COPD- 98% O2 sat? - page 2

by payang0722 | 17,732 Views | 13 Comments

Hello everyone, How nice to have an online community like this! Anyway, I worked yesterday (my 3rd.week! I'm surviving) pm shift at the snf. We had a lady who has COPD & complained to me at around 5.30 pm that she can't... Read More


  1. 0
    My apologies I meant pulmonary airways...thanks for providing such great literature to make this "evidence based practice".
  2. 1
    In hospice we use a touch of morphine and anxiolytic to manage symptoms of respiratory distress when people are otherwise stable (and sometimes when they are not). It is important to remember that dyspnea makes people particularly anxious and that sometimes it is necessary to treat that anxiety before we can manage dyspnea very well. I know this is specific to hospice, but it can be helpful even to use non-pharmacologic anxiety management in COPD.
    GreyGull likes this.
  3. 0
    Quote from msnurse14
    My apologies I meant pulmonary airways...thanks for providing such great literature to make this "evidence based practice".
    Extensive research went into those guidelines which are updated frequently just like the AHA does for cardiac issues.

    Many don't realize that the treatment for COPD and Asthma is an international collaboration. If you note for these guidelines the American Thoracic Society (ATS) and the European Respiratory Society worked closely together. Canada also has a huge Society addressing COPD and Asthma as does New Zealand/Australia.

    ATS
    http://www.thoracic.org/index.php

    ERS
    http://www.ersnet.org/

    Canadian Thoracic Society
    http://www.lung.ca/cts-sct/home-accueil_e.php

    Australia/New Zealand
    http://www.thoracic.org.au/

    There are also other countries with their own Associations and they present their research with the others at international conferences.

    Just like the AHA with its journal Circulation, each of these societies have professional journals to keep others up to date on the advances in pulmonary medicine. Those who like to state up to date on what other countries are doing may be envious in knowing that some technology and meds may not become available in the U.S. for many years.

    They also address many other pulmonary diseases and will work with other associations such as the AHA when issues overlap or guidelines pertain to other disease processes which in some cases it is hard to treat just one disease process without addressing the other.

    Examples:
    http://www.thoracic.org/statements/

    If you have an interest in pulmonary diseases, I do recommend attending an ATS conference if it is offered near you.

    For those who have an interest in COPD and Asthma, there are educator courses available which are worth the time.



    Quote from heron
    I'll grant that "thinking has changed" regarding CO2 retainers and oxygen. However, my empirical experience with hospice - thus very end stage - lungers is that they will often c/o dyspnea and look restless and anxious when their pulse ox climbs too high and have gotten relief by reducing the oxygen a bit.
    By reducing the oxygen you may also be reducing mentation. When a patient is dying, the number on the pulse ox is not always indicative of what the tissues are receiving. This is similar to when we use ScvO2 monitoring in the ICUs. The SpO2 might be great but the ScvO2 might not be.

    In fact, when we do have patients in hospice or with comfort care orders, we do not number watch. We watch for signs of discomfort and will usually treat that through other means of pharmaceuticals since we know the body is probably no longer able to oxygenate the tissue or organs as a healthy person would.

    If the patient is alert enough and wants to remain awake, we may nebulize fentanyl with a breath-actuated nebulizer. This also seems to give them some relief of the dypnea they feel which is difficult to relieve without making them almost unconscious with other medications.
    Last edit by GreyGull on May 23, '11
  4. 0
    Quote from GreyGull
    Extensive research went into those guidelines which are updated frequently just like the AHA does for cardiac issues.

    Many don't realize that the treatment for COPD and Asthma is an international collaboration. If you note for these guidelines the American Thoracic Society (ATS) and the European Respiratory Society worked closely together. Canada also has a huge Society addressing COPD and Asthma as does New Zealand/Australia.

    ATS
    http://www.thoracic.org/index.php

    ERS
    http://www.ersnet.org/

    Canadian Thoracic Society
    http://www.lung.ca/cts-sct/home-accueil_e.php

    Australia/New Zealand
    http://www.thoracic.org.au/

    There are also other countries with their own Associations and they present their research with the others at international conferences.

    Just like the AHA with its journal Circulation, each of these societies have professional journals to keep others up to date on the advances in pulmonary medicine. Those who like to state up to date on what other countries are doing may be envious in knowing that some technology and meds may not become available in the U.S. for many years.

    They also address many other pulmonary diseases and will work with other associations such as the AHA when issues overlap or guidelines pertain to other disease processes which in some cases it is hard to treat just one disease process without addressing the other.

    Examples:
    http://www.thoracic.org/statements/

    If you have an interest in pulmonary diseases, I do recommend attending an ATS conference if it is offered near you.

    For those who have an interest in COPD and Asthma, there are educator courses available which are worth the time.





    By reducing the oxygen you may also be reducing mentation. When a patient is dying, the number on the pulse ox is not always indicative of what the tissues are receiving. This is similar to when we use ScvO2 monitoring in the ICUs. The SpO2 might be great but the ScvO2 might not be.

    In fact, when we do have patients in hospice or with comfort care orders, we do not number watch. We watch for signs of discomfort and will usually treat that through other means of pharmaceuticals since we know the body is probably no longer able to oxygenate the tissue or organs as a healthy person would.

    If the patient is alert enough and wants to remain awake, we may nebulize fentanyl with a breath-actuated nebulizer. This also seems to give them some relief of the dypnea they feel which is difficult to relieve without making them almost unconscious with other medications.
    You pretty much said it all. The pulse ox is only a guideline, it may or may not give you a true reading about oxygen delivery OR use.
    If your pt. is anemic, they may have a pulse ox of 98%, with an awful paO2. It's all about o2 uptake, NOT delivery. So, if you think they are not respirating, send 'em too the ER for an ABG, and sort it out there.


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