COPD pt sob

jadelpn, LPN, EMT-B · May 17, 2012

It depends. You should have an order that reads what the oxygen should be at, and what the optimum sat should be. Most COPDers are retaiining, so this is figured out by the MD after a blood gas. Always get a clear order.

serenie222 · May 17, 2012

Is a test question... it ask you your pt with cod sob. other options such do nothing is wrong. Only two answers you give oxygen or not give. I think is a lame question. Didn't even state what pts oxygen level is at too. but which you would pick then.

classicdame, MSN, EdD · May 17, 2012

In real life there should be an order and the nurse can request respiratory assessment if condition changes. Don't know how the question was asked, but the answer is probably centered around knowing you cannot automatically turn up O2 on COPD patients.

Unknown member · May 17, 2012

serenie222 said:
I got ask this question....so you have a copd pt who is sob. already on oxygen that is 2L. I know with cod pts they require a lower amount of oxygen than most people some only (85-89%) do u increase the level of oxygen or not...

I had a similiar test question in the past. But the question specifically stated that the COPD pt was terminally ill and was SOB on 2L. Options were: sit with the pt, turn O2 to 3-4L, get a fan, and I forget the last one.

The answer was get a fan. I'm not sure if it was because the pt was terminal, but I've come across alot of COPDers who love their fans and it eases their breathing.

kalpesh555 · May 17, 2012

Nice question atleast for me it was the first question on allnurses.com....even answer also surprise.

Esme12, ASN, BSN, RN · May 17, 2012

Traditional teaching emphasizes that hypercapnia results from suppression of hypoxic ventilatory drive and warns that "patients will stop breathing" if given oxygen. However, this interpretation does not account for the many factors that contribute to the control of breathing in these patients, and has resulted in oxygen being withheld inappropriately from some patients with acute respiratory failure.

Regardless of the mechanism of hypercapnia, it is essential to administer oxygen to patients with significant hypoxemia to avoid the potentially life-threatening complications of a low PaO2.

There was a recent good thread about this as a case study...

https://allnurses.com/can-anyone-give-ideas-case-t429428/

Read the whole thread there are some great answers there

GitanoRN, BSN, MSN, RN · May 17, 2012

Needless to say, these are the type of questions that gets your brain going during school exams, they are a bit challenging and they are meant for you to think quickly and resolve the issue on hand. however, in real life is a little different scenario, although I must admit all of the above answers are right on target, and as a seasoned nurse I can testify the fan requirement from patients in this type of acuity is dead on. wishing you all the best always...aloha~

Christy1019, ASN, RN · May 17, 2012

I'm assuming that you posted your question using your phone, but the "text speak" is making it difficult to understand what exactly you are asking. I don't usually complain, seeing as I'm part of this text generation (posting this from my phone right now), but after reading similar posts and the negative opinions of "text speak", I have to agree that it does come across unprofessional, hard to decipher, and tends to make me think I'm doing some student's homework for them... just food for thought... ;-)

In response to what I think you're asking... yes, most COPD'ers will have baseline O2 sats 88-93% (may or may not be on home O2), and many will be CO2 retainers that may have baseline PaCO2 >50 without any mental status changes, and will likely not require any intervention if not in acute resp distress.

With COPD, the lungs & alveoli have become abnormally & permanently enlarged with decreased elasticity, and can eventually cause right sided heart failure (cor pulmonale) d/t pulmonary HTN. Basically the air can get IN but can't get OUT, which requires normally passive expiration to become active In the early stages, the body responds normally to elevated CO2 levels, (normally stimulates resp drive), however after prolonged elevated CO2 levels the body starts to give up & becomes tolerant to increased CO2 and becomes dependent on hypoxemia as their drive to breathe instead. Therefore use of prolonged high flow O2 should be avoided as it can wipe out their drive to breathe (aka CO2 narcosis).

Now with that said, you aren't going to put a pt w/a pulse ox of 70% and resp rate of 40/min on 2L nasal cannula b/c the book says to. You must always refer to your patient assessment, & ABCs, then treat accordingly. Let's say you assess this same patient and find that lung sounds are decreased w/expiratory wheezes b/l, pt appears anxious but is a&o x 3, able to speak 2-3 word sentences, noted to be in tripod position, BP 210/100, HR 130bpm, with history of asthma, copd, htn and previous intubations x 3.

First, I would start albuterol/atrovent neb tx and either prednisone or solumedrol, if pt isn't improving or tells you they're "tiring out", consider preparing for RSI or bi-pap if tolerated. If pt does start to improve, consider continuous neb treatments as needed, then titrate down to least amount O2 required, or if on bipap, least amount of fio2 to maintain pulse ox >89% without symptoms of acute resp distress.

Assuming that was all done in triage or resuscitation room, and pt is now in monitored treatment area, I would send ABG if not already done, the results will help guide treatment, and assess response, as well as to determine severity of current exacerbation.

Patients with moderate to severe COPD will likely look sick even if not currently having exacerbation, meanining they frequently present with pale complexion, fatigued-looking, thin, with dry cough, poss. dyspnea, barrel chest, and dependant edema in cases of resulting heart failure. They may already be on home oxygen tx, as well as bronchodilators and/or steroids, yet maintain baseline hypoxemia, hypercapnea, tachypnea etc that does not require any aggressive treatment, and may actually be detrimental to the patient if treated.

You should NOT make it a practice of throwing a NRB mask on these pts if they present like my earlier example pt, with some exceptions of bipap patients during transport off floor who aren't tolerating a venti mask, and if pt presents with severe SOB and unable to provide medical history. Most of your COPD pts will be just fine with nasal cannula 2-3L O2 even though their O2 sat never goes above 93%.

Sorry for the long post but hopefully that answered your questions, otherwise let me know if I can explain anything further

Sent from my SPH-D700 using allnurses.com

metal_m0nk, BSN, RN · May 17, 2012

I've always been taught that you give as much O2 as they need to be free from distress and then titrate it down as soon as possible b/c of hypoxic drive.

serenie222 · May 17, 2012

My answer is wrong then? Iput give oxygen, my rationale behind that question is that the patient is sob and no oxygen level given stated. if she is sob and oxygen level is 70% then you can probably give more oxygen I would think. I know in real life you would first have to put HOB up, check oxygen level, call for help, vitals, chart for desire oxygen level and call doctor.

Patti_RN · May 18, 2012

Somewhat related question... Does anyone teach pursed lip breathing anymore? I've had COPD/emphysema patients who have never heard of it. Am I the only one suggesting this?

COPD pt sob

More Like This