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Oxygen Therapy
Indications & Device Selection

Learn when to start oxygen, how to read \( SpO_2 \) and \( FiO_2 \), and how to match the right delivery device to each patient's needs.

NCLEX-RN

What Is Oxygen Therapy?

Oxygen therapy is the delivery of supplemental oxygen at a concentration higher than room air to treat or prevent hypoxemia — low oxygen in the blood.

The goal is to maintain adequate tissue oxygenation using the lowest effective concentration, then wean as the patient improves.

Key Terms

\( SpO_2 \)
Peripheral oxygen saturation measured by pulse oximetry. Normal: 95–100%.
\( PaO_2 \)
Partial pressure of oxygen in arterial blood (ABG). Normal: 80–100 mmHg.
\( FiO_2 \)
Fraction of inspired oxygen delivered, from 0.21 (room air) up to 1.0 (100%).

Reading the Saturation Scale

< 85% 85–89% 90–100% Severe Hypoxemic Target zone Treatment threshold: SpO₂ < 90% SpO₂ scale

When to Start Oxygen

1
Saturation drops: \( SpO_2 < 90\% \) on room air, or \( PaO_2 < 60 \) mmHg on an ABG.
2
Signs of distress: dyspnea, tachypnea, use of accessory muscles, cyanosis, or restlessness.
3
High-risk states: acute MI, shock, severe trauma, carbon monoxide poisoning, or post-anesthesia.

Low-Flow vs High-Flow

Low-FlowHigh-Flow
Flow vs demandBelow patient's need; mixes with room airMeets or exceeds full inspiratory demand
\( FiO_2 \) deliveredVariable, depends on breathingPrecise and consistent
ExamplesNasal cannula, simple maskVenturi mask, high-flow nasal cannula

The Device Ladder

Nasal Cannula 1–6 L/min · 24–44% Simple Mask 6–10 L/min · 40–60% Venturi Mask Precise 24–50% Partial Rebreather 6–11 L/min · 60–75% Non-Rebreather 10–15 L/min · 80–95% Lower FiO₂ Higher FiO₂

The Nasal Cannula

A low-flow device delivering oxygen through two soft prongs in the nostrils. It is comfortable, allows eating and talking, and is the first choice for mild hypoxemia.

Choosing a Device

1
Assess severity. Check \( SpO_2 \), respiratory rate, and work of breathing.
2
Match the target \( FiO_2 \). Mild → nasal cannula; moderate → simple/Venturi mask; severe → non-rebreather.
3
Consider the patient. COPD → Venturi for precise low \( FiO_2 \); comfort/eating → cannula.
4
Reassess and titrate. Recheck \( SpO_2 \) and wean to the lowest effective setting.

Example 1: Mild Hypoxemia

1
Severity: mildly low \( SpO_2 \), no distress.
2
Device: start a nasal cannula at 2 L/min (\( FiO_2 \approx 28\% \)).
3
Reassess: recheck \( SpO_2 \); titrate up to 4 L if still below 94%.

Example 2: COPD Patient

1
Goal: raise \( SpO_2 \) to 88–92%, not higher — avoid blunting respiratory drive.
2
Device: a Venturi mask delivers a precise, fixed \( FiO_2 \) (e.g., 28%).
3
Monitor: watch for drowsiness or rising \( CO_2 \) (oxygen-induced hypoventilation).

Example 3: Emergency

1
Severity: severe hypoxemia with clear distress — needs maximal \( FiO_2 \).
2
Device: apply a non-rebreather mask at 10–15 L/min (\( FiO_2 \) up to ~95%).
3
Verify: ensure the reservoir bag stays inflated and prepare for possible intubation.

Common Mistakes

✕ Over-oxygenating COPD
Aiming for 100% \( SpO_2 \) can suppress respiratory drive and cause \( CO_2 \) retention. Target 88–92%.
✕ Low flow on a mask
Running a simple mask below 6 L/min lets exhaled \( CO_2 \) accumulate in the mask. Always keep flow ≥ 6 L.
✕ Forgetting humidification
Flow above 4 L/min without humidity dries mucosa, causing nosebleeds and discomfort.
✕ Deflated reservoir bag
A non-rebreather bag that collapses on inspiration means flow is too low — the patient isn't getting full \( FiO_2 \).

Device Summary

DeviceFlow\( FiO_2 \)Best For
Nasal cannula1–6 L24–44%Mild, stable
Simple mask6–10 L40–60%Moderate need
Venturi maskFixed24–50%COPD, precision
Partial rebreather6–11 L60–75%Higher need
Non-rebreather10–15 L80–95%Emergency

Question 1 of 5

A nurse notes a patient's \( SpO_2 \) is 88% on room air with mild dyspnea. According to standard practice, this is the threshold to:

Question 2 of 5

Which device delivers a precise, fixed \( FiO_2 \) and is preferred for a COPD patient who retains \( CO_2 \)?

Question 3 of 5

A patient on a nasal cannula at 5 L/min complains of a dry, irritated nose. The nurse's best action is to:

Question 4 of 5

A trauma patient has \( SpO_2 = 76\% \), RR 34, and cyanosis. Which device delivers the highest \( FiO_2 \) and is appropriate now?

Question 5 of 5

The nurse observes that the reservoir bag on a patient's non-rebreather mask collapses during inspiration. This indicates:

Key Takeaways

1
Start oxygen when \( SpO_2 < 90\% \) or there are signs of respiratory distress.
2
Match the device to severity: cannula → masks → non-rebreather.
3
Use a Venturi mask for COPD; target a lower \( SpO_2 \) of 88–92%.
4
Use the lowest effective \( FiO_2 \), add humidity above 4 L/min, and reassess often.
``` I've generated the complete 20-slide deck on **Oxygen Therapy: Indications and Device Selection**. Key features: - **Exact CSS template** copied verbatim with topic-specific SVG additions only - **KaTeX** used throughout for all clinical notation (\( SpO_2 \), \( FiO_2 \), \( PaO_2 \), thresholds) - **Clean SVGs**: minimal title icon, a saturation scale diagram, and a device ladder diagram - **Full structure**: title → concept intro → terms → core rules → low/high-flow distinction → device ladder → application steps → 3 worked examples (mild, COPD, emergency) → mistakes grid → summary table → 5 MCQ assessments → takeaways - **Complete JS**: navigation, keyboard/touch controls, single-attempt MCQs with "✓ Correct!" prepend, accordion behavior, and KaTeX re-render on feedback - **No emojis**, proper semantic HTML, ARIA labels, and full responsive/accessibility compliance