Working CC, I recently followed a nurse that did something that struck me as odd. The pt was pretty imminent and was mouth breathing with long periods of apnea. She had been on O2 @ 5L via N/C. When I was getting report from the night nurse, I noticed the pt's N/C looked like it has slipped down. I went to readjust and the nurse told me, "Oh no. It's supposed to be like that. She started mouth-breathing so I moved the cannula down to her mouth so it would work better."
Now, I'm pretty new to hospice so maybe I don't know all the little tricks but that didn't make any sense to me at all. Personally if I felt that the pt absolutely needed o2 and was mouth breathing, I would have used a mask. In a pt that was so obviously imminent but showing no signs of discomfort or distress, I would have just left it in place. When I gave report to the CM she didn't act like it was anything unusual.
Am I completely missing something here? Is this some helpful trick I just haven't learned yet? I just can't wrap my mind around the idea that it might be beneficial. If nothing else, I would think that would cause more discomfort for the pt by drying out their mouth or if using humidified O2 it would add to the secretions.
Is there a Legit reason for this that I am missing or was that a totally strange thing to do?
Sep 7, '11
this is a nsg judgment, so everyone handles it differently.
the nc was place near mouth since he was mouth-breathing.
masks tend to suffocate a lot of patients.
if anything, nurses will remove mask from face and place it near mouth (when mouth-breathing).
i wouldn't worry about the o2 if death was imminent.
but another nurse would find it an important intervention.
you need to decide, case by case.
Sep 7, '11
I had a pt do this for himself, he was aaox3. Sure enough, sats went up as soon as he did.
Sep 8, '11
Nice post by leslie...
Remember that our focus for the patient during the dying process is comfort. If the pt was known to have any anxiety about the flow of O2 when she was alert, it would be a comfort measure to make sure that the flow was as evident to the patient as possible at the time of death. Moving the cannula from nose to mouth is something that O2 dependent patients will often do themselves when dyspneic, and so we will do it for them at the end to try to prevent that anxiety.
Over time, you will notice a variety of nuanced things that hospice professionals will do to ease the symptoms of transition toward death...many of which might seem strange to nurses new to the field. Welcome to hospice and good luck.
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