confuse about an NCLEX question.

[hotshot12345]

So the scenario is a pt w/ COPD getting O2 at 2L/minute per nasal canula. RN observe pt has SOB and chest pain. Nurse notify MD, but there is no order to change amount of O2 for pt.

I pick that answer that said "report to the supervisor." However, the rationale about this being the wrong answer is "pt have s/s of oxygen toxicity. Hypoxemia is of greater concern than oxygen toxicity."

So the answer turn out to be "cont. to monitor respiratory status of client."

However, I still don't understand the rationale concerning the oxygen toxicity and hypoxemia. I know that COPD shouldn't receive a lot of O2 b/c of their hypoxic drive.

[gwafuh_rn, BSN, RN]

oxygen toxicity????

[hotshot12345]

oxygen toxicity????

Yes, that is exactly that it says.

[Silverdragon102, BSN]

When you give COPD patients too much Oxygen their body reacts as if it is a toxic agent. Some do tolerate a slightly high concentration but I have seen patients go into severe respiratory distress because the ambulance crew gave them too much oxygen whilst transporting them to hospital

[EricJRN, MSN, RN]

I think that disagreements on this subject have to do with a difference in perspectives and training between EMS and nursing.

In prehospital care, we are taught that you can safely administer high-flow oxygen to any potentially hypoxemic patient without worrying about the hypoxic drive theory.

Here is a great article on COPD that supports that view:

http://www.emedicine.com/emerg/topic99.htm

Most of the research into the hypoxic drive theory indicates that, if high-flow oxygen can knock it out at all, it's a process that takes hours or days, far longer than typical EMS transports. But it makes sense that nurses would be trained to avoid high-flow oxygen in these patients, since they likely are caring for them over hours or days.

Okay - now back to the question. If you have a patient with new-onset chest pain and difficulty breathing, I'm surprised that the answer would be to just monitor. With chest pain, you would anticipate orders (or a protocol) for a 12-lead EKG, ASA, nitro, and possibly other interventions.

[jjjoy, LPN]

Was there more to the incorrect answer? Something like "report to the supervisor that the patient has s/s of oxygen toxicity" ?