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Discussion

Continuous O2 effect on O2 sat and CO2 Levels

I'm hoping some of you nurses out there can help me. I live with my grandmother, who is on hospice for advanced COPD. Her nurse consistently raves that her O2 sat is 98-99%. Yes, that's great, but she's been getting more and more alterations in mentation and I'm concerned that she's once again retaining CO2. I just can't figure out what else would be creating these changes. There have been no new medications, no over medicating (as I have moved her pills to the kitchen and I give them to her). Her O2 is at 2.5 LPM NC.

So, my question....can you have a normal O2 sat with high CO2 levels? If so, how do you get someone to draw a damn ABG to check on care?

I've tried to find some answers, but it's just not coming to me easily...perhaps because I'm too worried...

Featured Replies

  • Experts

The object of hospice care is to support the deterioration of the patient and keep the comfortable since they are not expected to recover. I would recommend that you look up alterations in mentation and what you can do to be supportive of that. There is a lot going wrong with patients who have COPD (http://www.merck.com/mmpe/sec05/ch049/ch049a.html). Why don't you research hypercapnia (elevated carbon dioxide in the blood) and its signs, symptoms and treatment (http://www.merck.com/mmpe/sec05/ch046/ch046c.html#sec05-ch046-ch046b-195)? It is always connected with breathing/ventilation problems.

  • Experts

Sounds like you are having a hard time seeing a loved one change before your eyes. Part of the pieces you need to connect are End Stage COPD, Hospice and stages of death and dying.

Once someone accepts Hospice Care you are no longer looking at currative but tons of comfort care and symptom management. ABG's are not performed as not planning on trying to reverse the dying process. Change in mentation is quite common. As a palliative care RN, I focus on patients comfort: are they breathless, very anxious, aggitated and try to lessen their impact and explain whats happening to the family.

A booklet that might help you is: Living with Advanced Lung Disease: A Guide for Family Caregivers

COPD and Hospice thread: https://allnurses.com/hospice-nursing/copd-and-hospice-167036.html#post1726632

The shift in thinking to witnessing, validating and honoring the dying person's experience rather than trying to fix, cure, change or correct any specific symptom or condition helps in creating a healing environment for both patient and family...along with hospice staff. Grief will come and go too, a natural part of this life experience.

Please discuss your concerns with the Hospice nurse and ask for pamplets on the dying process to help you prepare for the moments ahead.

{{{Hug}}} to you for caring about your Grandmother.

I would definetly look at some of the sites listed above, and to answer your question about the

O2 sats.....Yes you can show a good 02 sat when you are on oxygen, but in the case of your

grandmother it is possible that her 02 sat is normally because CO2 attaches to the hemoglobin in

the same way 02 does which in turn reads as normal when its not......I hope all is well, but

know that hospice is a pallative care service and they do what is best for the patient to make them

comfortable, not necessarily what will make them live longer.....best wishes...

  • Author

Thank you all for your responses. I know that hospice if more about comfort than cure. As you can imagine, it's hard to know so much about A&P and see a loved one going through all of this. This is actually the second time I've helped nurse a grandmother through COPD, but, we had a much easier time with comfort with the other (who was a non-smoker). This is actually the third time since April (when she was admitted to hospice) that I've experienced this downhill slope with the mentation changes and hallucinations. So, I was more curious about the O2 sat reading normal with the other changes that we've seen in the past correlating to high CO2 than anything else. Thank you all for your suggestions and links, thoughts and prayers. They are greatly appreciated.

One more question, then....if she is retaining CO2 again...how do we keep her comfortable?

Honestly the only thing I can think of is possibly the use of opiates. I have seen morphine used

to help with whatever pain is there, but as you know this will as decrease her respirations. I am

sorry you are seeing her go thru this, especially this time of the year. Did she fill out advance

directives? If so you can go by what she is either capable of deciding if she is still able to make

those kind of decisions or you can go by her directives if not.....best wishes...

  • Experts

morphine is used with copd for terminal breathlessness/ air hunger ... can even be given via nebulizer---see links in copd and hospice thread: https://allnurses.com/hospice-nursing...ml#post1726632

having a small fan turned on low @ beside which hleps move air around near face can be comforting to some while others just get annoyed or c/o cold...we try whatever works to help with this issue!

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