Nursing Management of Patients on Oxygen Therapy and Inhalers

Clinical Principles of Oxygen Therapy

Oxygen is treated clinically as a drug, requiring a clear prescription for flow rate and delivery method. In obstetric and gynecological settings, pregnant women may require supplemental oxygen during acute respiratory distress, severe preeclampsia complications, or maternal hemorrhage to maintain adequate fetal oxygenation. The primary goal is reversing hypoxemia without causing oxygen toxicity or suppressing the respiratory drive in vulnerable patients.

Oxygen Delivery Systems and Equipment Handling

Different clinical scenarios call for specific delivery devices. Low-flow systems like the nasal cannula provide variable FiO2, while high-flow systems like the Venturi mask deliver precise, fixed concentrations.

• Nasal cannula: Delivers low concentrations of oxygen (1-6 liters per minute), allowing the patient to talk and eat easily.
• Simple face mask: Delivers moderate oxygen flows (5-10 liters per minute), useful for short-term therapy.
• Venturi mask: Uses color-coded valves to mix room air with pure oxygen for precise percentages, ideal for chronic conditions.

Always ensure cylinders are secured upright in heavy stands or chained to the wall to prevent tipping. Keep oil, grease, and naked flames far away from oxygen tanks because pure oxygen accelerates combustion violently.

Monitoring and Patient Safety During Oxygen Administration

Continuous observation prevents adverse events during oxygen therapy. Nurses track respiratory rate, depth, effort, and skin color. A pulse oximeter offers a non-invasive way to measure peripheral oxygen saturation (SpO2), though poor peripheral circulation or nail polish can yield false readings.

Mucous membranes dry out quickly under high oxygen flows. Humidification using sterile distilled water through a bubbling bottle helps protect the upper airway when flow rates exceed 4 liters per minute. Regular checks of pressure gauges ensure patients never breathe an empty tank.

Understanding Inhalers and Bronchodilator Therapy

Inhalers deliver medications directly to the respiratory tract, providing rapid relief for bronchospasm. Bronchodilators relax the smooth muscles surrounding the airways, making it easier for air to move in and out.

Two main device categories dominate clinical use:

1. Metered-Dose Inhalers (MDIs): Pressurized canisters that release a specific chemical puff, requiring good hand-breath coordination from the user.
2. Dry Powder Inhalers (DPIs): Breath-activated devices where the patient's own deep inhalation draws the powdered medication into the lungs.

Midwives frequently encounter pregnant women with pre-existing asthma or pregnancy-induced bronchospasm. Keeping their airways open with proper inhaler technique is vital to protect maternal and fetal oxygen supply.

Techniques for Administering Metered-Dose Inhalers and Spacers

Poor technique stops inhaled medications from reaching the small airways. Using a spacer (valved holding chamber) solves coordination problems by trapping the aerosol spray so the patient can inhale it at their own pace.

Steps for MDI administration with a spacer:

1. Check the drug name, expiry date, and dose counter.
2. Shake the canister vigorously for five seconds.
3. Remove the caps from the mouthpiece of both the inhaler and the spacer.
4. Insert the MDI mouthpiece firmly into the rubber end of the spacer.
5. Instruct the patient to sit upright and exhale completely away from the device.
6. Place the spacer mouthpiece gently between the teeth, sealing the lips tightly around it without biting.
7. Depress the canister once to release a puff into the chamber.
8. Breathe in slowly and deeply through the mouth over five seconds. If a whistle sound is heard, the inspiration is too fast.
9. Hold the breath for 10 seconds, or as long as comfortably possible, before breathing out slowly.
10. Wait one full minute if a second puff of the same medication is ordered.

Patient Education and Compliance for Respiratory Care

Many patients struggle with respiratory regimens because inhalers and oxygen setups feel cumbersome. Education must be simple, practical, and reinforced through return demonstrations. Patients using corticosteroid inhalers must rinse their mouths thoroughly with water and spit it out afterward to prevent oral candidiasis (thrush) and hoarseness.

Nurses should establish clear action plans so patients recognize early warning signs of worsening respiratory distress. Adherence improves when patients understand how their devices protect their daily breathing capacity.

Potential Complications and Nursing Interventions

While oxygen and inhalers save lives, they carry specific risks if mismanaged. High concentrations of oxygen given to certain chronic respiratory patients can depress their hypoxic respiratory drive, leading to carbon dioxide narcosis. Oxygen toxicity can also damage delicate alveolar membranes if high fractions are administered over prolonged periods.

Inhaler misuse can cause local irritation, tachycardia from systemic beta-agonist absorption, or fungal infections. Nurses must monitor vital signs regularly, inspect mucous membranes, adjust flow rates within ordered bounds, and report sudden respiratory deterioration without delay.