| 👀 Tracheostomy Care – Managing tracheostomy and preventing infections 👀 Suctioning – Procedures for secretion removal and safe execution 👀 Oxygen Therapy – Proper oxygen usage and application to patients (Nasal Cannula, Simple Oxygen Mask, and Partial Rebreather Mask) 👀 Nebulizer Therapy – How to use nebulizers for drug delivery and their application |
Scene: Applying a Partial Rebreathing Mask for Oxygen Therapy
Nurse:
Good morning, Ms. Brown. My name is Emily, and I’ll be your nurse today. Your physician has prescribed oxygen therapy using a partial rebreathing mask to help support your breathing and increase the oxygen level in your blood. I’ll explain everything step by step so you know what to expect. Please let me know immediately if you feel any discomfort at any point during the process.
Patient:
Good morning, Emily. Thank you. I’ve never used this type of mask before. Is it hard to wear or uncomfortable?
Nurse:
That’s a very good question. This mask is designed to deliver a high concentration of oxygen comfortably. It’s a bit different from the nasal cannula or simple oxygen mask, but it’s still quite tolerable for most patients. I’ll make sure it fits properly and feels secure without being too tight.
Before we begin, could you sit up a little in bed? The best position for this therapy is called the semi-Fowler’s position. It means sitting at a 30- to 45-degree angle, with your back supported. This position helps your lungs expand and allows the oxygen to reach deeper into your lungs.
Patient:
Sure. How about this? Is this the right position?
Nurse:
Yes, that’s perfect. Your position looks good, and it will help optimize the effectiveness of the therapy. Now, I’ll go ahead and prepare the oxygen equipment.
Procedure Preparation
(Nurse performs hand hygiene and gathers all necessary supplies: a partial rebreathing mask with reservoir bag, oxygen tubing, and checks the oxygen flowmeter on the wall unit.)
Nurse:
I’m now connecting the oxygen tubing to the wall outlet and attaching it to the partial rebreathing mask. This type of mask includes a soft plastic reservoir bag attached to the bottom. I’ll also check that the flowmeter is set to the prescribed rate of 8 liters per minute, which typically delivers an oxygen concentration between 60% and 90%. This range is much higher than what you get with a nasal cannula or simple mask.
Patient:
I see. What’s the purpose of that bag attached to the mask?
Nurse:
That’s a great question. The reservoir bag stores a portion of the oxygen you exhale, which still contains a higher amount of oxygen than room air. During your next inhalation, you’ll re-breathe this enriched air along with the new oxygen from the tank. This design increases the amount of oxygen you receive with each breath, which is especially helpful for patients with low oxygen saturation.
Let me quickly block the mask’s opening for a moment so the reservoir bag can inflate to about two-thirds full. That’s the recommended inflation level before placing it on your face. (Nurse ensures the reservoir bag inflates properly.)
Applying the Mask
Nurse:
Now I’ll gently place the mask over your nose and mouth. I’ll loop the elastic strap around the back of your head to keep it in place. Let me know if the strap feels too tight or uncomfortable—I can adjust it right away.
(Nurse places the mask and adjusts the strap to a comfortable fit.)
Nurse:
Can you take a few slow, deep breaths for me? Just inhale normally through your nose or mouth, whichever feels most natural for you.
Patient:
Sure. It feels okay so far. I hear a kind of hissing sound when I breathe in. Is that normal?
Nurse:
Yes, that’s completely normal. What you’re hearing is the sound of oxygen flowing through the mask and into the reservoir bag. It’s a good sign that the equipment is working properly. The sound may be more noticeable at first, but most people get used to it quickly.
If you start to feel any tightness, pressure, or irritation around your face, let me know so I can make adjustments. Also, if you feel lightheaded, short of breath, or too warm or cold, please press the call button. These could be signs that we need to reassess the therapy.
Monitoring and Reassurance
Nurse:
Now, I’ll place a pulse oximeter on your finger. This non-invasive device will allow us to continuously monitor your oxygen saturation level, or SpO₂, as well as your pulse rate. We aim to keep your oxygen saturation above 92%, unless your doctor has recommended a different target range.
(Nurse places the pulse oximeter and waits for readings to stabilize.)
Nurse:
Your oxygen level looks good right now. I’ll continue checking it periodically throughout your therapy session to ensure the oxygen is working effectively. We’ll also listen to your lung sounds and assess your respiratory effort as needed.
Patient:
Is there anything I should be doing—or not doing—while wearing this?
Nurse:
Yes, there are a few important safety and comfort tips. First, try not to touch or adjust the mask or tubing on your own. Even a small shift can reduce the effectiveness of the oxygen delivery or cause skin irritation. If something feels uncomfortable, let me know, and I’ll help.
Second, keep an eye on the reservoir bag. It should remain at least partially inflated while you’re breathing. If it completely deflates, that means you’re not receiving the full oxygen dose, and you should call for assistance immediately.
Also, please remember: Do not smoke or go near open flames while using oxygen therapy. Oxygen is highly flammable and even a small spark could cause a fire. We also ask family members and visitors to follow the same precautions when near oxygen equipment.
Patient:
Understood. How long will I need to wear this mask?
Nurse:
That depends on how well your oxygen levels respond. For some patients, the need for oxygen is temporary, while others may require it for a longer period, especially during recovery from respiratory illness or surgery. Your physician will review your progress and determine the next steps—whether to reduce the oxygen flow, switch to another device, or stop therapy altogether.
Ongoing Care and Documentation
Nurse:
For now, I’ll be checking on you again in about 30 minutes to reassess your oxygen levels, inspect the equipment, and make sure you’re still comfortable. I’ll also be documenting everything in your medical record—including the type of oxygen delivery device used, the flow rate, the oxygen saturation readings, your tolerance to the mask, and any changes in your condition.
If you need anything before I return, just press the call button, and I’ll come right away.
Patient:
Thank you, Sarah. I appreciate the detailed explanation. I feel more at ease now.
Nurse:
You’re very welcome, Ms. Brown. You’re doing a great job. I’ll be nearby if you need anything at all.
Educational Notes for Nursing Students:
- Device Description: A partial rebreathing mask delivers higher concentrations of oxygen (60–90%) than a simple mask or nasal cannula. It includes a reservoir bag without one-way valves.
- Flow Rate: Minimum 6–10 L/min to prevent CO₂ buildup in the reservoir bag.
- Monitoring: Use pulse oximetry to assess SpO₂ and track response to therapy. Watch for signs of hypoxia or respiratory distress.
- Safety Precautions:
- Never allow the reservoir bag to deflate fully.
- Educate patients and families about fire risks.
- Ensure no kinks or disconnections in tubing.
- Patient Comfort:
- Regularly check for skin pressure or breakdown around ears, cheeks, and nose.
- Adjust mask fit as needed.
- Documentation:
- Type of mask, flow rate, SpO₂ readings, patient tolerance, and any adverse events or adjustments made.
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