Change in status

Are you allowed to establish an IV line if none present?

The problem there is the COPD. You don't want to crank the patients O2 up and mess them up even worse. The other thought is, CHF, SOB, no wheezes probably means fluid overload. So the only way to really, truly help with the SOB is to diurese the patient.

To answer your question I'd use my nursing judgement. If their breathing is labored is probably try bumping the nasal cannula up to 4 liters to see if there was a response. If not I'd put the patient on the non-rebreather @10liters/min until EMS arrived.

hm....have they been using the cpap regularly? What about nebs? IV access would be nice, but EMS will be sticking a nice big old cath in first.

Were you thinking more chf or COPD? is 86% good for this patient?

EMS wait time is less than 5 minutes for me, so when I decide to seen, I don't have much time to treat/ make calls and get the paper work together. Not a bad problem for anyone to have :)

In situations such as that, (and I've had my share) I'd start a breathing tx if ordered and put them in the high Fower's position (as high as possible without them slumping over anyway) while staying at bedside to monitor O2 sats or for further degradation of condition. Meanwhile, I send CNA's or another nurse to gather an O2 tank and a NR as well as check code status. If the neb isn't helping in pretty short order I'll start the NR @ 10L until sats are over 90%, then begin to back it down d/t the COPD until they are maintaining on the least amount of O2 possible. With COPD'ers I'm perfectly happy with 87-ish%+ and no s/sx cyanosis. Definite call to MD regardless of code status.

I would not put nrb at 10L on copd, At first, I would do breathing tx if wheezing,if ordered, if not ordered, I would get it ordered, then apply cpap

-----you do not want to wipe out their. c02 respiratory drive.....

but OP, said with out history of chf, and copd......she did say diminished breath sounds..... I am thinking pneumonia, and ARDs.....in which case blue goo, knocks it out of park

Well it sounds like CHF/COPD exacerbation

1. IV line

2. Give nebulizer treatment albuterol/atrovent with 3 liters of oxygen

3. Give 40 mg of lasix IV (if sbp greater than 120)

4.Give steroids solumedrol 125mg IV

5. Await for medics

Most SNFs don't do IV steroids...not many do IV lasix. Too many residents to watch to spend that much time with one sick one.

In my facility we had a resident that had an allergic reaction to ABT (she started to swell up pretty bad tongue lips) we gave her iv solumedrol, benadryl and epi sq. We save her life btw the Dr order all that over the phone. But we did it because it was an emergency, the medics were so happy with us because we did all the work for them. I have ER experience so that help me a lot, we do have a policy and procedure for iv drugs