Oxygen... Comfort or Life Saving?

dazey71 · Feb 10, 2007

Whenever I haven't been sure, I put the the oxygen on, and then just let the doctor know. I've never (so far) had a doctor tell me to take the O2 off. Even if someone is dying, I don't think it is out of bounds to make them more comfortable.

TigerGalLE, BSN, RN · Feb 10, 2007

I agree I just wanted to know what y'all thought...

taramayrn · Feb 10, 2007

I think it can be seen either way. However I would have not checked his sats, but would have put the oxygen on for his comfort only - not to bring his sats up.

Do you thinking putting oxygen on a patient is considered comfort or life saving? I had a "category 3" patient yesterday. Category 3 patients are not to recieve CPR or be put on the ventilator.... That morning he started gasping for air and appeared to be in agony. (I am still on orientation) So we checked his pulse Ox (which was 36).... Then applied 100% O2 with a NRB... She called the son and the MD... His O2 Sat climbed back up to 100% within a few minutes...
There were many disagreements on the floor as to whether oxygen is a comfort measure or a life saving measure... Now if they take the O2 off... the patient will surely pass....
The patient was still alive when I left yesterday... on the oxygen

nrsang97, BSN, RN · Feb 10, 2007

I agree with Tazzi. Oxygen is a comfort measure and life saving. This pt was truly uncomfortable and gasping for air. I would have given O2 without a second thought. I would want someone to do the same for me. Giving passive O2 via mask on NC will not prolong life. I will make them more comfortable. I would also be giving morphine as often as they can have it. I worked with a nurse who had a pt who was a DNR and low BP (70/30) and pt was in distress and she wouldn't give the morphine even though family was asking because she thought she was going to kill the pt. I tried explaining that we weren't going to revive her if her BP and HR were gone but she felt that giving the morphine she was killing the pt. I truly believe in doing all to make someone comfortable.

nuangel1, BSN, RN · Feb 10, 2007

I agree with Tazzi. Oxygen is a comfort measure and life saving. This pt was truly uncomfortable and gasping for air. I would have given O2 without a second thought. I would want someone to do the same for me. Giving passive O2 via mask on NC will not prolong life. I will make them more comfortable. I would also be giving morphine as often as they can have it. I worked with a nurse who had a pt who was a DNR and low BP (70/30) and pt was in distress and she wouldn't give the morphine even though family was asking because she thought she was going to kill the pt. I tried explaining that we weren't going to revive her if her BP and HR were gone but she felt that giving the morphine she was killing the pt. I truly believe in doing all to make someone comfortable.

well said and i couldn't agree more .o2 and morphine no problem .keep pt comfortable.

Myxel67 · Feb 10, 2007

I would use O2 and morphine. If it wasn't time for the morphine yet, I'd call for increased dose or ask to change to q1h. This was SOP on the Pulmonary floor I worked on several years ago. Yes, it does help the family feel better--unless they're the type who go berserk over morphine. But I believe it also helps relieve pts distress as well. Not being able to breathe is a terrifying experience, and the morphine allows pt to relax and breathe easier. (Most of our pts were still conscious, so I believe you can evaluate a positive response from the pt.)

Antikigirl, ASN, RN · Feb 10, 2007

ITs both for sure, but in cases of terminally ill pts...the hands of the ol medicine pendulum swings towards the comfort side!

I mean look at it..say you have a pt..could be anyone, and they are seriously ill. Will O2 alone save them or extend their live...rarely...there is underlying factors that must be addressed and corrected with the use of treatments and medicines. So is it life saving...well, one of the tools yes, but alone won't cut it in most cases!

BUT does a pt in the same scenero get comfort from the O2...more chances out of any yes! Putting off that nasty hypoxia is a comfort measure because our good ol brains do tend to get really ticked when O2 isn't there and does all sorts of horrible things to the body in order to get O2! (Hallucinations, pain, feeling of doom or drowning, temp flux, SOB, Alt consciousness, muscle using lactic acid and burning, spasms, seizures,coma.....etc.). Now who wants to do that to a dying person or even a person that will make it through their condition???

I find it essential to give O2 to pts that need it, and will follow the wishes of a person if they don't want to be vented or an artificial airway..but dog gone I will give it NC or Mask even in hopes of some O2 making it in the mouth, nose or stoma just by drifting there!

taramayrn · Feb 10, 2007

Another medication that could have been used along with the morphine is Versed. It is especially helpful in terminal patients who are air hungry and feel as though they cannot breath.

cannoli · Feb 11, 2007

So what about when the patient is a category 5... in our hospital that means you start taking things away... As in tube feeding, SQBS checks, labs... You continue to give them pain meds but no other meds. Do you take away the oxygen or leave it?

What type of unit do you work in?

TigerGalLE, BSN, RN · Feb 11, 2007

renal and respiratory floor

ginger58, ASN, RN · Feb 12, 2007

I've been thinking about this question as in palliative one often has to answer questions about the pros and cons of continuing oxygen. One pulmonalogist thinks that oxygen isn't comfort care. I've been trying to find some articles about oxygen as comfort and what I found follows:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=126248

zacarias, ASN, RN · Feb 12, 2007

Also, you said category 3 or 5 (new to those terms) means no CPR or ventilator. Like another poster said, these are heroic and invasive (broken ribs) procedures for patients. DNR is the same thing in this case. Nothing in those aforementioned designations state that "Oxygen by non-invasive means such as nasal cannula or face mask should not be given." It's a given 02 would be given and drugs to make them more comfortable. If they need that much 02 to survive a little bit, they aren't long for this world.

Sometimes at work I hear people say, "oh don't worry, he's DNR." The person could be NO WHERE near dying but people saying makes it like people aren't gonna try their utmust should something bad happen?