COPD pt sob

kanzi monkey · May 18, 2012

If a patient is in respiratory distress I give oxygen until they are at least slightly more comfortable (regardless of diagnosis. Unless they have a lit cigarette hanging from their mouth, they get oxygen). Even if this means putting them on non-rebreather.

THEN I am talking to doctors, getting consults (maybe the palliative care service, maybe pulmonary, definitely medicine, etc). Try to get the ABGs without O2 on.

They may get some morphine too. I am a surgical NP. I have not been in this situation very often, and once I WAS chastised (by my surgical chief resident) for "giving too much O2 to a COPDer". My gut reaction is "bull$&*!".

I haven't tried a fan. Next time in this situation I will make sure one is on the way.

When it comes to test answers, do your best. Some of those questions are absolutely useless when it comes to actual clinical scenarios. In the real world, you will find yourself doing whatever you can to ease the pained expression on your patient's face (THEN making sure that the treatment is appropriate or adjusted as necessary--like, now).

Kan

applewhitern, BSN, RN · May 18, 2012

Strangely enough, I once worked at a hospital that banned the use of fans. They claimed fans were unsanitary and "blew" germs and stuff around.

metal_m0nk, BSN, RN · May 18, 2012

Patti_RN said:
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?

Yeah, the technique is still taught/used. Along with the use of a fan as mentioned in an earlier post.

metal_m0nk, BSN, RN · May 18, 2012

applewhitern said:
Strangely enough, I once worked at a hospital that banned the use of fans. They claimed fans were unsanitary and "blew" germs and stuff around.

Ha!

I guess they'd better turn off the heat too...and the AC. All that air movement just makes people sicker.

Ha!

Esme12, ASN, BSN, RN · May 18, 2012

sereny 222 said:
My answer is wrong then? I put 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.

OK now you have supplied the proper amount of information to answer the question. First not all COPD patients are CO2 retainers. Second of course it is the attention to the ABCs. If your patient is hypoxic (Sat of 70%) ...you need to give O2. If they are not hypoxic and complaining of SOB then you will observe and try alternative RX to assist the patient to breathe....ie:nebs, fans, air conditioning, anti-anxiety meds.

What exactly did the question say.....if no oxygen saturation information is given I would do nothing, assess the patient further and observe the patient closely.

serenie222 · May 18, 2012

I already explain what question say twice. All the case study say was your pt is admitted with COPD exacerbation, he is already on 2L oxygen via NP. You enter room and you notice your pt sob, skin pale, diaphoretic. Then they give you 4 choices.

1) monitor pt-is normal 2)increase oxygen 3)dont give anymore oxygen 4) chart findings

Well you know that 1 and 4 is incorrect. so only 2 and 3 is possible answer and base on the fact that my pt sob and no oxygen given, I pick 2 because they didn`t give a oxygen level, 2l oxygen is not much and pt SOB.. I think the question is not a good question to ask especially the options they given... sure I know COPD pts don`t require much oxygen like the rest of us but they don`t give you a oxygen level how you can know to answer it. if question was to say 70% sa02 yah I would give more oxygen whereas if it says pt sa02 90% up course I won`t give anymore because it will make matters even worst

Esme12, ASN, BSN, RN · May 18, 2012

YOU "already explained what the question said twice and All the case study said was..." . You picked #2 and you don't think it is a good question and they didn't give an oxygen level. Yes, you would give more oxygen if the question said the patient has a low SPO2 and you wouldn't give more O2 if the SPO2 was 90% and would make matters worse. The patient already has O2 via NC at 2 lpm. They gave you four choices but it also said the patient was not only SOB but pale and diaphoretic indicating the patient is in distress.

It is an ambiguous question.......What was the answer.