Oxygen Use and the CNA

Signs and Symptoms to ReportUnusual skin colorUnusual color of

lips, mucous membranes, nail beds

Cool, clammy skinSlow, rapid

breathingNoisy breathing

Dyspnea or SOBGaspingRalesChoking on

secretionsChanges in mental

statusTachycardia

Patients at risk for Poor OxygenationCardiac diseasePulmonary diseasePostop patientSleep apneaDecreased LOCNeuromuscular diseasesMorbid obesitySevere kyphoscoliosis

Cap RefillGives a quick look into how well oxygen

gets to body tissuesWe first check the color of the nail bedsPress the nail for a few seconds-the skin

underneath blanchesRelease the nail and evaluate how long it

takes to return to normal colorHow long should this take?Can we check Cap Refill through nail polish?

Oxygen TherapySome facilities have oxygen pumped into the room and

others rely on portable devices for providing oxygen to residents.

How and what amount of oxygen a resident receives is decided by the doctorCertain conditions such as COPD can cause a patient to

become compromised when given too much 02. Always follow orders.

Pulse Oximetry is used to measure the level of saturation of hgb with oxygenThis detects changes in the patient’s oxygen levels before

you see outward changes in skin colorIf patient is on oxygen, make sure you document how many

L/min the patient is on

Oxygen Delivery SystemsOxygen may be delivered by nasal cannula

which is a simple way of giving oxygen in which the tubing attaches to an oxygen source and has two prongs that fit in beginning passageway of the nose. For this to benefit the resident, the prongs

must be kept in the nose. There are also different types of mask

which can deliver a greater concentration of oxygen. The mask covers the mouth and nose

NASAL CANNULAThey are easy to set

up and are well tolerated by patients

Usually used with orders for 1 - 6 liters per minute.

A humidifier is used with liter flows > 4 LPM or for patient comfort.

Higher flows can cause nosebleeds and headaches.

Should use “Cannula Cushions” for sore ears.

SIMPLE MASK Flows of 5 - 12 LPM. Liter flow must be at

least 5 LPM to ensure that CO2 is being flushed out of the mask.

Good for patients with blocked nasal passages and mouth breathers.

Guard against aspiration.

A humidifier is optional.

The masks are difficult to tolerate with skin irritation and at meal times.

NON-REBREATHER MASK Delivers FiO2 of 50 -

70%. This mask utilizes 3 one-

way valves and a bag reservoir to supply the highest possible oxygen concentration of any of the masks.

Flow can set to meet the patient’s maximum inspiratory needs and so the bag should not completely deflate on inspiration.

A tight fit is necessary to deliver a high FiO2.

REBREATHER OR PARTIAL REBREATHER MASK Delivers FiO2 40 –

60%Can be achieved by

removing valves from the mask.

Allows for partial re-inhalation of the Carbon Dioxide that is expelled during respiration