O2 for comfort measure and living wills - page 2

I need the hospice nurses' input. I have a terminal resident who has been comfortable. I work P/T, not always on same unit. Resident was offered and given O2 for comfort one evening, and today... Read More

  1. by   leslie :-D
    Quote from Demonsthenes
    I disagree with those that say a pulse oximeter reading is inappropriate for hospice patients on O2. One of the reasons for using a pulse oximeter is to determine if O2 administration is efficacious and/or the machine is working correctly. If pulse oximeter readings indicate that the the Sp02 has not improved upon oxygen administration, then the machine may not be operating correctly, the oxygen may not be applied correctly, there may be a blockage in the respiratory tree, the oxygen concentration may have to be increased, and etc. Further, when administrating narcotic angalgesics to the hospice or other patients, a pulse oximeter is mandatory to determine if the side affect of respiratory depression necessitates reducing doseage or, to the contrary, oxygen delivery can be increased.
    It should, also, be remembered that patients that have COPD should have low levels of O2 delivered as their stimulus to breath is from low SA02 or low S02 rather from high carbon dioxide levels in other patients. Giving too much 02 to COPD patients, therefore, can cause them to stop breathing, therefore.
    i'm not understanding this.
    one doesn't need a pulse oximeter to assess resp distress/depression.
    also, a pulse ox can read 98% yet the pt can still be severely hypoxic and present accordingly.l
    i have found that hospice nurses have unusually keen assessment skills r/t the lack of assistive devices that hospice situations do not warrant or cover.

    leslie
  2. by   doodlemom
    Quote from earle58
    i'm not understanding this.
    one doesn't need a pulse oximeter to assess resp distress/depression.
    also, a pulse ox can read 98% yet the pt can still be severely hypoxic and present accordingly.l
    i have found that hospice nurses have unusually keen assessment skills r/t the lack of assistive devices that hospice situations do not warrant or cover.

    leslie
    VERY good point Leslie!
  3. by   CaseManager1947
    I concur with all that has been said, but would like to add the following point. Hospice goals are palliative not curative. A little O2 by cannula is not going to cure the patient's problem, but certainly will provide comfort and amelioration of symptoms. So think symptom relief and pain control, and if oxygen helps, then the patient should have it.

    Morghan, ARNP
  4. by   aimeee
    Quote from Demonsthenes
    I disagree with those that say a pulse oximeter reading is inappropriate for hospice patients on O2. One of the reasons for using a pulse oximeter is to determine if O2 administration is efficacious and/or the machine is working correctly. If pulse oximeter readings indicate that the the Sp02 has not improved upon oxygen administration, then the machine may not be operating correctly, the oxygen may not be applied correctly, there may be a blockage in the respiratory tree, the oxygen concentration may have to be increased, and etc. Further, when administrating narcotic angalgesics to the hospice or other patients, a pulse oximeter is mandatory to determine if the side affect of respiratory depression necessitates reducing doseage or, to the contrary, oxygen delivery can be increased.
    As stated by others above, the pulse oximeter tells you NOTHING about the feeling of dyspnea. Skilled observation of your patient can tell you what you need to know. Hospice is not about nursing by the numbers.

    I hope that nobody is holding narcotics for a patient in pain because of respiratory depression.
  5. by   EmptytheBoat
    Thanks to all for your comments and suggestions. I'm also against
    Pulse-Ox, just adds to anxiety levels. I'm also against accuchecks
    routinely for most Hospice patients, but an accucheck at time of
    crisis may be beneficial. I had a CHF patient, also a diabetic, that
    was unarousable, family did accucheck and received a normal reading.
    Family was divided on calling 911 (patient had been a Hospice patient
    2 years with an ejection fraction of 10%) but opted to do so, signing
    a revocation. 911 arrived, got an accucheck in the 30's, IV dextrose
    administered, patient began to respond, taking to hospital, patient
    diagnosed with hypoglycemia, responded well to treatment and sent
    home same day. Patient lived another 6 months enjoying another
    Thanksgiving/Christmas with family.
  6. by   KellieNurse06
    I would also like to say first and foremost look at the patient first...........never rely on a machine for anything................
  7. by   KellieNurse06
    Quote from aimeee
    As stated by others above, the pulse oximeter tells you NOTHING about the feeling of dyspnea. Skilled observation of your patient can tell you what you need to know. Hospice is not about nursing by the numbers.

    I hope that nobody is holding narcotics for a patient in pain because of respiratory depression.
    OMG....I would hope not either And maybe I'm all wet here..but if someone is actually dying......ummm wouldn't their respirations become depressed anyway???????

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