The correct way to send a patient out to the hospital...

Nurses General Nursing

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just for clarification. regarding LTC facilities. ok, lets say you have a patient having SOB you check the O2 sat. and it's 84% you give 2 liters of o2 via NC and it's about 86% now, pt. is a code, patient is a&o X3 how would you go about sending this patient out? would you first get an order from the MD first to send the patient out, or do you use your nursing judgement and send out patient then call the doctor after the ambulance picks him up? do you call 911 at all? curious to see your answers.

Specializes in LTC, Hospice, Case Management.
Something wrong with obfuscating scientifically relevant information to back your clinical assertions.

Oh my..bringing out the big words now.

Please back to the original topic.... (big words make my head hurt)

Specializes in Med Surg, Tele, PH, CM.

I am a Case Manager who makes a lot of home visits, and have on more than one occasion found a patient in condition that warranted a trip to the ER. I call 911, then notify the PCP that I have initiated emergency services. Have never had negative feedback from paramedics or physicians - the patient is often another story, but they always end up thanking me. Use your powers of assessment and instincts, your license could be on the line.

Specializes in Emergency & Trauma/Adult ICU.
NO! If the patient has certain medical conditions the oxygen should never be above 2.0 lpm because of acid base imbalance. Poor nursing judgement and possibly dangerous. Know the diagnoses first!

Frightening. Truly frightening.

But hey, if you have COPD and you want to put in your own advanced directive that you should never be given more than 2L O2 ... go right ahead ... I'll honor your wishes. There's no hypoxia in the afterlife.

A general question, just because I'm curious: when licensed, practicing nurses post this, is it because they have never seen actual respiratory distress? I'm struggling to identify some other rationale for how it would be possible for a nurse to watch a patient struggle to breathe ... using accessory muscles ... getting increasingly restless ... respiratory rate in the 30s or 40s ... with some dinky little nasal prongs spitting out 28% FiO2 while saying, "no, no ... no more oxygen for you ..."

Specializes in CCT.
I said nothing about withholding O2 from a hypoxic patient. If you can show me that your comment that O2 has very, very, very little to do with acid base was intended to illustrate that point, I'll concede the point. However, the nature of your comment was not so specific. It made a very broad, exclusive, very easily misinterpreted statement. There are a lot of students on this board, a few who might be struggling with these concepts in their nursing programs. It's better to say that the science behind respiration and blood pH balance is complicated and explain why than to make blanket statements that provide a barrier to true understanding.

Nothing wrong with providing clinically relevant information to back your clinical assertions.

Something wrong with obfuscating scientifically relevant information to back your clinical assertions.

The poster I responded to was advocating exactly that, that's why I responded the way I did.

Oxygen DOES only have a limited effect on pH. It's much easier to explain oxygenation and ventilation as seperate, but very closely interlinked concepts. There is a common misconception among lay people and students that oxygen is the primary reason for ventilation, when in fact CO2 is much more important to the actual mechanics of it. Oxygen is critically important in cellular respiration, but isn't the driving force in mechanics of breathing.

I do agree there is nothing wrong applying science to clinical assertions.

Specializes in ICU.
The poster I responded to was advocating exactly that, that's why I responded the way I did.

Oxygen DOES only have a limited effect on pH. It's much easier to explain oxygenation and ventilation as seperate, but very closely interlinked concepts. There is a common misconception among lay people and students that oxygen is the primary reason for ventilation, when in fact CO2 is much more important to the actual mechanics of it. Oxygen is critically important in cellular respiration, but isn't the driving force in mechanics of breathing.

I do agree there is nothing wrong applying science to clinical assertions.

I am familiar with the recent research with COPD'ers and hypoxic drive, however your assertion that oxygen has very, very, very little to do with acid base takes the concept far further than it is intended to go. Perhaps you originally intended to say that oxygen has very little to do with ventilation.

Your current assessment is closer to the reality, but FAR from your original statement.

Nice save.

Although, ya coulda just said, "Oops, I meant ventilation."

Specializes in CCT.
I am familiar with the recent research with COPD'ers and hypoxic drive, however your assertion that oxygen has very, very, very little to do with acid base takes the concept far further than it is intended to go. Perhaps you originally intended to say that oxygen has very little to do with ventilation.

Your current assessment is closer to the reality, but FAR from your original statement.

Nice save.

Ehhh, I'll admit I swing towards the dramatic sometimes. But since ventilation is the driving factor in respiratory control of acid-base, at least in normal physiology, I stand by it somewhat, however as mentioned I VASTLY oversimplified it. I'll at least concede that point.

Specializes in ICU.
Ehhh, I'll admit I swing towards the dramatic sometimes. But since ventilation is the driving factor in respiratory control of acid-base, at least in normal physiology, I stand by it somewhat, however as mentioned I VASTLY oversimplified it. I'll at least concede that point.

See now, that's a whole other kind of discussion.

The truth of that matter is that it is all about perspective. It's a chicken or egg type discussion.

You can assign whatever degree of facility you like to oxygen in maintaining acid/base balance so long as you recognize that doing so is somewhat arbitrary, because even assigning it a diminutive role from the perspective of hypoxic drive does not release the fact that its role is essential and that CO2 is a waste product of life processes driven in part by oxygen. The choice to value the role of CO2 is nothing more than choosing a point along a biological continuum for the sake of resolving specific clinical challenges with relative ease and/or in the confines of our contemporary knowledge and tools. It doesn't mean you can forget the rest of the continuum, or that the rest of the continuum doesn't matter, even clinically. Chemistry doesn't assign the same qualitative judgments that people do (scientists included).

That is the mistake that I hate to see people make and is what I mean when I mention barriers to true understanding. Once you start thinking something is non-essential based on syntax or circumstance....slippery slope and all of that. Pet peeve.

Specializes in CCT.
See now, that's a whole other kind of discussion.

The truth of that matter is that it is all about perspective. It's a chicken or egg type discussion.

You can assign whatever degree of facility you like to oxygen in maintaining acid/base balance so long as you recognize that doing so is somewhat arbitrary, because even assigning it a diminutive role from the perspective of hypoxic drive does not release the fact that it's role is essential and that CO2 is a waste product of life processes driven in part by oxygen. The choice to value the role of CO2 is nothing more than choosing a point along a biological continuum for the sake of resolving specific clinical challenges with relative ease and/or in the confines of our contemporary knowledge and tools. It doesn't mean you can forget the rest of the continuum, or that the rest of the continuum doesn't matter, even clinically. Chemistry doesn't assign the same qualitative judgments that people do (scientists included).

That is the mistake that I hate to see people make and is what I mean when I mention barriers to true understanding. Once you start thinking something is non-essential based on syntax or circumstance....slippery slope and all of that. Pet peeve.

I think we're probably closer than you think on this issue.

I'm not a nurse, I'll state that upfront. The reason I describe this the way I do is that the most common mistake I see providers make is to assume oxygen will fix everything, or to a somewhat lesser extent withholding of O2 to hypoxic patients due to misplaced fears of hypoxic drive. It is much easier to get the base concepts across when you seperate them, and teach that the clinical interventions needed for one don't nessecarily help the other. Once that understanding is acheived you can begin to explain how closely oxygenation and ventilation are linked and how they affect one another (and how disruptions of either one will disrupt the other, and how they both end up leading to death). You'd be shocked how many people in my particular allied health field have never even seen an oxyhemoglobin disassociation curve.

I get where your coming from, and understand the concept that they are in the end one and the same, and you can't optimize one without affecting the other. Just explaining why I explain it the way I do.

Specializes in LTC, Memory loss, PDN.

That's it. I just drafted an advance directive for myself, "Under no circumstances are there any biologists to partake in my care", :D because when I cannot breathe, I don't need a scholar, I need someone to crank up the O2.

Frightening. Truly frightening.

But hey, if you have COPD and you want to put in your own advanced directive that you should never be given more than 2L O2 ... go right ahead ... I'll honor your wishes. There's no hypoxia in the afterlife.

A general question, just because I'm curious: when licensed, practicing nurses post this, is it because they have never seen actual respiratory distress? I'm struggling to identify some other rationale for how it would be possible for a nurse to watch a patient struggle to breathe ... using accessory muscles ... getting increasingly restless ... respiratory rate in the 30s or 40s ... with some dinky little nasal prongs spitting out 28% FiO2 while saying, "no, no ... no more oxygen for you ..."

It really is frightening. I have two theories. I'm a LPN and I was taught this (the 2LPM crap) in school (20 years ago).

It is possible for LPNs to practice fairly isolated from changes in the field. I was fortunate enough to work with several DONs who would cover the cost for me to attend seminars and workshops. Most of the seminars were tailored towards RNs.

I've seen situations where LPNs were discouraged from decision making and questioning orders or instructions. That's not me so I made a decision to move on, but I believe some are quite happy with that arrangement.

Specializes in ICU.
That's it. I just drafted an advance directive for myself, "Under no circumstances are there any biologists to partake in my care", :D because when I cannot breathe, I don't need a scholar, I need someone to crank up the O2.

I see what you did there...

What's funny 'bout that, is if it weren't for scholars, we'd still be convinced that bacterial growth was the product of spontaneous generation and your cannula might come straight to your nose from your roomie with the bacterial pneumonia without any pause for the thought of sterilization.

It is nice in this day in age to be able to take some things for granted. But that luxury didn't come without the work of those who continued to ask questions when the state of the world had been "determined" by others.

Dont yo have a POC on this patient that states 02 parameters and a med order for the amount of 02 you can give? I worl pediatric home health. If I have a questionable emergency situation where I do not feel 911 is needed, then I call the MD to get feedback on what steps to take next IF my patient is stable! In any case, you would need to use nursing judgement and bump that 02 up as much as needed to get sats aove 90% at least..... unless your patient has emphasema. Good Luck!

did you have a situation like this occur or are you planning ahead?

just planning ahead, this is only an example. curious to see how others would handle this situation.

Get the order to transfer, call the family/ POA, call EMS or transport company, and call the ER and give report.

shouldnt the family be called last?

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