Giving O2 without an order?? - Page 4

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  1. Jun 12, '12 by
    Quote from ~*Stargazer*~
    Sorry, I just can't let this slide. Just because the person has COPD does NOT in any way, shape, or form, mean that they are a CO2 retainer and that you should withhold oxygen if they are in respiratory distress! And even if they are a retainer, as I said in my earlier post, CO2 narcosis takes time to develop. If the person is in respiratory distress, you GIVE THE O2 and worry about CO2 narcosis later.

    Exactly. As long as your not driving up their sats to 98-100 %, keep em at 88-92. They need oxygen, they need oxygen. I mean are you really going to let them sit at 75% because they are a COPD'er? Yeah didn't think so.
    sapphire18 likes this.
  2. Jun 12, '12 by
    Wow. Is this discussion only SCARY to me???!!!

    In my area (I've worked at 3 hospitals), giving oxygen to pt is a nursing order up to 10L. Even if it isn't, I would never leave a pt is resp distress without providing what the OP has done. It's very easy for a person who is desatting/having difficulty breathing to go down rapidly - why take the precious minutes you have and waste on walking to the nursing station, looking for the doc's number, call him up, explain the situation, then get an order. That can happen AFTER!

    Now, I'm not sure if the situation OP experienced is as dramatic as I'm describing, but still...
    ktliz likes this.
  3. Jun 12, '12 by
    Quote from strawberryfields
    Thanks everyone for your replies yes I did give the duoneb first the patient told me it was helping a little but his o2 was still 78-79 so I got the oxygen. I'm a new nurse so I am learning. What is awful is that where I work everyone seems like they are afraid to call the md ... I was ready and willing but they advised me not to call this late. We have a dr that gives us times you can call him and if you call him outside of that time frame he yells at you. You all are right and this is my license if he wants to yell at me so be it .. On call dr is no joke. One of the nurses I work with had a really high blood sugar reading and it said call the md and I was like are you going to call ? And he said, "why make my night more difficult ... When the dr is just going to tell me to tweak the insulin?" it was 410 and the order said 400+ call md. This is something I want to bring up to my facility in the next meeting.
    As another allnurses poster said, "If the doctors do not write prn standing orders for something this simple, I will assume that they are lonely and wish to be called often at home at 3am."
    sapphire18, DeLanaHarvickWannabe, NoonieRN, and 4 others like this.
  4. Guide
    Jun 13, '12 by
    Quote from Altra
    I'll repeat what I have said before here at AN ...

    If you are ever taking care of me, and find me in respiratory distress ... unless we all agree that it's my day to die please, PLEASE crank up that O2.
    Me too. Having twice been hospitalized with asthma I can say that if you have me on 2L I might be tempted to crank it up myself when you leave.
    Altra and sapphire18 like this.
  5. Jun 13, '12 by
    Quote from Florence NightinFAIL
    Wow. Is this discussion only SCARY to me???!!!In my area (I've worked at 3 hospitals), giving oxygen to pt is a nursing order up to 10L. Even if it isn't, I would never leave a pt is resp distress without providing what the OP has done. It's very easy for a person who is desatting/having difficulty breathing to go down rapidly - why take the precious minutes you have and waste on walking to the nursing station, looking for the doc's number, call him up, explain the situation, then get an order. That can happen AFTER!Now, I'm not sure if the situation OP experienced is as dramatic as I'm describing, but still...
    No one has said to call the doctor BEFORE helping the patient. People are saying she should have called once the patient was stable to inform the doctor of the situation,get an order for the oxygen already administered as well as any other orders the doctor might have wanted.
    prinsessa, ~*Stargazer*~, Cat_LPN, and 1 other like this.
  6. Jun 13, '12 by
    The dr came in that morning and he ordered a chest X-ray that was done that after noon he has lower lobe infiltration. And hasn't used the o2 since my sunday shift but now he does have orders for 2-3L OF O2 prn and use incentive spirometer. I actually called that doctor yesterday at midnight about a PTs blood sugar I was monitoring that went up to 515 8) she had a sliding scale that said >300=9u but no further order so i called to see what he wanted. looks like he's going to hate me but I'm going to call him regardless of what my coworkers say.. I'm going to use my own judgement.
    vintagestudent, sapphire18, DeLanaHarvickWannabe, and 4 others like this.
  7. Jun 13, '12 by
    You REALLY need to get over 'the doctor is going to hate you'. You called for legitimate reasons. If he's mad, he needs a new career. It's not our job to worry about the doctor's sleep.

    I'm not saying calling the MD for Ted Hose in the middle of the night is OK, but really now, call when the patient needs help.
    Altra and rn/writer like this.
  8. Jun 13, '12 by
    Quote from strawberryfields
    The dr came in that morning and he ordered a chest X-ray that was done that after noon he has lower lobe infiltration. And hasn't used the o2 since my sunday shift but now he does have orders for 2-3L OF O2 prn and use incentive spirometer. I actually called that doctor yesterday at midnight about a PTs blood sugar I was monitoring that went up to 515 8) she had a sliding scale that said >300=9u but no further order so i called to see what he wanted. looks like he's going to hate me but I'm going to call him regardless of what my coworkers say.. I'm going to use my own judgement.
    That is the spirit!!!! Remember when you think someone is Hating you, that this is HIS/HER JOB. When he starts yelling...or acting like a jerk, you can easily say..."The order you gave says to call with XYZ, so I am calling. Did you not want me to call, then how did I get this order that says I am to call you?" Usually they sort of calm down then, because I mean, they wrote the order. It is very hard to get used to calling MD's at all hours, especially if it is not the norm where you are. And yes, it takes some getting used to, but in the long run, they will either adjust their orders, or get used to it, and the patient is getting great care from you! Good Work...not Easy, but Good on you!
    vintagestudent likes this.
  9. Guide
    Jun 13, '12 by
    Either have an MD order or a standing order or policy. Never venture out on your own. I would use this incident to insist on getting a documented plan of action so nurses are covered.
  10. Jun 13, '12 by
    Quote from ~*stargazer*~
    sorry, i just can't let this slide. just because the person has copd does not in any way, shape, or form, mean that they are a co2 retainer and that you should withhold oxygen if they are in respiratory distress! and even if they are a retainer, as i said in my earlier post, co2 narcosis takes time to develop. if the person is in respiratory distress, you give the o2 and worry about co2 narcosis later.
    i do not see where i said do not adminster oxygen. (: