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Concentrator Oxygen Therapy
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* Indicates required question
First name-Last name
*
Your answer
Verification
*
Did you check the most recent CXR to verify tube placement and notify the nurse that your are performing Airway Management?
Choose
Yes
No
PPE
*
Personal Protection Equipment. Did you use universal precautions, wash your hands, glove and wear eye protection for this procedure?
Choose
Yes
No
Is the electrical plug healthy
*
Yes
No - will arrange for repair
Other:
Wipe down concentrator. Is the concentrator look clean?
*
Yes
No - will educate user of 02 concentrator hygiene
Other:
Does 02 humidifier look healthy
*
yes
No - will arrange for repair
Other:
Check 02 connections for heath of the 02 interface
*
Appears Healthy
No-Changed out
Other:
Explain
*
Did you explain this procedure to the patient and the family if the family was in the room during this procedure?
Choose
Yes
No
Suction
*
Did you suction the patient?
Choose
Yes
No
Position Pt.
*
Did you place the patient in semi fowlers?
Choose
Yes
No
Oral Care
*
Did you perform oral care on the patient?
Choose
Yes
No
Breath Sounds
*
Listen to breath sounds and chart below
Your answer
Sputum
*
Chart Sputum Production Below
Your answer
Cough
*
Chart cough effort below
Your answer
Interface
*
What type of 02 interface does the patient have?
Choose
Cannula
Simple Mask
Venti Mask
Non Rebreather
Aerosol Mask
Other
02 Flow
*
What is the 02 flow
Choose
1 LPM
2 LPM
3 LPM
4 LPM
5 LPM
6 LPM
7-10 LPM
10-15 LPM
Flush
Other
Sp02
*
Chart SP02
Your answer
Skin
*
Did you need to notify the nurse of face or mouth sores from airway pressure or tape skin damage?
Choose
Yes
No
Notify
*
Did you notify the nurse/M.D. of the results and an make the appropriate respiratory therapy changes?
Choose
Yes
No
Clean Up
*
Did you clean up the mess you made?
Choose
Yes
No
Comments
*
Chart any significant concerns
Your answer
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