Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
COLLEGE OF HEALTH SCIENCES
Name: ________________________________ Rating: ________________________
Year and Section: _______________________ Group: ________ Date: _________
PROCEDURE CHECKLIST:
ADMINISTERING OXYGEN BY CANNULA AND FACEMASK
Instruction: Below is the grading scale which will be used in rating your performance.
5 - Excellent - 95-100
4 - Very Satisfactory - 88-94
3 - Satisfactory - 82-87
2 - Fair - 76-81
1 - Needs Improvement - 70-75
PREPARATION 5 4 3 2 1 Remarks
1. Assess:
Skin and mucous membrane color – note
whether cyanosis is present.
Breathing patterns.
Chest movements.
Lung sounds.
Presence of clinical signs of hypoxemia.
2. Determine:
Vital signs – especially pulse rate and
quality- and respiratory rate, rhythm, and
depth.
Results of diagnostic studies.
Hemoglobin, hematocrit, complete blood
count.
Oxygen saturation levels
3. Assemble equipment
Cannula
Oxygen supply with a flow meter and
adapter.
Humidifier with distilled water or tap water
according to agency protocol.
Nasal cannula and tubing
Tape
Padding for the elastic band
Facemask
Oxygen supply with a flow meter and adapter
Humidifier with distilled water or tap water,
according to agency protocol.
Prescribed face mask of the appropriate size
Padding for the elastic band
4. Determine
Need for oxygen therapy.
Verify order for therapy.
Perform a respiratory assessment to develop
baseline data, if not already available.
5. Assist the client to a semi-Fowler’s position, if
possible.
6. Explain that oxygen is not dangerous when
safety precautions are observed. Inform the
client and support people about the safety
precautions connected with oxygen use.
PROCEDURE
1. Introduce yourself and verify the client’s
identity. Explain to the client what you are
going to do, why it is necessary, and how the
client can cooperate.
2. Perform hand hygiene and observe other
appropriate infection control procedures.
3. Provide for client privacy, if appropriate.
4. Set up the oxygen equipment and
the humidifier.
Attach the flow meter to the wall outlet or tank.
The flow meter should be in the OFF position.
If needed, fill the humidifier bottle.
Attach the humidifier bottle to the base of the flow
meter.
Attached the prescribed oxygen tubing and
delivery device to the humidifier.
5. Turn on the oxygen at the prescribed rate, and
ensure proper functioning
Check that the oxygen is flowing freely through
the tubing. There should be no kinks in the tubing,
and the connections should be airtight. There
should be bubbles in the humidifier as the oxygen
flows through. You should feel the oxygen at the
outlets of the cannula and mask.
Set the oxygen at the flow rate ordered.
6. Apply the appropriate oxygen delivery device
Cannula
Put the cannula over the client’s face, with the
outlet prongs fitting into the nares and the elastic
band around the head.
If the cannula will not stay in place, tape it at the
sides of the face.
Pad the tubing and band over the ears and
cheekbones as needed.
Facemask
Guide the mask toward the client’s face, and
apply it from the nose downward.
Fit the mask to the contours of the client’s face.
Secure the elastic band around the client’s head
so that the mask is comfortable but snug.
Pad the band behind the ears and over bony
prominences.
7. Assess the client regularly
Assess the client’s vital signs, level of anxiety,
color, and ease of respirations, and provide
support while the client adjusts to the device.
Assess the client in 15-30 minutes, depending on
the client’s condition, and regularly thereafter.
Assess the client regularly for clinical signs of
hypoxia, tachycardia, confusion, dyspnea,
restlessness, and cyanosis. Review arterial blood
gas results, if they are available.
Nasal Cannula
Assess the client’s nares for encrustations and
irritations. Apply a water-soluble lubricant as
required to soothe the mucous membranes.
Assess the top of the client’s ears for any sign of
irritation from the cannula strap. If irritation is
present, padding with a gauze pad helps relieve
discomfort
Facemask
Inspect the facial skin frequently for dampness or
chafing, and dry and treat it as needed.
8. Inspect the equipment on a regular basis
Check the liter flow and the level and the level of
water in the humidifier in 30 minutes and
whenever providing care to the client.
Be sure that the water is not collecting in
dependent loops of the tubing.
Make sure that the safety precautions are being
followed.
9. Document findings in the client record.
Date ________________________________
Clinical Instructor ______________________
