCAR S U CAR N UO CAR C Q Mental Health L Inpatient Q Outpatient O Occupational Therapy Q Physical Therapy O Speech Language Pathology QJ Recreation Therapy Information for TA Assignment Patient Name Unit Room CHR ID Priority Referring Therapist Pager Cell phone Diagnosis Relevant Hx Precautions Oxygen Level of Risk Circle high moderate low Oxygen L min__ FiO2 Maintain SpOz at range HR range Respiratory Rate range o Max O to Vmin oDO NOT CHANGE O Frequency of Rx Requested Rx Goals Treatment Activity Scheduled time day Please contact therapist by pager phone in person _ Daily Weekly _ Monthly Other Z TARP TARP Binder 2012 Inform for TA Assignmen
13. eee ne ea enenenaeeneeneeneeeeeneees Section Eight Pulse Oximetry SpO Section Nine Allied Health Rehabil Appendix A Self Test Answer Key Appendix B Post QUIZ mese ioei r E E E i ede ben wea eka Set eee bungee ie header eee Appendix C Practical Component ss oi e aoee ra EAA E e A nee ne ence beens ene ee nae eae sees eee Nan ae Appendix D Performance Checklist Appendix E Referencesss i4 genccbiaiahiisssavbaiied nusentiddessachebint A EAR EEE E E OUREA Allied Health Services Be Aiea Gi et E A A AS itation Services Acute Care Sites Emergency Response April 7 2015 13 16 22 26 32 41 45 49 52 53 58 59 60 Oxygen Therapy Learning Module for Category 1 and 2 Staff Introduction In compliance with the Oxygen Management Allied Health Adult Acute Care Inpatients Guideline this module is designed to provide Allied Health excluding respiratory therapists with the necessary knowledge and skills to provide and support safe delivery of oxygen therapy Oxygen is an odorless colorless tasteless gas constituting one fifth of the earth s atmosphere and is essential to the life of living organisms Oxygen is also a medical intervention in the prevention and treatment of hypoxia Oxygen therapy is an area of patient care where recognition of its need and efficient administration can have a significant impact on a patient s well being Caring safely for patients receiving oxygen thera
14. engaged Place one hand on top of the portable directly over the fill connector and press straight down The portable will lower a further 10 mm into place j aw Aiii amp i vi tii AA ey i AUN AAS 2 While still holding the portable down in the fill position open side vent valve A loud hissing sound will occur This will continue until the valve is closed Filling the portable completely should not take longer than two minutes An irregular hissing sound will occur when the unit is full You may also note that there is a white cloud of liquid oxygen around the reservoir Close the valve when this occurs as the unit is full Push Down Vent Valve 3 Disengage the portable from the stationary reservoir by holding the carrying strap above the unit and depressing the release button Place portable unit upright on the floor There will be some Lift steam at the bottom of the portable unit this is normal To weigh contents with one hand grasp the strap closest to the f contents indicator about six inches from portable The needle will move into the green area on the content indicator Repeat 3 times for an average reading Pressing Portable Release Button e Itis very important to connect the portable liquid unit all the way down onto the reservoir and hold it there while filling e If the portable sounds like its filling but the hissing sound slowly fades within a minute you h
15. extremities makes it difficult for the sensor to lock onto a pulsatile artery Ambient light may enter the space between the sensor and the finger affecting the optics of the oximeter and give a false low reading Skin pigmentation dark skin may cause an over estimation of oxygen saturation at saturations below 80 Acrylic nails and nail polish lowers the saturation reading Movement that occurs with tremor shivering or patient transport may mimic vascular pulsations and result in an inaccurate reading Cold hands or feet may cause a poor signal and lead to an inaccurate reading False high readings are obtained from smokers and anyone who is exposed to carbon monoxide A falsely high reading may be produced up to 4 hours after smoking a cigarette Clinical Points of interest Therapists should be aware of the trends in changes of the SpO reading and be able to identify and record factors that cause increases and decreases in the individual patient s SpOy Post treatment it should be noted whether improvements in SpO are maintained The target SpO for individual patients may be different and may depend on the patient s pathology The medical chart should be checked for a specified SpO gt goal or range Is the pulse oximeter reading correct The reading can be correlated with other measures as follows palpation of radial pulse heart rate reading on the monitor signal quality indicator on the monitor shown as 1 2 or 3 ba
16. less changing levels of oxygen than 5 LPM to prevent re breathing CO High Concentration Oxygen Mask with Oxygen rate is The reservoir bag provides for extra oxygen when Reservoir set to ensure the patient breathes faster or deeper reservoir bag Ensure the reservoir bag remains partially inflated remains at during inspiration least 2 3rd inflated during inspiration Generally run at 10 LPM Interfaces used with high flow devices venturi cold nebulizer and high flow nebulizer include a Aerosol mask with or without tusks See photo attached to high flow nebulizer description b Tracheostomy mask collar c Face tent Can be used with a venturi device for short term application i e patient transport Other than for the purpose of transport must be used with a cold nebulizer or high flow nebulizer Used for patients who find a mask claustrophobic have burns to the face or have facial nasal surgery Use with a cold nebulizer Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 43 High flow Meets all of the inspiratory demands of the patient and therefore provides fixed oxygen concentrations Concentration is precise and constant regardless of the patient s breathing pattern Oxygen Flowmete Point of interest concentration rrate Venturi device Available in 24 blue 2LPM _ The minimum flow rate for a
17. range set by the physician What would you do A Rest the patient encourage deep breaths and increase the flowrate if required up to prescribed maximum B Encourage deep breathing while maintaining the current exercise program C Change to a less intense exercise and monitor Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 54 5 During exercise your patient s respiratory rate increases above the maximum as set by the therapist What would you do A Rest the patient check SpO and encourage slow deep breaths B Explain to the patient that increased respiratory rate us a normal response to exercise while encouraging the patient to continue the exercise program at the same intensity C Encourage patient to continue the exercise program at the same intensity and document the results in the medical chart 6 Match the vital signs with the correct normal adult range 1 SpO A 12 to 16 2 BP B 60 to 100 3 Respiratory Rate per minute C 95 to 100 4 Heart Rate per minute D approximately 120 systolic approximately 80 diastolic 7 Therapist Assistants may switch between oxygen supply sources for A High risk patients B Moderate risk patients C Low and moderate risk patients D Low patients 8 Match the level of risk low moderate and high with the amount of oxygen being received A Less than 6 liters of oxygen Moderate B Great
18. staff will document the outcome of the discussion with the attending physician or nurse practitioner Documentation for patients clients receiving oxygen therapy Assessment and documentation of oxygen administration will include oxygen flow rate or FiO2 the oxygen delivery device and the connection of oxygen delivery device to oxygen source Initiation and all changes to the FiO or flow rate shall be documented by all disciplines The SpO where monitors are available vital signs and respiratory assessment including respiratory rate and abnormal patterns of respirations are obtained and documented on the progress record as follows for all patients e Before and 10 30 minutes after an FiO change or change in O flow rate e When the patient s client s condition changes e Prior to and post transport of patients away from the patient care area for diagnostic or therapeutic procedures e After connection reconnection to a portable oxygen delivery system e Before and after any intervention that may have an impact on oxygenation Allied Health documentation must occur at least once per rehabilitation visit This applies whether the patient is treated in the rehabilitation department or on the nursing unit This may not apply to patients who are in acute care while waiting for placement in an alternate level of care Documentation must include all necessary content as outlined in the Oxygen Management Allied Health Adult Acute Care
19. than 8 or greater than 30 Signs of respiratory instability see section 4 Acute Change in O3 Sats less than 90 despite O greater than SLPM Heart rate less than 40 or greater than 140 BP systolic less than 90 or greater than 200 or acute drop in systolic blood pressure Sudden decrease in level of consciousness or Glasgow Coma Scale drop greater than 2 points Seizures Indications for calling a Code Blue e Unresponsive not breathing with or without pulse Please refer to your site specific guidelines to learn how to activate the emergency response system in your facility In cases of acute respiratory distress category 1 and 2 staff may initiate oxygen therapy i e place patient on supplementary oxygen or increase flow rate while awaiting further medical direction This is contraindicated if the oxygen order specifically states not to increase oxygen under any circumstances Staff working with patients away from the nursing unit must be aware of the patient s goals of care designation at all times Goals of Care documentation Patients who have discussed and decided upon a Goals of Care designation will have the goals of care documented in the electronic and or paper chart While on hospital property the goals of care designation in the chart is the source of truth When a patient is away from the nursing unit and in an area to which the code team does not respond during a medical emergency EMS will need evidence of the patien
20. the specific treatment procedure s provided to a patient and who is authorized by Alberta Health Services to perform the duties required to fulfill the delivery of such a treatment procedure s within the scope of his her practice Oxygen Therapy Risk Assessment clinical determination of the patient s client s inability to tolerate interruption of therapeutic oxygen administration PaCO partial pressure of carbon dioxide in arterial circulation Pulse Oximetry is the measurement of the oxygen saturation of hemoglobin in arterial blood with 100 as the maximum reading possible It is a measure of the average amount of oxygen bound to each hemoglobin molecule Respiratory Acidosis a decrease in pH in the blood due to an increase in partial pressure of carbon dioxide in the arterial blood PaCoz Significant Change a variation in values outside of a predefined range set by an appropriate regulated health professional category 1 staff physician nurse practitioner registered nurse licensed practical nurse or respiratory therapist The predefined range will be individual for each patient SaO arterial oxygen saturation of hemoglobin Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff SpO the measurement of functional saturation of oxyhemoglobin This measurement is obtained non invasively i e via pulse oximeter Student an individual enrolled in an entry
21. with the pulse B Patient is able to talk normally C Correlates with the respiratory rate Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 58 Appendix C Practical Component New Staff Demonstrate competency in the following activities 1 2 Filling the liquid portable oxygen system if available Moving the O2 delivery system from wall to portable system and back to wall outlet while providing the correct level of oxygen for liquid oxygen and portable oxygen cylinder Evaluation of O reserve in the liquid oxygen and portable oxygen cylinder Measurement of respiratory rate Correct use of pulse oximeter including correlating the pulse oximeter reading with the heart rate Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 59 Appendix D Performance Checklist New staff T Alberta Healih W Services Oxygen Therapy Performance Checklist Name Unit Dept _Allied Health Rehabilitation Criteria Completed 1 Complete post test 2 Fill the portable liquid oxygen system if available 3 Move the O2 delivery system from wall to portable system and back to wall outlet Provide the correct level of oxygen for each device 4 Evaluate Oz reserve in the liquid oxygen and portable oxygen cylinder 5 Measure respiratory rate 6 Measure saturation of oxyhemoglobin via a pulse oximet
22. 00 2200 psi pounds per square inch A pressure regulator reduces the 2000 2200 psi cylinder pressure to about 50 psi The flow meter controls the rate of oxygen delivery to the patient The safe residual pressure for an oxygen cylinder while actively being used is 500 psi An oxygen tank should never be allowed to run dry and should be changed at 500 psi The Grab nGo systems operate ONLY when positioned at the flow rates marked on the flow adjusting knob The flow rates are marked in liters per minute Refer to page 34 for flow rates If the flow rate your client is on is not available on the Grab nGo select the next highest level available For example a client is on wall oxygen at 2 5LPM The only option on the Grab nGo is 2 or 3 therefore choose 3 LPM if no other portable system is available Remember when they go back on wall oxygen at 2 5LPM they need to be monitored to ensure they can tolerate the decrease in oxygen See Section 3 for details For high flow rates if the correct setting is not available on the oxygen tank any change in flow rates should be discussed with the respiratory therapist or attending physician and documented Some sites have oxygen cylinders that need to have a regulator attached before use refer to page 35 for details Liquid Oxygen Units Tanks Liquid tanks are measured by weight To determine the amount of oxygen in a liquid tank grasp the strap closest to the content indicator approximately 6 in
23. A pulse oximeter gives no information about the following e The amount of hemoglobin in the blood e The amount of oxygen dissolved in the blood e The cardiac output or blood pressure A pulse oximeter also gives no indication of a patient s ventilation only of their oxygenation It can give a false sense of security if supplemental oxygen is being given In addition there may be a delay between the occurrence of a potentially hypoxic event and a pulse oximeter detecting low oxygen saturation Pulse oximeters rely on adequate perfusion to function effectively Pulse oximetry readings correlate closely with the oxygen saturations obtained by arterial blood gases when the SpO saturation of oxyhemoglobin level is above 70 Oxygen saturation values below 70 obtained by pulse oximetry are unreliable Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 46 Advantages of measuring blood oxygen saturation by pulse oximetry Non invasive Inexpensive Easy to tolerate Allows continuous measurement Indications To obtain baseline data and data trends during intervention and post intervention To detect a patient at possible risk of hypoxemia Symptoms of respiratory distress Monitoring and adjusting O therapy During invasive procedures Following anesthesia During exercise Limitation Pulse oximeters vary in accuracy especially at saturations lt 70 Poor perfusion to the
24. Active Hollondaise11 Y Ty scmt di Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 31 Self Test Section Five 1 Therapist Assistants may switch between oxygen supply sources for A Low risk patients B Moderate risk patients C High risk patients D Low and moderate risk patients 2 Match the level of risk low moderate and high with the amount of oxygen being received A Greater than 8 liters of oxygen Low B Less than 6 liters of oxygen Moderate C Between 40and 50 per cent concentration of oxygen High 3 Documentation for patient client receiving oxygen therapy will include the following A Oxygen delivery device e g nasal prongs Yes No B Oxygen flow rate or FiO Yes No C Oxygen source Yes No D SpO if monitor is available Yes No E Respiratory rate Yes No Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 32 Section Six Oxygen Equipment Learning Objectives Upon completion of this section the learner will be able to 14 Identify the different oxygen tanks 15 Identify the reserve volume in an oxygen tank and safe duration time for use 16 Understand how to safely fill a liquid oxygen tank 17 Identify injury prevention measures when working with oxygen Oxygen Equipment Oxygen Cylinders Oxygen cylinders e g Grab nGo are made from steel or aluminum and hold compressed oxygen at 20
25. Grab nGo tank Oxygen tank checked 14 50 for adequate oxygen supply SpO2 95 respiratory rate RR 15 heart rate HR 93 Pt had no complaints of being short of breath A Patient seen in Speech Language Pathology SLP office to initiate Communication communication assessment Respiratory assessment completed upon arrival Assessment and before transportation back to the nursing unit R Patient needed to rest X 2 during the 30 minute session due to dyspnea SpO2 90 RR 18 HR 93 at each rest session Returned to baseline within 1 minute Oxygen tank checked for adequate oxygen before return to unit P Continue with daily communication assessment S Peach MSc R SLP Date Time IRole IFocus INotes DARP Discipline Content D Patient received in the department on 2 liters per minute Ipm oxygen O2 2014 06 22 Therapist Mobility by nasal prongs via a liquid portable tank Oxygen tank checked for adequate 14 50 Assistant oxygen supply SpO2 94 respiratory rate RR 18 heart rate HR 80 Pt had no complaints of being short of breath A Patient ambulated with a 4 wheeled walker 10 meters X 2 repetitions Patient requires person standby assist to ambulate R Patient stopped ambulating due to leg fatigue SpO2 90 on 2 liters after exercise HR 85 RR 20 Vitals returned to baseline within 5 mins Oxygen tank checked for adequate oxygen before return to unit P Therapist Assistan
26. Manual Number Site Oxygen Therapy for Acute Adult Inpatients Learning Module for Allied Health Staff Category 1 and 2 Alberta Health Services Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff This document has been reviewed and revised in 2015 by an Allied Health provincial multi disciplinary group to reflect the needs of all areas of the province It is intended for the use of adult acute care Allied Health Staff across AHS and is based on previous educational material produced in the Calgary Zone The original document was developed in 2006 by a group of Calgary Health Region staff including Physical Therapists Management and Program Facilitators In 2013 it was reviewed and revised by the Allied Health Educators of the Calgary Zone AHS Copyright 2015 Alberta Health Services This material is protected by Canadian and other international copyright laws All rights reserved This material may not be copied published distributed or reproduced in any way in whole or in part without the express written permission of Alberta Health Services please contact Health Professions Strategy and Practice Senior Practice Lead Physiotherapy June Norris at 780 735 348 1 June Norris albertahealthservices ca This material is intended for general information only and is provided on an as is where is basis Although reasonable efforts were made to confirm the accurac
27. Module for Category 1 and 2 Staff 51 Self Test Section Nine 1 You would call a Code Blue when A No pulse Yes No B Respiratory rate is greater than 26 Yes No C No breathing Yes No Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff Appendix A Self Test Answer Key Section 1 l A 2 C 3 B Section _2 1 B 2 A Yes B Yes C Yes 3 A Section _3 1 ice a DWWAN Section 4 1 1 B 2 D 3 A 4 C 2 A Yes B Yes C No D Yes E Yes Section _5 l A 2 Low B Moderate C High A 3 A Yes B Yes C Yes D Yes E Yes Section 6 1 B 2 A Yes B Yes C Yes 3 A 4 A 5 B Section 7 1 A 2 1 B 2 A 3 C Section 8 1 A Yes B No C Yes D No 2 D 3 C Section 9 1 A Yes B No C Yes Allied Health Services April 7 2015 52 Oxygen Therapy Learning Module for Category 1 and 2 Staff 53 Appendix B Quiz 1 COPD patients may have an acceptable oxygen saturation of 88 A True B False 2 Every patient needs to have SpO greater than 92 A True B False 3 What action would you take if during exercise your patient s heart rate increases to maximum as set by the therapist A Continue exercise at the same level B Rest the patient for 3 minutes while monitoring heart rate C Call immediately for medical intervention 4 During exercise your patient s SpO gt decreases below the
28. Pulse oximetry is a measure of how well oxygenated the hemoglobin in arterial blood is It is used in conjunction with other assessment tools see section 4 to help assess a person s ability to tolerate physical activity such as exercising feeding chewing and swallowing A pulse oximeter measures a person s pulse in beats per minute and estimates the arterial oxygen saturation of hemoglobin in percent through a sensor typically clipped to a finger but is also effective on the toe different sensors are available for the earlobe or bridge of the nose The sensing device detects changes in oxygen saturation level by monitoring light signals generated by the oximeter and reflected by the blood through the tissue at the probe site As the oxygen saturation changes so does the amount of light absorbed A pulse oximetry reading in and of itself is not a reliable indicator of oxygenation status and must be done in conjunction with clinical assessment This includes but is not limited to appearance respiratory rate depth of ventilation peripheral circulation and blood pressure See Section 4 Physical Assessment and Signs of Respiratory Distress What does a pulse oximeter measure e The oxygen saturation of hemoglobin in arterial blood with 100 as the maximum reading possible It is a measure of the average amount of oxygen bound to each hemoglobin molecule e Pulse rate is measured in beats per minute averaged over 20 seconds
29. aking it more difficult to breathe A patient with a diagnosis of emphysema Note the generalized muscle wasting shortness of breath with pursed lip breathing and use of accessory muscles with a forward leaning posture A patient who is showing signs of respiratory instability distress is considered to be breathing inadequately and should be treated accordingly Treatment consists of providing adequate oxygenation and reversing the respiratory instability If a category 2 staff encounters a patient experiencing one or more of these symptoms they should immediately stop any activity and notify the nurse or any category 1 staff The category 1 staff or RN should do an assessment of the situation and treat accordingly If needed they should immediately page Respiratory Therapy or activate the emergency response system at your site see Section 9 Under no circumstances should a patient in respiratory distress who has not been assessed by a category 1 staff or RN be sent back to the nursing unit Note A known unstable airway can cause respiratory instability All of the following can place a patient at greater risk for unstable airway retropharyngeal abscess laryngospasm smoke inhalation amp facial burns from a thermal or chemical injury neck masses epiglottitis inflammation by whatever cause foreign body laryngitis asthma and COPD exacerbations tracheostomy laryngectomy or tracheal stent chest injuries fractured ribs cau
30. any change in oxygen delivery Observe patient for changes to breathing pattern and rate All category 1 and 2 staff are expected to check the chart prior to treating the patient For category 2 staff if the flow rate or FiO fraction of inspired oxygen is outside the parameters provided by the category 1 staff they need to clarify flow rate or FiO with the category 1 staff Expectations of the Category 1 staff for assigning patients with O to a Therapist Assistant 1 Determine the patient s level of risk according to the definitions on page 26 of this module 2 Determine the activities location of activity and parameters for treatment Please note e Therapist Assistants are able to independently treat those patients in the low risk categories e Therapist Assistants may work with high and moderate risk patients on the patient care unit providing they don t adjust the level of O2 or switch between oxygen supply sources during their treatment and the category 1 staff has deemed the patient medically stable e There may be exceptional circumstances when Therapist Assistants who work exclusively in Pulmonary or Thoracic units and who have received specialized training may switch oxygen sources for stable high risk patients The category 2 staff member must receive direction from the category 1 staff assessing the patient That direction will be based on discussion by the category 1 staff and with approval from the physician or nu
31. ave not held the portable down all the way Reconnect the portable and try again e If the portable makes a hissing sound and seems like it is leaking after it s been filled this is normal The pressure relief valve is releasing pressure from excess filling e If the portable is leaking it will vent immediately Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 38 e The portable unit may make a honk sound if knocked over or picked up suddenly If the honking continues after being placed upright it should be considered faulty and should not be used If the unit is found lying down and is not honking it should be sent for maintenance Trouble shooting the portable oxygen system Problem Cause Solution Portable unit not filling Unit has become disengaged from the reservoir 1 Push portable down to secure it onto the reservoir 2 Make sure the vent valve lever is open Unit has been filled but no oxygen coming out Unit is frozen due to excessive filling 1 Allow the unit to sit at room temperature until it thaws 2 If the problem persists once the unit is thawed it is considered faulty and should not be used Portable unit cannot disengage from the reservoir after filling procedure Unit is frozen onto valve This can happen after filling numerous portables in a row Allow 15 minutes between filling portables 1 Mak
32. ay be due to muscle cramping caused by increased oxygen demands of the muscles versus shortness of breath Although cardiopulmonary factors are generally considered the most important skeletal muscle dysfunction has been increasingly recognized as a key factor that contributes to exercise intolerance The perception of increased leg effort or discomfort is the main symptom that limits exercise in 40 45 of patients with COPD e Large bodies will expend more energy may need more rest or oxygen than small bodies e Recovery after vigorous exercise may take 5 10 minutes or more to return to baseline vitals Allied Health Services April 7 2015 Monitoring a deconditioned patient during exertion Oxygen Therapy Learning Module for Category 1 and 2 Staff L7 System Findings What it means Category 2 Category 1 Therapist Therapist Action to perform Assistant Action to perform Heart Rate Increased Normal to a set If maximum HR HR maximum identified by reached rest patient Regulated rehabilitation use cardiac the therapist and monitor HR for professional will use their monitor 3 minutes Tf still at clinical judgment and manual pulse or near maximum assessment skills check call any category 1 or pulse staff or RN May require the following oximeter Decreased Be concerned if lower Call any category 1 interventions correlated than set minimum staff or RN e Stop treatment let with manual
33. ch between oxygen supply sources for low risk patient client under the supervision of a category 1 staff member who has demonstrated competency in oxygen therapy Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 27 Category 2 staff must not adjust or switch between oxygen supply sources for moderate and high risk patients Category 2 staff may work with moderate and high risk patients on the patient care unit providing they don t adjust oxygen or switch between oxygen supply sources during their treatment and the category 1 staff has deemed the patient medically stable Category 2 staff are unable to independently treat patients in the moderate and high risk category off the patient care unit They are able under direct supervision of a category staff to provide a second set of hands There may be exceptional circumstances for Therapist Assistants who work exclusively in Pulmonary or Thoracic units and who received specialized training may e Switch oxygen sources for stable high risk patients e Switch oxygen sources transport patients or work with them away from the nursing unit for stable moderate risk patients In both these exceptional cases above the category 2 staff member must receive direction from the category 1 staff assessing the patient This direction will be based on discussion by the category 1 staff and with approval from the physician or nurse practitioner category 1
34. ches above the tank Lift the unit off the floor The needle on the indicator is spring loaded and will move when the tank is lifted Repeat 3 times to get an average reading The needle in the green area indicates the amount of oxygen available The needle in the red area indicates a new oxygen source is needed If you find a liquid oxygen tank not working report it to the nursing unit remove from circulation and ensure unit is repaired replaced Tanks with Low Capacity Alarm Function If these are available at your site you must recognize the implications of an activated low capacity alarm and act accordingly refer to page 36 for an example Replace the portable oxygen cylinder with a cylinder containing more oxygen or change the oxygen delivery system to a wall outlet if avavilable Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 33 Portable Oxygen Safety Improper handling of portable oxygen can create a potentially unsafe work area Improper handling of a portable oxygen cylinder can convert it into an unguided missile with enormous destructive power If the oxygen cylinder is punctured or if a valve breaks off the results can be lethal Oxygen cylinders E size should always be transported in a cylinder tank holder and never lying on a bed or stretcher Oxygen cylinders and liquid oxygen canisters are to be secured to prevent tipping and falling Liquid oxygen tanks must be transpor
35. counted for 15 seconds The value is then multiplied by 4 to determine the beats per minute If the pulse is irregular count the pulse for the full minute e Blood Pressure BP Is not done routinely on all patients Normal Adult Ranges Respiratory Rate 12 to 16 breaths per minute Heart Rate 60 to 100 beats per minute SpO2 95 to 100 BP approximately 120 systolic approximately 80 diastolic Reference 5 Signs of Respiratory Instability Distress Respiratory instability or distress occurs when the respiratory system cannot eliminate enough carbon dioxide to prevent respiratory acidosis and or pick up enough oxygen resulting in hypoxemia There are many causes of respiratory instability distress Some examples are lung disorders e g COPD or asthma mechanical disorders e g spinal cord injury or chest trauma and depression or overstimulation of the respiratory center caused by drugs CVA metabolic issues or head injury During rehabilitation treatment there may be an increased demand for oxygen If this is not readily available it may lead to respiratory instability distress Signs of Respiratory Instability Distress e Oxygen Saturation e consistently less than the prescribed acceptable range indicated in an order from the most responsible health practitioner or e less than 90 if no range has been identified on supplementary oxygen e Respiratory Rate e less than eight or greater than thirty
36. e sure the vent valve is in the closed position and let sit for 15 20 minutes to thaw 2 Do not attempt to pull off or you will break the lip seal on the portable Filling valve on the reservoir is frosted or very wet Reservoir has just been filled or more than 1 portable has been filled 1 Wipe excessive moisture with a lint free cloth 2 Use as required once the fill valve is dry Safety e Keep the unit away from electrical equipment or sources of heat e Keep flammable materials away from unit e Always turn unit off when not in use e Liquid oxygen is extremely cold 300 F 184 C Liquid oxygen or parts of the equipment that have been in contact with liquid oxygen can cause frostbite e Ifthe unit is turned over oxygen will escape e Liquid oxygen units should be transported in such a manner that they do not come into direct contact with the patient and must be in an upright position at all times to prevent leakage Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 39 Approximate use time of a FULL Grasp strap 6 inches portable liquid oxygen tank from unit to weigh Flow control Approx contents gt gt knob setting use time 1 15 5 hours 1 5 11 hours 2 8 hours 2 5 6 5 hours 3 5 5 hours 3 5 5 hours Flow Control 4 4 hours o Oxygen 5 3 hours pie 6 2 5hours 8 2 hours Carrying Strap
37. ecretions poor compliance with interface _ te dint Ds 7 A high flow oxygen delivery via an aerosol mask hypothermic core body temperature Do not use for transport This device may be referred to as Optiflow References 8 9 10 15 There may be other oxygen delivery devices used at your site please contact Nursing or Respiratory Therapy for further details on a specific device Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff Self Test Section Seven 1 Regular Nasal prongs are used for flow rates up to LPM for adults A 6 B C D w A oO 2 Match the oxygen delivery device to the most appropriate statement photo Answer A B or C Device Statement Photo High Concentration Oxygen Mask with Reservoir Regular Nasal Prongs A Should not exceed 6 LPM High Flow Nasal Prongs C Used for clients that require higher flows to adequately oxygenate but cannot tolerate a face mask for long periods of time Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 45 Section Eight Pulse Oximetry Learning Objectives Upon completion of this section the learner will be able to 20 Define pulse oximetry 21 Identify the indications for pulse oximetry 22 Understand the limitations of pulse oximetry Pulse Oximetry
38. er and correlate the reading with the heart rate Date Signature of Trainer Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 60 Appendix E References Guideline References e Oxygen Management Allied Health Adult Acute Care Inpatients Guideline e AHS Emergency Procedures Code Blue Policy AHS staff not the public can access these documents on the internal web Insite gt Out Teams Departments gt Emergency Disaster Management gt Emergency Response Plans Sites Services References 16 17 18 19 20 21 22 23 24 AARC Clinical Practice Guideline 1992 Pulse oximetry Respiratory care 37 8 891 897 AARC Clinical Practice Guideline Oxygen Therapy for Adults in the Acute Care Facility 2002 Revision and Update Respiratory Care 2002 47 6 717 720 AACVPR 2007 Guidelines for Pulmonary Rehabilitation Programs Chest 2007 Volume 131 4 42 Airgas Product and Service Information Manual Calgary Health Region Cardiorespiratory Rehabilitation Steering Committee Calgary Heath Region Diagnostic Imaging Department Oxygen Therapy Manual Calgary Health Region Memo Dr Bruce MacLeod May 20 2005 Liquid Oxygen Tanks Calgary Health Region Nursing Policy and Procedure Manual Oxygen Therapy 0 12 Calgary Health Region Nursing Professional Development November 2005 Oxygen Therapy Learning Module Calgary Health Region Respiratory Ser
39. er than 8 liters of oxygen Low C Between 40 and 50 per cent concentration of oxygen High 9 Documentation for patient client receiving oxygen therapy will include the following B Oxygen delivery device e g nasal prongs Yes No C Oxygen flow rate or FiO Yes No D SpO if monitor is available Yes No Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 59 10 What should the Therapist Assistant do when they are assigned a client on oxygen and have not been given all the information needed A Treat the patient and contact the therapist afterwards B Contact the therapist as soon as possible for clarification and provide no service until further information is received 11 Signs of respiratory instability that require immediate attention include the following A SpO gt consistently less than prescribed range Yes No B SpO gt greater than 98 Yes No C Respiratory rate less than prescribed range Yes No D Patient struggling to clear secretions i e choking Yes No E Excessive use of accessory muscles Yes No 12 Why should oxygen cylinders be handled with care A Costly to repair Yes No B Injury to patient staff may occur Yes No C If damaged can become an unguided missile with enormous destructive power Yes No Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 56 13 Ifa portable liquid oxygen tank is set at 3 LPM
40. f patients with oxygen to a category 2 staff member Identify the components required for physical assessment monitoring of patients Identify the normal adult ranges for vital signs Identify the signs of respiratory instability distress and when to obtain assistance Determine the level of risk for a patient receiving oxygen and differentiate between low moderate and high risk Identify the key elements for oxygen therapy documentation Identify the different oxygen tanks Identify the reserve volume in an oxygen tank and safe duration time for use Understand how to safely fill a liquid oxygen tank Identify injury prevention measures when working with oxygen Differentiate between low flow and high flow oxygen delivery systems Identify different oxygen delivery devices Define pulse oximetry Identify the indications for pulse oximetry Understand the limitations of pulse oximetry Identify when to access medical assistance Differentiate between initiating a Code Blue and calling for medical assistance Understand the importance of the Goals of Care Learning Resources Resources that will assist the learner in oxygen safety Clinical Leaders and Clinical Educators Books Chung F Reid W D 2004 Cardiopulmonary Physical Therapy SLACK Incorporated New Jersey DeTurk W E Cahalin L P 2004 Cardiovascular and Pulmonary Physical Therapy An Evidence Based Approach McGraw Hill Companies Inc USA Frown felter
41. fuses from the alveoli into the capillaries it binds with the hemoglobin in red blood cells The oxygenated blood is transported to the left side of the heart via the pulmonary veins and then pumped throughout the body via the arterial system to the cells It is in the capillaries that Oz is released from the blood to supply the cells and CO is picked up for elimination Factors affecting internal respiration e Amount of O2in the blood e Medical conditions e g anemia e Loss of blood e g trauma e Impairment of circulation e Presence of drugs or chemicals that impair cellular O exchange Reference 6 Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 11 Respiratory Anatomy The thorax chest wall protects the principle organs of respiration and circulation as well as the liver and stomach The posterior thorax is formed by the 12 thoracic vertebrae and the posterior surface of the 12 rib pairs The anterior thorax is formed by the sternum and the costo chondral cartilage The lateral thorax is formed by the ribs The thorax provides the bony sites of attachment for the muscles of ventilation which mechanically enlarge the thorax for inspiration breathing in or compress the thorax for expiration breathing out The diaphragm is the principle muscle of respiration and separates the thoracic and abdominal cavities During inspiration the diaphragm contracts to force the abdom
42. g and swallowing Clinical decisions should not be based solely on information obtained from this procedure Levels below the target SpO2 or 90 if no range has been identified and on supplementary oxygen may be life threatening Ensure the pulse oximeter is reading correctly Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff Self Test Section Eight 1 What does pulse oximetry estimate A Arterial oxygenation saturation of hemoglobin B Amount of hemoglobin C Pulse rate D Blood pressure Yes Yes Yes 48 2 Below what percentage is the pulse oximetry reading unreliable A 88 B 80 C 85 D 70 3 You would know the pulse oximeter was reading correctly when A Correlates with respiratory rate B Patient is able to talk normally C Correlates with pulse Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 49 Section Nine Allied Health Rehabilitation Services Acute Care Sites Emergency Response Learning Objectives Upon completion of this section the learner will be able to 23 Identify when to access medical assistance 24 Differentiate between initiating a Code Blue and calling for medical assistance 25 Understand the importance of the Goals of Care Calling for Medical Assistance is required for any of the following e Any patient you are seriously worried about Respiratory rate less
43. ge of gases between the the and the cells A Atmosphere Blood B Air Skin C Atmosphere Skin D None of the above 2 The principle muscle s for respiration is the A Sternocleidomastoid B Pectoralis major C Diaphragm D Abdominal muscles 3 Normal expiration is achieved through A Contraction of the pectoralis major B Elastic recoil of the thorax and abdominal wall C Contraction of the sternocleidomastoid D Relaxation of the pectoralis major Allied Health Services April 7 2015 12 Oxygen Therapy Learning Module for Category 1 and 2 Staff 13 SECTION TWO Role of Oxygen Therapy in the Acute Care Setting Learning Objectives Upon completion of this section the learner will be able to 4 Define hypoxemia and hypoxia 5 Identify the conditions and indications for oxygen therapy 6 Identify the dangers problems and contraindications for oxygen Role of Oxygen Therapy in the Acute Care Setting Hypoxemia Is an inadequate supply of oxygen in the arterial blood In the clinical setting the pulse oximeter is used to estimate oxyhemoglobin saturation SpO2 The acceptable SpO2 is usually greater than 90 but may vary dependent on the patient and the nature of the condition being treated For example COPD patients may have an acceptable oxygen saturation of 88 therefore always refer to individual patient specific oxygen orders Examples of medical conditions that may cause acute hypoxemia
44. gen tank has a choice of 2 or 3 liters per minute flow rate your patient is on 2 5 LPM via nasal prongs what would you set the oxygen flow rate to A 2 liters per minute B 3 liters per minute C 4 liters per minute Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff Section Seven Oxygen Delivery Devices Learning Objectives Upon completion of this section the learner will be able to 18 Differentiate between low flow and high flow oxygen delivery systems 19 Identify different oxygen delivery devices Allied Health Services April 7 2015 41 Oxygen Therapy Learning Module for Category 1 and 2 Staff 42 Oxygen Delivery Devices Low Flow Provides variable oxygen concentration fraction of inspired oxygen FiO2 Concentration cannot be guaranteed It is influenced by the patient s rate and depth of breathing Flow meter Point of interest rate Nasal prongs cannula 1 6 LPM Ensure nostrils are not blocked Effectiveness is decreased with deformity secretions silastic or NG tubes Tubing color is clear Flow is adjusted to meet a target SpO High flow nasal prongs cannula 1 15 LPM Used for clients who require higher flows to Typically adequately oxygenate but cannot tolerate face mask 7 15 LPM for long periods Tubing color is usually green Simple oxygen mask 5 10 LPM Not recommended for long term use or when Never
45. inal contents away from the thorax abdomen moves out and elevates the ribs in a bucket handle fashion The external intercostals and part of the internal intercostals also contract during inspiration Expiration is achieved through the elastic recoil of the thorax and abdominal wall During forced deep breathing or labored breathing a large number of accessory muscles may also contract Inspiratory accessory muscles include the scalenes sternocleidomastoids upper trapezius pectoralis major and erector spinae muscles Expiratory accessory muscles include the rectus abdominis transverse abdominis internal obliques external obliques and pectoralis major muscles Respiratory Muscles Anterior View Scalenus External intercostals Internal intercostals Pectoralis major Diaphragm Abdominal Muscles Rectus abdominis Transversus abdominis Internal and External obliques not shown Reference 5 Posterior view not shown the trapezius muscles form a diamond shaped sheet extending from the head down the back and out to both shoulders The erector spinae is a large muscle extending from the sacrum to the skull For further information on the respiratory muscles please refer to DeTurk Cardiovascular and Pulmonary Physical Therapy an Evidence Based Approach Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff Self Test Section One 1 Respiration is the exchan
46. ing oxygen therapy Participants must successfully complete the theory component of this module by achieving 90 on the qualification quiz The quiz is open book format The practical component of the oxygen training includes demonstration of the correct application of oxygen therapy This module is intended to promote patient safety by enhancing the knowledge and skills of Allied Health staff who care for adult patients receiving oxygen therapy Discussion and consultation with nursing and respiratory therapy is recommended whenever necessary This module is not an educational package to ensure competency of health professionals to treat cardiopulmonary patients with chest physiotherapy techniques or to complete full chest assessments The educational program for oxygen therapy has been standardized It is comprised of four components e Oxygen Therapy Learning Module e Review of Oxygen Management Allied Health Adult Acute Care Inpatients Guideline e Qualification quiz e Practical component Who Should Complete This Module This module is mandatory for the following staff working in acute care adult inpatient settings Category 1 Staff e Occupational Therapists e Physical Therapists e Speech Language Pathologists Category 2 Staff e Therapist Assistants Demonstration and maintenance of competency is done annually by reading the module and completing the quiz As part of orientation new staff will also do a practical component under
47. iole It is here at the terminal bronchiole that the tiny air sacs called alveoli are located and where the exchange of gases takes place B External Respiration O in and CO out This is the exchange of O from the alveoli in the lungs for CO from the blood capillaries which surround the alveoli The thin membranes and the differences in gas pressures on each side of these membranes cause O to enter the bloodstream from the alveoli and CO to enter the alveoli from the bloodstream The CO is removed from the alveoli when the person exhales Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 10 Efficiency of external respiration depends on various factors Some of these are Total surface area available for O2 CO exchange any disease or injury which decreases or obstructs the gas exchange surface area of the lung decreases the efficiency of external respiration An example of this would be COPD e Minute volume of respiration minute volume is the total volume of air taken in during a minute of breathing Slow respiratory rates and or shallow respirations decrease the minute volume thereby reducing the efficiency of external respiration For example sedative drugs can result in a slower respiratory rate or respirations may be shallow due to pain from abdominal surgery C Internal Respiration This is the exchange of O and CO between the blood and the cells Once oxygen dif
48. l to indicate the cylinder is in use Once the tank reaches 500psi tear off the IN USE section of the label to indicate that the tank is now empty Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff How to attach a regulator to an oxygen cylinder Cylinder Valve Single Seal Reference Airgas Product and Service Information Manual FDA and NIOSH Public Health Notification Oxygen regulator Fires Resulting from incorrect use of CGA 870 Seals April 24 2006 Allied Health Services e Identify the oxygen cylinder e Check that the label says USP MEDICAL OXYGEN If the cylinder has not been used before it will have a green tab covering a seal around the outlet e Remove the tab by pulling it sharply forward and one green seal should remain around the outlet e Place the wrench on the cylinder valve and turn it counter clockwise just enough usually less than 45 degrees to allow gas to escape for less than 1 second and then close the valve before attaching the regulator This is done to expel foreign material from the outlet port of the valve e Ifthe cylinder is already in use only one green seal should be present Remove any other seals including any seals attached to the regulator e The regulator has two pins on it e The cylinder post has two matching holes e Place the regulator over the stem of the cylinder and line up the pins with the holes e Hand tighten
49. level health care discipline education program leading to initial entry to practice as a regulated or non regulated health care provider Titration the process of gradually adjusting the dose of oxygen until the desired effect is achieved Valid Oxygen Order an order issued by a health professional authorized to provide medication orders within AHS Instruction for completion 1 Please do not write in this module Record your answers to the self test on a separate piece of paper 2 Review the oxygen therapy learning objectives identified on page 6 Note if this is a re certification you can skip to 4 and only review the learning objectives if answers are incorrect 3 Review each section of the learning module and consult additional cited resources as needed 4 Complete the self tests at the end of each section of the module Compare answers with the information provided in the module Refer to Appendix A for the answer key Review sections of the module as needed for clarification 5 Complete the post quiz Oxygen Therapy Quiz for Allied Health Category 1 and 2 through MyLearning Link Print and submit a copy of the completed course page to your clinical educator or designate Note The quiz is open book The pass mark is 90 30 33 correct answers Errors will cue you to review the pertinent information and make corrections 6 New staff are also required to complete the practical component and the performance checklist
50. lth uab edu Allied Health Services April 7 2015
51. municate this to the category 2 staff e Category 2 staff can differentiate between low moderate and high risk High Risk e Patient client requires greater than eight liters per minute 8 Lpm of oxygen a lower oxygen requirement may be determined by the site or most responsible health practitioner or e Patient client requires greater than 50 per cent concentration of oxygen or e Patient client exhibits one or more symptoms of respiratory instability see page 23 or e Patient client requires transition from a heated high flow oxygen therapy system the integration of heated humidification and a precise blend of air and oxygen delivered via an innovative nasal cannula or tracheostomy interface for transport away from the unit Moderate Risk e Patient client requires six 6 to eight 8 liters of oxygen per minute e Patient client requires between 40 and 50 per cent concentration of oxygen e Patient client is receiving oxygen via an artificial airway less than 7 days post operatively after artificial airway insertion Low Risk e Patient client receiving supplementary oxygen who do not meet the criteria for high or moderate risk Other policies and procedures exist that guide the transportation of patients with respiratory instability or on high flow oxygen away from the care unit All staff working with these patients must be aware of these policies After demonstrating competency category 2 staff may adjust oxygen or swit
52. n until the desired effect is achieved can occur when the oxygen order provides instruction on titration discontinuation All changes in oxygen flow rate must be documented The patient must be reassessed 10 30 minutes after the change in FiO fraction of inspired oxygen or change in flow rate The new assessment finding s must be documented on the chart Category 2 staff Therapist Assistants who have demonstrated competency may adjust oxygen and switch between oxygen supply sources for low risk patients refer to section 5 for risk levels under the supervision of a category 1 staff OT PT SLP who have demonstrated oxygen therapy competency O flow rate and Fi may be increased during activity within the guidelines set by the category 1 staff These guidelines are patient specific and need to be communicated to the therapist assistant TA The therapist must assess the patient and communicate all the information to the TA before the TA sees the patient Example Mr X e Must keep his oxygen saturation SpO2 greater than 92 during activity e The O may be increased from 3 to a maximum of 5 liters per minute during activity if required e O flow rate should be returned to baseline within 5 minutes after exercise as long as SpO2is maintained within established parameters e SpO should be rechecked at least 10 minutes later e O saturations must be taken prior to activity during the activity immediately post activity and or after
53. ommended to keep their SpO gt in the range of 88 to 92 If their oxygen flow rates need to be significantly increased clarification is required from the physician involved Note Prevention of acute hypoxia should be your first priority Do not deprive the hypoxic COPD patient of oxygen while awaiting further medical intervention e Bleomycin Induced Pneumonitis Oxygen therapy is contraindicated If oxygen needs to be applied it is at very low levels i e 0 5LPM In this scenario clarification of the parameters must be obtained from the Physician e Absorption Atelectasis 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 blood stream the nitrogen is no longer present to distend the alveoli which contributes to their collapse and atelectasis e Oxygen Toxicity High levels of oxygen provided for more than 24 hours usually results in some lung damage because of oxygen radical production Oxygen radical production occurs because of incomplete reduction of oxygen to water Oxygen radicals are very reactive molecules that can damage membranes proteins and many cell structures in the lungs The goal of oxygen therapy is To achieve an optimal arterial oxygen tension by giving the lowest possible most effective dose of oxygen while avoiding its toxic effects For most patien
54. particular oxygen 28 yellow 4LPM _ concentration is stamped on the bottom of each 31 white 6 LPM venturi adapter 35 green 8 LPM Humidity and nebulized medications can be added 40 pink 8 LPM 50 orange 12LPM 28 30 35 The nebulizer unit attaches directly to the oxygen 40 50 70 10 15 flow meter Adjust the oxygen flow meter so that mist or 100 LPM is visible exiting the mask during inspiration The dial on the Adjust the venturi opening on top of the nebulizer by neck of the turning the collar to the desired oxygen concentration nebulizer gives At settings above 50 the flow delivered by the the O2 device will be diluted by the patients inspiratory concentration efforts lowering the effective FiO2 Do not use for transport 60 65 75 Oxygen Despite these high oxygen concentration settings on 85 or 96 flow meter the dial the actual delivered oxygen concentration is The dial on the must be less However it is still greater than with a cold neck of the open all nebulizer The addition of tusks to an aerosol mask nebulizer gives the way increases the reservoir size and provides a higher the O2 flush oxygen concentration shown with tusks concentration Do not use for transport High flow oxygen with 30 100 10 60 Patients who may benefit include those with heated humidity via A LPM high oxygen requirements high inspiratory flow nasal prongs or trach pu demands retained s
55. py is a vital part of Allied Health practice A patient not requiring supplemental oxygen therapy will receive 21 oxygen from the air This amount of oxygen is adequate provided that the airway is not compromised and there are enough oxygen carrying components in the blood As well the cardiovascular system must be intact and able to circulate blood to all body tissues If any of these systems fail higher concentrations of oxygen must be delivered to the patient s lungs This makes it more likely that adequate levels of oxygen will reach all vital body tissues necessary to sustain life Oxygen therapy should be provided continuously unless the need has been shown to be associated only with specific situations e g exercise and sleep Care should be taken to avoid interruption of oxygen therapy in situations including ambulation or transport for procedures ALWAYS REMEMBER OXYGEN THERAPY IS A MEDICAL INTERVENTION Ensure correct patient correct flow rate correct device and correct connection to an oxygen source If using a portable system check sufficient O reserve is available Without oxygen we cannot live Without supplemental oxygen therapy many patients cannot survive Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff Purpose of the Educational Program This learning module will familiarize the learner with the information necessary to work safely with patients who are receiv
56. ransport system which works to supply all muscles with the oxygen required to perform tasks Many factors influence the oxygen transport system For the purpose of this module the following will be considered System Function Normal response to exercise Heart pumps the blood increased heart rate and force of heart beat Lungs takes the O to the blood increased respiratory rate and deep breathing Vascular System transports the oxygen increased blood pressure Muscles utilize the oxygen increased use of oxygen delivered An acute care patient may have pathology or be taking medications that will affect his her response to exercise In addition the patient may be deconditioned Systems affected may include Heart the use of heart rate limiting drugs decreased blood circulation or heart disease Lungs limited oxygenation in lungs secondary to conditions like pneumonia COPD pleural effusions pulmonary fibrosis etc Muscle decreased available muscle mass makes the body work harder to do the same task The deconditioned body responds quickly to exercise to improve heart lung and muscle function To start out a deconditioned patient may be medicated with supplemental oxygen to decrease the stress on the whole body especially the heart General Considerations At no time should a patient be exercising using less oxygen than is used at rest e A patient should be asked why they need to stop exercising It m
57. rs with increasing quality To optimize infection prevention the finger probe and device should be cleaned with a disinfecting wipe between patients If the patient has a BP cuff on their arm ensure the pulse oximeter is placed on the arm without the BP Cuff Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff The pulse oximeter Volume up Volume down NELLCOR Alarm silence Finger probe permanent or disposable Instructions for operating the functions are usually located on the front or back of the oximeter For your site follow the manufacturer s user manual References 1 9 14 17 18 19 Clinical Implications Review e A clinician can obtain a baseline pulse rate and oxygen saturation level and then compare them when the person is engaged in physical activity such as exercise feeding chewing and swallowing Generally readings between 95 and 100 are considered normal however the target SpO2 for individual patients may be different and may depend on the patient s pathology The medical chart should be checked for a specified SpO2 goal or range A downward trend from the baseline may be a sign of fatigue increased work of breathing or aspiration During feeding and swallowing a drop in SpO2 may suggest possible aspiration NB There is inconsistent evidence that pulse oximetry can reliably determine the occurrence of aspiration events during feedin
58. rse practitioner Category 1 staff will document the outcome of the discussion with the attending physician or nurse practitioner Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 19 e Therapist Assistants are unable to independently treat patients in the moderate and high risk category off the patient care unit They are able under direct supervision of a category staff to provide a second set of hands Again there may be exceptional circumstances when Therapist Assistants who work exclusively in Pulmonary or Thoracic units and who have received specialized training may switch oxygen sources transport patients or work with them away from the nursing unit for stable moderate risk patients The category 2 staff member must receive direction from the Category 1 staff assessing the patient That direction will be based on discussion by the Category 1 staff and with approval from the physician or nurse practitioner Category 1 staff will document the outcome of the discussion with the attending physician or nurse practitioner e Other policies and procedures exist that guide the transportation of patients with respiratory instability or on high flow oxygen away from the care unit All staff working with these patients must be aware of these policies Communicate relevant information to the category 2 staff This would include the following e Oy liters per minute or the FiO e Level of risk e
59. sing hemo amp pneumo thoracies Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff Self Test Section Four 1 Match the vital signs with the correct normal adult range 1 SpO A 12 to 16 2 BP B 95 to 100 3 Respiratory Rate per minute C 60 to 100 4 Heart Rate per minute D Approximately 120 systolic Approximately 80 diastolic 2 Which of the following are signs of respiratory distress A SpO gt consistently less than prescribed range Yes B Respiratory rate outside the patients prescribed range Yes C SpO gt greater than 98 Yes D Patient struggling to clear secretions i e choking Yes E Excessive use of accessory muscles Yes Allied Health Services April 7 2015 25 Oxygen Therapy Learning Module for Category 1 and 2 Staff 26 Section Five Determination of Level of Risk and Documentation Learning Objectives Upon completion of this section the learner will be able to 12 Determine the level of risk for a patient receiving oxygen and differentiate between low moderate and high risk 13 Identify the key elements for oxygen therapy documentation Determination of level of risk The oxygen therapy risk assessment is the clinical determination of the patient s client s inability to tolerate interruption of therapeutic oxygen administration It is important that e Category 1 staff can determine the level of risk and com
60. t s Goals of Care designation to treat appropriately The green sleeve where available is the universally identified container for Goals of Care documentation in the community and becomes the source of truth for Goals of Care designation EMS will look for this green sleeve when responding to a medical emergency Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 50 Facilities with electronic charting A current Goals of Care order must be printed from the electronic charting and placed in a green sleeve The green sleeve is then taken on the outing with the patient On returning the patient to the unit the Allied Health staff member ensures that the print out of the order is destroyed The patient s own green sleeve often contains other supporting documentation that is better left with the chart during the Allied Health outing Facilities with paper charting A current copy of the Goals of Care paper order 103547 must be made and placed in the chart The green sleeve and original order is then taken on the outing with the patient On returning the patient to the unit the Allied Health staff member ensures that the original order goes on the chart and the copy of the order is destroyed The patient s own green sleeve often contains other supporting documentation that is better left with the chart during the Allied Health outing Allied Health Services April 7 2015 Oxygen Therapy Learning
61. t doe Allied Health Calgary Zone Document November 15 2005 REV December 2012 Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 21 Self Test Section Three 1 The normal response of the heart rate to exercise is A No change B Decreases C Increases 2 During exercise your patient s heart rate increases to maximum as set by the therapist What would you do A Call immediately for medical intervention B Continue exercise at the same level C Rest the patient for 3 minutes while monitoring heart rate 3 During exercise your patient s respiratory rate increases above the maximum as set by the therapist What would you do A Explain to the patient that increased respiratory rate is a normal response to exercise while encouraging the patient to continue the exercise program at the same intensity B Rest the patient check SpO and encourage slow deep breaths C Encourage patient to continue the exercise program at the same intensity and document the results in the medical chart 4 What action would you take if during exercise your patient s SpO gt decreases below the range set by the physician A Encourage deep breathing while maintaining the current exercise program B Rest the patient Encourage deep breaths and increase oxygen flow rate if required up to prescribed maximum C Change to a less intense exercise and monitor 5 What should the Therapist
62. t will continue to see patient 5x a week Pt will continue a program of exercises and ambulation as outlined by Physiotherapist F Ixit Therapy Assistant Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 30 Below is an example of an electronic flow sheet from the Calgary Zone A Hollondaise11 Yellow Sunrise Clinical Manager e x PETEN h File Registration Edit view GoTo Actions Preferences Tools Help dP OVARY FRE Gi we inti fed Hollondaise11 Yellow Patient List Orders Results Patient Info Pen Flowsheets Clinical Summary smog Q 2006 0ct 11 This Chart 8 40 b 2006 Oct 11 e E Oxygen Therapy 5 9 Limin 02 Sat 96 92 98 2006 Oct 11 el San 02 Therapy Device Nasal cann Nasal cannu Simple face P POCT Blood Glucose Filter To I mmol L I 1 Room air Ze N NT F earn kg I 4 Venturi device n o o IT 5 Nontebeaher mask Height cm I 6 Simple face mask Flowsheet I 7 Cold nebulizer Clinical Record Flovsheet Gene I 8 High fow nebuizer Intake amp Output FS Generic Head Circumference cm I 9 Other Neurological Observations FS om Pain Assessment FS E Abdominal Gith Abdominal Girth cm em Flowsheet View 10 Summary Totals View Pain Present HHH suondg yde suondg aces euayug 1034 E m m a Unitrn One Generic Registered Nurse CR3TRN37 Master
63. table but this does not affect the regulator function DISCLAIMER Data shown on gauge is for information purposes only The user is responsible for ensuring oxygen therapy and oxygen delivery This product is MR CONDITIONAL outside the MRI bore Allied Health Services Automatically switches to reserve mode at of the full cylinder pressure Audible alert sounds once Content gauge displays the remaining time in minutes and the content in liters The bar graph showing cylinder pressure flashes When the remaining time decreases to less than 15 minutes at the current flow rate e Audible alert sounds Content gauge ceases to display the remaining time Continuous flashing of the hourglass starts WARNING The pressure displayed on the bar graph indicates an empty cylinder CYLINDER IS NEARLY EMPTY VitalAire giem uao April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 37 A Guide to Portable Oxygen Units Filling the portable unit In acute care settings it is best practice to use thermal gloves and eye protection while filling portable liquid oxygen units gt J Ii 1 Clean and dry the fill connectors on both the stationary and portable units to prevent freezing Hold the portable unit with both hands and position the contoured case over the matching recessed area on top of the stationary reservoir Ensure that the fill connectors are properly
64. ted upright Placing a liquid oxygen tank on its side will lead to leakage of liquid oxygen which will cause skin burns and corrosion of building materials like laminate floors or tiles Liquid oxygen tanks must never be placed on a patient s lap or beside them on a stretcher This can result in frostbite to the patient Instruct the patient client and family in the following safety measures as appropriate e Do not use oxygen in the presence of an open flame e Do not smoke around oxygen e Do not wear synthetic fabrics that can build up static electricity e Do not apply oils and petroleum products to the patient s client s face e Do not allow the oxygen tubing to become tangled as this may result in kinks cutting off the oxygen supply e For Home Care clients assess the environment to ensure liquid oxygen storage is available in a well ventilated area away from direct heat or sunlight and properly grounded If storage racks are not available lay compressed gas oxygen cylinders flat when storing them Points of Emphasis e Under no circumstances should a patient be sent from or back to a nursing unit with a low empty portable oxygen source e A portable oxygen source should be assessed for the amount of oxygen before and after treatment to ensure adequate supply A patient must always be provided with enough oxygen to last for the treatment time porter wait time transportation time and any delays after returning to the
65. the guidance of a local educator or designate The practical component may be required yearly at the discretion of Allied Health management Students Students of category 1 staff OT PT SLP and students of category 2 staff Therapist Assistants are able to provide oxygen therapy as set out in the Oxygen Management Allied Health Adult Acute Care Inpatients Guideline under the supervision direct indirect or remote of category 1 staff who have demonstrated oxygen therapy competency The category 1 supervisor is responsible for determining the competence of the student with respect to knowledge and skill in providing oxygen therapy and for providing the appropriate amount and type of supervision Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff Learning Objectives On completion of the learning module the learner will be able to OSE Gh 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Differentiate between ventilation internal respiration and external respiration Identify the major muscles of respiration Identify factors affecting external and internal respiration Define hypoxemia and hypoxia Identify the conditions and indications for oxygen therapy Identify the dangers problems and contraindications for oxygen Identify the normal response to physical activity Identify the communication components needed for safe assignment o
66. the handle of the regulator as much as you can to get a good seal but don t use a wrench To turn cylinder on e Place the wrench on the cylinder valve and turn it counter clockwise until it is fully open then back it off 1 4 turn e Observe the cylinder pressure gauge A full cylinder will read about 2200 psi e Check the cylinder duration chart to ensure that there is enough oxygen to last as long as you require see below Duration chart for compressed gas portable oxygen cylinders calculation assumes that cyli 500 2200psi full 1600psi 3 4 full 1100 psi 1 2 full 4 hours 2 hours 30 min 1 hour 25 min 2 hours 50 min 1 hour 45 min 56 min 2 hours in in 6 LPM 1 hour 20 min 51 min 28 min 7 LPM 1 hour 10 min 24 min a 8 LPM 1 hour 21 min 9 LPM 53 min 19 min E i 11 LPM e Turn the handle to obtain the desired flow rate To turn cylinder off e Place wrench on cylinder valve and turn clockwise until off e When the needle in the pressure gauge is at zero ball in flow litre gauge will fall to zero Turn flow litre control knob to off e Tear off the lower section of the label to indicate that the cylinder is IN USE e A cylinder should be changed when the pressure gauge reaches 500 psi and enters the red zone To indicate the cylinder is EMPTY tear off the remaining section of the label Cylinders should be stored
67. ts SpO 92 to 98 will achieve this goal For COPD patients with hypoventilation a target SpO of 88 to 92 may be ordered to prevent further increases in PaCO In circumstances where there is not an oxygen order in place category 1 health care professionals may initiate oxygen based on their assessment of the patient s condition Consultation and an oxygen order for further oxygen therapy shall be obtained as soon as possible Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 1S Self Test Section Two 1 Every patient needs to have SpO gt greater than 92 A True B False 2 Indications for oxygen in the acute care setting include A Hypoxemia Yes No B To decrease the work of breathing Yes No C To decrease myocardial work Yes No 3 COPD patients may have an acceptable oxygen saturation of 88 A True B False Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 16 Section Three Activity and Oxygen Learning Objectives Upon completion of this section the learner will be able to 7 Identify the normal response to physical activity 8 Identify the communication components needed for safe assignment of patients with oxygen to a category 2 staff member Activity and Oxygen Endurance is the ability to work for a prolonged period of time and resist fatigue Endurance is dependent on an individual s oxygen t
68. unit before being returned to the wall supply e If there is an inadequate supply replace with a full tank e Always test that the system is intact and you can feel flow coming out of the nozzle when turning the oxygen tank on e Prior to reattaching to the wall outlet ensure the proper oxygen flow rate e Always ensure the correct flow rate is set on the portable oxygen source If your patient is on 2 5lpm and the tank gauge has settings for 2 Ipm or 3 Ipm you would place them on 3lpm for the duration of using the tank Remember when they go back onto wall Oxygen at 2 5 Ipm they need to be monitored to ensure they can tolerate the decrease in oxygen See Section 3 for details e An additional source of oxygen should be available for all high risk patients If a patient arrives in the department or is found on the unit connected to an empty tank complete a Patient Safety Learning Report through the Reporting and Learning System RLS after ensuring that the patient has a new oxygen tank To determine oxygen duration using the Grab nGo oxygen tank refer to the chart on the next page For example e If the needle is at 1800 psi and your patient is on 3 liters per minute flow the tank will last approximately 136 minutes e If the needle is at 800 psi and your patient is on 3 liters per minute flow the tank will last only 31 minutes Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 34 Ne
69. upright secured in a stand or lying horizontally DO NOT store under the Total Care beds April 7 2015 35 Oxygen Therapy Learning Module for Category 1 and 2 Staff l ntel i n ox TRAINING INSTRUCTIONS Valve instructions Before connection check The bar graph pressure 4 e The contents gauge liters Connect according to use Connect the tube to the nipple outlet B Or connect the appropriate equipment to the 50 psi DISS connection Using the cylinder Adjust the dial Oro the required flow rate if the nipple outlet 6 is used After each use e Turn the cylinder off by setting the flow rate to 0 litre min dial 0 Remove the tubing or the equipment if necessary Filling outlet DO NOT USE WARNING If the dial is set between two flow rate values the flow will stop 2 IMPORTANT Refer to EZ OX Plus brochure for further handling storage amp maintenance Contents Gauge instructions When the cylinder s not in use e Pressure is displayed on the bar graph Contents are shown in liters When a change in flow rate is detected the gauge enters the calculation mode When the cylinder is in use Pressure is displayed on the bar graph e Remaining time at the set flow rate is displayed in hours minutes Flashing hourglass NB Time remaining is updated periodically Adjust flowrate to force an update When the flow rate is low or intermittent the contents display can be uns
70. urate measurement will occur Respiratory rate should increase during exercise e Respiratory Pattern o Normal breathing Upper chest thoracic or abdominal diaphragmatic pattern Upper chest the thorax elevates and expands during inspiration and the abdomen remains relatively motionless Abdominal during inspiration the abdomen expands and the thorax remains relatively motionless o Abnormal Breathing Excessive accessory muscle use excessive upper chest motion with increased use of the sternocleidomastoid scalene and other accessory muscles of inspiration Paradoxical breathing pattern is the reverse pattern of normal breathing e Oxygen flow rate or Fraction of inspired Oxygen FiO refer to the section in manual on oxygen equipment page 32 e Oxygen delivery device refer to the section in manual on oxygen delivery devices page 41 e Connection of oxygen delivery device to oxygen source refer to the section in the manual on oxygen equipment page 32 e Saturation of oxygen by pulse oximetry SpO refer to the section in the manual on pulse oximetry page 45 Allied Health Services April 7 2015 Oxygen Therapy Learning Module for Category 1 and 2 Staff 23 e Pulse In most cases the radial pulse is used Two or three fingers not your thumb are placed just lateral to the flexor tendons on the radial side of the wrist Gentle pressure is applied and released until the pulse is palpated and
71. vices Policy and Procedure Manual Oxygen Therapy Clin 022 Oxygen Management Allied Health Adult Acute Care Inpatients Guideline Chung F Reid W D 2004 Cardiopulmonary Physical Therapy SLACK Incorporated New Jersey DeTurk W E Cahalin L P 2004 Cardiovascular and Pulmonary Physical Therapy An Evidence Based Approach McGraw Hill Companies Inc USA Fearnley S J 1995 Update in Anesthesia Practical procedures Issue 5 Fisher and Paykel Optiflow Retrieved from the Calgary Zone Respiratory Services Webpage May 2013 Frownfelter D L Dean Elizabeth Cardiovascular and Pulmonary Physical Therapy 2006 Mosby Inc Grap Mary Jo 2002 Pulse Oximetry Critical Care Nurse 22 3 69 76 Hill E Stoneham M D 2008 Update in Anesthesia 24 2 156 159 Howell M The correct use of pulse oximetry in measuring oxygen status Professional Nurse 2002 Mar 17 7 416 418 Ingrassia TS III et al 1991 Oxygen Exacerbated Bleomycin Pulmonary Toxicity Mayo Clin Proc 66 173 178 Kisner C Colby L A 1990 Therapeutic Exercise Foundations and Techniques Davis and Co Philadelphia PA Praxair Grab N Go Operating Instructions Booklet B20442 ECN 13275 05 04 Schnell H Puntillo K Critical Care Nursing Secrets 201 Hanley and Belfus Incorporated Sherman B et al 1999 Assessment of dysphagia with the use of pulse oximetry Dysphagia 14 3 152 6 25 UAB Health System Signs of Respiratory Distress www hea
72. w All In One Portable Oxygen Cylinder Praxair Vantage l Grab nGo Never search for a cylinder regulator again Never worry about removing or attaching a cylinder regulator again No cylinder wrench No problem you won t need one Available flow rates of 0 5 to 25 LPM Other flow rates available with respiratory or physician consult How to Use the Grab nGo Portable Oxygen Cylinder Ensure adequate amount of oxygen check pressure gauge Attach O2 tubing to outlet port Turn flow adjusting knob to desired flow setting Verify flow at the patient s end of the tubing before applying on patient When patient is returned to wall oxygen ensure flow adjusting knob is turned to the OFF position Flow Rates Available on the Grab nGo Litres Per Minute os 10 is 20 30 40 60 80 15 E Size Oxygen Cylinder Duration Chart in Minutes Cylinder Pressure PS Flow LPM 2200 2000 1800 1600 1400 1200 1000 800 600 500 OS 1066 41 BIS 690 S6 439 314 188 63 o0 1 33 470 48 345 22 220 157 A a o 1S 355 Z 34 30M2 2o i88 i o 3 A o0 2 27 235 2 172 It no 7 47 16 o 3 17 46157 6 S A B 52 31 0 o 4 133 8 102 8 7 ss 39 e o NEVER attach an 6 89 78 68 57 47 37 26 16 5 0 oxygen connector 8 6 9 SI 43 35 mama ot 4 0 Christmas tree to is 36 3i 7 23 19 1S 10 6 2 0 the Auxiliary Port 2 2 19 16 14 T 9 6 4 1 0 When you first use the Grab nGo tear off the lower section of the labe
73. y of the information Alberta Health Services does not make any representation or warranty express implied or statutory as to the accuracy reliability completeness applicability or fitness for a particular purpose of such information This material is not a substitute for the advice of a qualified health professional Alberta Health Services expressly disclaims all liability for the use of these materials and for any claims actions demands or suits arising from such use Allied Health Services April 7 2015 Oxygen Thera Table of Contents Introduction c cece cece eee Purpose of Education py Learning Module for Category 1 and 2 Staff Learming OBJectivess uc veik iiescu tic E ieee es EEA and be desea hid eacew eh A AEEA OE EO deeb eden Learning Resources Definitions and Abbreviations Instructions for Completion Section One Respiratory Physiology and Anatomy cece ece eee ece ese ec cece eeeeeeeneees Section Two Role of Oxygen Thera Section Three Activity and Oxygen py in the Acute Care Setting c cece cece ence eee eens Section Four Physical Assessment and Signs and Symptoms of Respiratory Distress Section Five Determination of Level of Risk and Documentation ccc ccc cece cece cee Section Six Oxygen Equipment Section Seven Oxygen Delivery System ccc cece cece eee

Oxygen Therapy Learning Module Cat.1 and 2, 2015

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