Chapter 25: Concepts of Care for Patients Requiring Oxygen Therapy or Tracheostomy

Oxygen serves as both a therapeutic agent and a pharmaceutical intervention, prescribed when hypoxemia or tissue hypoxia develops due to respiratory or cardiac pathology. Nurses must understand the physiological mechanisms of gas exchange and apply evidence-based assessment techniques including arterial blood gas analysis and pulse oximetry to determine oxygen requirements and evaluate treatment effectiveness. The fundamental nursing goal involves delivering the minimum fraction of inspired oxygen necessary to maintain adequate tissue oxygenation while minimizing iatrogenic complications such as oxygen toxicity, absorptive atelectasis, mucous membrane desiccation, and infection from contaminated delivery equipment. The chapter delineates distinct oxygen delivery systems categorized as low-flow and high-flow devices, with low-flow systems including nasal cannulas and various mask types delivering 24 to 95 percent oxygen concentrations depending on flow rates, while high-flow systems such as Venturi masks, high-flow nasal cannulas, and aerosol delivery mechanisms provide precise controlled concentrations up to 100 percent with integrated humidification for critically ill populations. Noninvasive positive-pressure ventilation modes including continuous positive airway pressure and bilevel positive airway pressure improve alveolar recruitment and reduce mechanical ventilation requirements. Home oxygen therapy necessitates patient and caregiver education regarding equipment operation, maintenance protocols, and critical safety measures including smoking prohibition near oxygen sources. The tracheostomy portion addresses surgical creation indications such as airway obstruction, facial trauma, and prolonged mechanical ventilation support, along with comprehensive postoperative and chronic management strategies. Essential nursing interventions encompass respiratory monitoring, humidification maintenance, secure tube fixation, sterile suctioning technique with appropriate duration limitations, cuff pressure management within therapeutic ranges to prevent tracheal stenosis, and meticulous wound care. The chapter emphasizes psychosocial support and interprofessional collaboration involving respiratory therapy, nutrition services, speech pathology, and home health nursing to facilitate patient adaptation, communication strategies, self-care competency, and successful community reintegration following discharge.