[Verified Answer]: Many of the clients you encounter will…

Many of the clients you encounter will require the use of oxygen (O2) as part of their treatment.Oxygen is a gas that is vital to life without it, tissue cells can die in four to six minutes. Withproper handling and storage techniques, it is a safe and effective therapy.How is it decided that a client requires oxygen?Oxygen must be prescribed by a physician and is therefore treated like a drug: the PSW may notadminister Oxygen; however, they may assist clients with their therapy. If the PSW should haveany questions or concerns, they should immediately notify their supervisor.In order to decide whether or not a client will require Oxygen therapy, several factors must beconsidered. The first thing is the clients oxygen saturation (you might hear this called the O2sat). A special monitor is attached to a clients finger or toe, and a sensor measures how muchoxygen is in the blood (how much oxygen has saturated the blood). This measurement is readas a percentage. Most healthy people have an O2 sat in the high nineties to 100 range. Anythingconsistently below 90% is usually a sign that the client will need O2 therapy.Chronic breathing illnesses causing lung damage, like Bronchitis, or COPD (chronic obstructivepulmonary disease), as well as cigarette smoking, are major causes of low O2 sats. These clientsare usually placed on long-term, continuous O2 therapy.Sometimes people are admitted to hospital with a breathing crisis, such as pneumonia oranother respiratory infection. Their O2 sat would be low and O2 immediately given. This is notconsidered long term therapy because once the crisis is over, their O2 sat should recover and,therefore, the need for oxygen will be gone.It is important to remember that every client is different and will be prescribed oxygen therapyon an individual basis. The PSWs observations and input regarding the clients status and howwell they manage their treatment are key factors in the successful use of O2 therapy.© N A C C P S W D E 2 0 2 2 Section IV. Module 12. Health Conditions 2 | 11What is the difference between intermittent and continuous therapy?Intermittent therapy is used only when the clients symptoms require it. An example of thismight be when a client becomes short of breath after activity. At rest, they dont require O2.However, the activity will increase their need for it.Continuous therapy is used when clients require O2 24 hours a day. Usually, these clients havea chronic type of respiratory illness that results in a low O2 saturation. They will generally feeltired, sluggish, and have a low activity tolerance all of these should stabilize as treatmentprogresses.Always remember that the client with breathing difficulties may have a tendency to besomewhat anxious, which can, in turn, increase shortness of breath! Many state they feel liketheyre suffocating, or that something bad is going to happen to them. Oxygen therapy can bevery reassuring to them. Support from the PSW is a vital part of the therapy. Helping to keepcalm, staying with them, and making sure they are using the equipment safely are part of thePSW role.Who decides how much oxygen a client receives?Again, because oxygen is considered a drug, the physician not only decides what type oftherapy the client receives, but also how much.Oxygen is delivered at a specific flow rate. This flow rate is measured in liters per minute(L/min). All oxygen is turned on, and then the flow meter is dialed to the appropriate number(e.g. a client is prescribed 2L/min per NP). Clients and family members are instructed on how touse and regulate the flow meter.It is important to understand that the PSWs role is only to assist with this aspect of oxygentherapy. The PSW should never adjust or prescribe a different flow rate. Many clients andfamily members will ask the PSW to do this for a good number of reasons. They might say, butIm so short of breath. If the 2L isnt helping me, shouldnt I try the 3L? Its not much more! Ifthe family or PSW has concerns regarding the clients breathing status, they should notify thedoctor and nursing supervisor immediately.How is oxygen supplied to the client?Several different methods are used. In some facilities, there will be a central storage area foroxygen, and the users simply plug their O2 tubing into a wall outlet. This is not practical in asmaller facility or in a private home.© N A C C P S W D E 2 0 2 2 Section IV. Module 12. Health Conditions 3 | 11Portable oxygen tanks (cylinders) are an option when your client is mobile. Large tanks areavailable for use inside the home/facility. Long, extendable tubing is attached so that the clientmay freely move about the area. Caution should be used to avoid tripping over the tubing!When clients wish to venture to another location outside of the home/facility, smaller, portablecylinders are available. These cylinders may be moved on a cart or carried in a special carryingdevice. They dont last as long as the larger cylinders, but do give clients the freedom to travel,keep appointments, and escape the four walls of their home! These small cylinders are alsohandy in an emergency situation, or whenever a client is being moved from one area toanother.It is important to note that the oxygen we have been discussing has been in the form of gas.Liquid oxygen is also available. Large canisters (similar to tanks) are used to store the cold (-294degrees F) liquid oxygen. The client and family may be trained to fill smaller, portable canistersfrom a larger, main unit. The O2 supplier would be scheduled to refill the main unit on a regularbasis.Perhaps the most cost-efficient and commonly used system in the community is the oxygenconcentrator. It is an electrical device that takes room air, extracts the oxygen, and delivers itto the patient. Since it is powered by electricity and is not portable, the client should have analternate source of O2 available (such as a canister of O2). The backup system could be used inthe event of a power failure, or if they wish to leave the home and must keep their oxygen on.Lengthy O2 tubing could be attached to the concentrator to allow the client mobility withintheir home.Some clients may be concerned about the added cost of electricity on their monthly hydro bill.Using the current rate, the cost for one client on 24hr/day O2 concentrator therapy wouldamount to approximately $260.00 per year, or approximately $21.60 per month. This can be aburden to someone who is living on a fixed income. The Assistive Devices Program is designedto help clients cope with the added financial burden by providing partial or full financialassistance.How does the oxygen get from the source to the client?Before the oxygen reaches the client a couple of things must happen first. Think about therespiratory system: what happens to the air you breathe before it gets in your lungs? First, thelittle hairs in your nose and bronchus filter out many of the microscopic particles of dirt andother materials. Second, the air is warmed and moistened by passing over the mucousmembranes that line the structures of the respiratory system.Since we are not using room air in most cases, the oxygen the client receives has no real needto be filtered, because the oxygen concentrator will filter the room air before delivering it to© N A C C P S W D E 2 0 2 2 Section IV. Module 12. Health Conditions 4 | 11the client. However, the oxygen remains very dry and needs to have some humidity added to it.This procedure is usually done by attaching a humidifier (water bottle) to the oxygen sourcebefore the oxygen is sent through the tubing. This way, the client receives oxygen that hasalready been moistened.Note: It is important to remember that even though this humidity has been added, O2 canstill be very drying to the clients mucous membranes. This may result in complaining of a drynose, sore nose, nosebleeds, or a dry mouth. It is important that these complaints be listenedto: if we ignore them, the client is less likely to be compliant with their treatment. Dealing withthese problems will be discussed later on in this assignment.There are two main ways to get the oxygen to the client. The first method is by using a facemask. This mask should cover both the nose and mouth. Small holes on the sides of the maskallow CO2 (Carbon dioxide a waste material from breathing) to escape when the clientbreathes out, and room air to enter when the client breathes in.The face mask has a tendency to be uncomfortable for some clients. Some people find thepressure from the mask constantly on their skin very bothersome. Others find that having themask on their face feels as if they are going to suffocate. The mask will also interfere with apersons eating, drinking, and conversation. It is beneficial for clients who are on a high-flowrate of O2.In some cases, a special colour-coded plastic device at the base of the tubing will determine thepercentage of O2 that the client receives. This will be ordered by the physician and is not to bedetermined by the PSW. The PSWs role is to follow the clients normal routine for oxygen use.If this routine changes, they should notify their supervisor.The second method used in nasal cannula: these are often referred to as nasal prongs, NP forshort. This is the most widely used method. This device will look like a very long piece of oxygentubing with two little prongs sticking out. These two prongs will curve slightly and should beplaced in the nostrils (nares) so that the prongs point downward otherwise, it will be veryuncomfortable and irritating for your client and may hamper the flow of oxygen. The tubing isthen placed behind the ears to hold the prongs in place. A small, sliding plastic holder can beslid up the neck portion of the tubing to secure the prongs in place, much like a hat that fitsunder the chin. Some clients prefer the tubing to be placed behind their head, going down theirback: this would be most comfortable for clients who are immobile.Nasal cannulas allow a great deal more freedom than a mask. A client would be free to wander,eat, drink, talk, and complete their ADLs. By attaching one or more pieces of extension tubingto the cannula, you can allow the client to go further distance. Caution should be used with theuse of canes and walkers you dont want them to get tangles in the tubing! Tubing may bepinned or taped to the clients clothing to keep it free of kinks and from getting in the way.© N A C C P S W D E 2 0 2 2 Section IV. Module 12. Health Conditions 5 | 11Although cannulas are used with lower flow rates of O2, clients may still complain of the dryingeffects. They may also complain of irritation from the tubing on the face or behind the ears.This can be dealt with by gently padding the area with some gauze.It is important to understand that although clients are prescribed continuous O2 therapy, theywill not die if they go without it for a short while. Many clients will have their face mask or nasalprongs fall off while they are asleep and not notice until a couple of hours later. Removing theoxygen while they dress, or bathe is generally not a problem either. Just remember that someclients get extremely anxious, and the PSW should be there to support and reassure them.What do I need to know to handle oxygen safely?The greatest risk that O2 use presents is that of fire. Although O2 itself will not burn, it will helpor accelerate other materials to do so. In fact, a fire will generally not continue without thepresence of oxygen. Listed below are some of the safety measures that can be used by theclient/family/PSW:1. Any flammable materials and/or heating sources should be kept a minimum of 5-10feet away from O2 equipment. Such items may include curling irons, heating pads, hairdryers, electric blankets, and electric razors.2. Do not attempt to lubricate equipment. Leave this for the professionals! Oil and grease-based lubricants easily explode. Also, aerosolized sprays often contain particles that canbe dangerous if inhaled by a client with breathing difficulties.3. Avoid the use of aerosol sprays around oxygen equipment. These cans are underpressure and can easily explode. Also, aerosolized sprays often contain particles that canbe dangerous if inhaled by a client with breathing difficulties.4. Petroleum based products should be avoided. These include Vaseline (petroleum jelly),Nivea cream, or any combination cream that contains petroleum. Clients may wish touse these products to moisturize areas left dry and irritated by the use of O2 equipment.Water based products can be used as safe alternatives: Muko, KY Jelly, or Secaris can beused inside a dry nose instead of Vaseline. Vaseline Intensive Care Lotion or a similarproduct may be used on other areas.5. Keep all equipment in a well-ventilated area. Doing this will prevent an accumulation ofO2 that could be a fire hazard6. Liquid oxygen units should always be kept airtight. This will prevent an accumulation ofO2 that could be a fire hazard.© N A C C P S W D E 2 0 2 2 Section IV. Module 12. Health Conditions 6 | 117. 8. Oxygen tubing should never be obstructed or kinked. Never place the tubingunderneath carpeting, furniture, blankets, or clothing as this may allow O2 toaccumulate, causing a fire hazard.Use caution when transporting O2. The oxygen supply company should be consulted onhow to safely move O2 cylinders and tanks: this should be reviewed when the O2therapy is initiated. The tanks/cylinders should not be stored in an area withoutventilation, such as the trunk of the car.9. Avoid smoking in the area where the oxygen is being used. Smoking near O2 poses anEXTREME risk for fire, explosion, or injury. The following are some situations you mayencounter:a. b. Client smokes well away from O2 equipment that has been turned off. There isno real immediate hazard with this, but it is possible that the client may forget toturn off the O2 at some point. Be sure to notify your supervisor and documentcarefully.Client smokes with O2 on. This is EXTREMELY dangerous! If the client is doingthis when you arrive for your visit, you MUST ask them to put out their cigarette,etc. If they refused your request, you must leave the premises for your ownsafety. Your supervisor must be notified IMMEDIATELY!c. Client who is cognitively impaired and states that they still smoke while theyare on O2 therapy. As long as the client is not doing this while you are visiting, itis safe for you to stay. However, safety rules should be reviewed with the clientand their family as well as notifying your supervisor.These guidelines also apply to family members and visitors in the home. It is suggested that iffamily or visitors wish to smoke, they do so at least 10 feet from the oxygen even betterwould be to go outside. A warning sign may be obtained from the oxygen supply company andposted on the door to warn all visitors that oxygen is in use.When it comes right down to it, oxygen safety is mostly about common sense. If you are ever indoubt about how to handle a situation, contact your supervisor or even the oxygen supplycompany and ask its advice. Educate yourself about safe handling practices and you will be ableto pass their knowledge along to your clients.This learning package was designed to help you become familiar with the basics of oxygentherapy. If possible, you should try to get some hands-on experience while completing your© N A C C P S W D E 2 0 2 2 Section IV. Module 12. Health Conditions 7 | 11clinical rotation. Be certain to let your instructor and the clinical staff know that you areinterested so they will be on the lookout for learning opportunities for you.The following pages contain your oxygen therapy assignment and are to be completed outsideof classroom time and handed in on the due date given by your instructor. Please keep thisreading assignment in your notes for future reference.© N A C C P S W D E 2 0 2 2 Section IV. Module 12. Health Conditions 8 | 11Oxygen Therapy Hand-in Assignment /301. Define the term oxygen saturation. (1 Mark)__________________________________________________________________________________________________________________________________________________________________________________________________________________2. List two causes that can contribute to a low O2 sat reading. (2 Marks)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3. Define the term continuous oxygen therapy and explain why it is beneficial for peoplewith chronic breathing difficulties. (2 Marks)______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4. Why is humidity added to the oxygen source before it is breathed by the client? (1 Mark)__________________________________________________________________________________________________________________________________________________________________________________________________________________© N A C C P S W D E 2 0 2 2 Section IV. Module 12. Health Conditions 9 | 115. You are assigned to Mr. Cy Hendriks to provide assistance with ADLs. This client hasemphysema and there is oxygen equipment in the home. While preparing to assist himwith his morning bath, you notice that he smells of cigarette smoke, although you dontnotice any cigarettes or ashtrays nearby. How would you proceed with this situation? (3Marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________6. List two possible hazards that occur when clients/family members smoke near oxygen.Describe two actions the PSW could take to avoid these hazards in the workplace andensure their safety as well as the clients. (4 Marks)Hazard one_____________________________________________________________________________________________________________________Hazard two_____________________________________________________________________________________________________________________Actions________________________________________________________________________________________________________________________7. What is the PSWs role regarding the clients use of oxygen therapy? (1 Mark)__________________________________________________________________________________________________________________________________________© N A C C P S W D E 2 0 2 2 Section IV. Module 12. Health Conditions 10 | 118. During your home visit with Mrs. Emma Rock, she complains that the nasal cannula she hasbeen wearing is irritating her cheeks and behind her ears. What are two ways the PSWcould assist her? (2 Marks)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________9. Name two products that should be avoided when a client is using oxygen. For each productname a safer alternative. (4 Marks)Product to be avoided Alternative product10. List three ways that oxygen may be supplied to the client. (3 Marks)______________________, ____________________, ____________________11. When clients have dyspnea (difficult or painful breathing), they are often anxious andupset. What are two interventions the PSW could do to help reduce their anxiety? (2Marks)________________________________, _______________________________12. Name three breathing illnesses that may require the client to use oxygen on either atemporary or continuous basis. (3 Marks)____________________, ____________________, _____________________13. Your client complains he is SOB and asks you, his PSW, to turn their oxygen up just a bit.The oxygen is currently running at the prescribed amount of 3L per minute. How do yourespond to your client? (2 Marks)___________________________________________________________