How many liters of O2 can a patient with COPD be on - page 4

I recall being told by an instructor during my nursing clinicals that a patient can be on up to 4L of O2 but no more due to the retention of CO2 and loss of respiratory drive if they have COPD. A... Read More

  1. Visit  CraigB-RN profile page
    3
    Quote from ChristopherH
    I recall being told by an instructor during my nursing clinicals that a patient can be on up to 4L of O2 but no more due to the retention of CO2 and loss of respiratory drive if they have COPD. A colleague of mine today told me that she was told that it shouldn't go over 2 Liters however. What is the correct answer, or is it one of those things that is more individualized to meet the needs of the specific patient? Also if anybody has any good sources or links to studies for this info it would be a bonus.
    The hypoxic patient gets as much O2 as they need. There is no limit. now that being said if your giving the COPD patient lots of O2, you have to watch for decreased resp drive.

    In most places when you move past a NC on a COPD patient you go to a Venti mask, BiPAP or a tube depending on what is going on.

    One thing for sure, if you move past a couple of L/M you need to be assessing your patient pretty frequently.
  2. Visit  crissrn27 profile page
    0
    Another thing about my dad. His resting sats are around 88%. His "working" sats can drop into the 70's. He has to be very, very SOB, with cyanotic lips, for him to stop what he is doing and rest. The man still mows my lawn, and weed-eats, and works as a traveling mechanic for the company he retired from, part-time! He tolerates his low sats very well, and has, thus far, refused any home O2.
  3. Visit  cardiacRN2006 profile page
    1
    Quote from CraigB-RN
    The hypoxic patient gets as much O2 as they need.

    When I read the title of this thread, I immediately thought, "as much as they need".

    If they lose their hypoxic drive, then we can correct that. But it's a whole lot harder to correct hypoxia/brain damage/death.
    Last edit by cardiacRN2006 on Oct 27, '07
    Angie O'Plasty, RN likes this.
  4. Visit  leslie :-D profile page
    1
    Quote from CraigB-RN

    One thing for sure, if you move past a couple of L/M you need to be assessing your patient pretty frequently.
    if you have a pt in resp distress, the nurse would be continually assessing the pt, never leaving their side. isn't that a given?

    leslie
    Angie O'Plasty, RN likes this.
  5. Visit  cardiacRN2006 profile page
    1
    Quote from Tweety
    I find nurses who practice medicine without a license and arbitrarily bump up patients oxygen a bit frigthening as well.

    I don't consider this practicing medicine. It's a titratable medication just as much as any other kind.


    Don't most people have it written in their orders "O2 @ blank, titrate to keep sats at Blank....?
    ginger58 likes this.
  6. Visit  RainDreamer profile page
    0
    Quote from cardiacRN2006
    I don't consider this practicing medicine. It's a titratable medication just as much as any other kind.


    Don't most people have it written in their orders "O2 @ blank, titrate to keep sats at Blank....?
    We can titrate the FiO2 to keep sats WDL, but not the liter flow. If they're requiring more liter flow, we need a doctor's order. But that's in the NICU, I'm not sure about adults.
  7. Visit  cardiacRN2006 profile page
    1
    We can do both.

    Our orders for non-intubated pts says, "O2 via NC at 2lpm, titrate to keep sats >92%". I've seen it say lower sats for COPD pts.
    nuangel1 likes this.
  8. Visit  ginger58 profile page
    0
    Originally Posted by Tweety
    I find nurses who practice medicine without a license and arbitrarily bump up patients oxygen a bit frigthening as well. As I've said, I've seen outcomes when a patient is tolerating being 90% (which by definition is hypoxic) and the nurse cranks it up only to obtund then with a CO2 past 100.

    Titrating oxygen with an order is practicing nursing with a license and proudly. I have never thought of 90% sat as being hypoxic and I could not find any definition stating such. I think it depends on the patient's condition and/or ABG.
  9. Visit  FireStarterRN profile page
    0
    I forwarded this thread to a pulminoligist I work with, I hope he reads it and gives me some feedback.
  10. Visit  Altra profile page
    0
    Quote from ready4crna?
    Third rule: If rule 1 patient happens to be a COPD person, continue to kick and scream up the chain of command until someone intervenes for and fixes whatever is causing said decompensatory need for increased FiO2, but do NOT deny the patient oxygen. (People can be intubated and mechanically ventilated if they lose their respiratory drive, but it is real hard to raise the dead. Not impossible, just reeeaaaalll hard.)
    Amen.
  11. Visit  PageRespiratory! profile page
    4
    Quote from Tweety
    Not a very helpful post, unless you clarify. Thanks.
    Yes sorry, I did'nt have time to clarify.

    " if you got a COPD'er on more than 2-3 liters, you better be assessing them for mental status changes. IF they are sleeping, wake em up and really check em for loopiness, if they are gettin loopy, you need ABG's, Bipap, or a vent, also some breathing treatments, steroids, etc.... "

    I assume by loopy the OP means CO2 narcosis, and yes depending on the gas, ventilatory support may be indicated, but I fail to see how the administration of a bronchodialator or anti-inflammatory would be indicated (unless Pt. is wheezing). Bipap is typically used to foster ventilation, not oxygenation but may be indicated in the hypoxic Pt. BTW - Bipap is a vent, and most machines CAN be used on an intubated Pt. if neccessary.


    Also: Any Pt. on a NC or simple mask at ANY flow rate has an indeterminable Fio2, it will vary with effort, anatomy ect. Usually titrated by pulsox.
    The terms "high flow" and low flow" have very specific meanings, a high flow system (like a venturi style entrainment system) is an exact Fio2, while a low flow sysytem (NC, Blow-by, simple mask) has an unknown Fio2. Just a note about Venti masks, lowering the flow rate without changing the entrainment cartridge will raise the Fio2, twice I've had people with good intentions make that mistake. Once was no biggie, but another time was on a heavy duty retainer and 3 hours later he was sufficiently narcotized!

    And whoever had the RT walk off the floor with a Pt's HR in the 40's, Ugh, sounds like a crappy therapist to me
    nuangel1, sharona97, leslymill, and 1 other like this.
  12. Visit  PageRespiratory! profile page
    2
    Quote from ginger58
    Titrating oxygen with an order is practicing nursing with a license and proudly. I have never thought of 90% sat as being hypoxic and I could not find any definition stating such. I think it depends on the patient's condition and/or ABG.
    Remember the SpO2 is not the SaO2. But if the pulse-ox is accurate, 90% is equal to a PaO2 of 60mmHg, which is technically hypoxemia.
    As per the oxyhemoglobin dissociation curve.
    http://rnceus.com/abgs/abgcurve.html
    NurseBobbyJack and ginger58 like this.
  13. Visit  NRSKarenRN profile page
    4
    sharona97, Tweety, leslymill, and 1 other like this.

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