COPD pt's and 2L o2

allnurses Guide · Dec 8, 2006

There is a great article addressing this in Medsurg Nursing from April 2004 Vol 13/No 2. It is called Informed Nursing Practice: The Administration of Oxygen to Patients with COPD. Only a small percentage of COPDers will have problems with higher O2 flows. As other posters have said, you cannot deprive the pt of O2 when the science really isn't as clear as you may have been taught. Here is a portion-
"Despite the fact that ample research has rendered [The hypoxic drive theory] defunct, perpetuation of this medical myth and a nurturing of the ensuing clinical mindset persist. The result is a danger that misinformed clinicians may deliver doses of oxygen that are inadequate for the patient's metabolic needs."
Check it out!

This is the way I practice. Thanks for the article.

And an O2 sat of 82% means vital signs are NOT stable.

steph

loafin' · Dec 8, 2006

I don't understand where the info comes from regarding o2 liter flow and client's with COPD. Just because you have COPD doesn't mean that you are a chronic hypercapnic. You can be a chronic hypercapnic and not have COPD. It's not about the Fio2, it's about how much is diffused across the AC membrane and becomes PaO2 and o2 sat. We traditionally like a chronic hypercapnic's sat 88-92%, regardless of Fio2.

SuesquatchRN, BSN, RN · Dec 8, 2006

I don't understand where the info comes from regarding o2 liter flow and client's with COPD. Just because you have COPD doesn't mean that you are a chronic hypercapnic. You can be a chronic hypercapnic and not have COPD. It's not about the Fio2 it's about how much is diffused across the AC membrane and becomes PaO2 and o2 sat. We traditionally like a chronic hypercapnic's sat 88-92%, regardless of Fio2.[/quote']
That's what we were taught is where it comes from. And whenever I tried to get an explanation that made sense I couldn't. The instructors couldn't explain why we were being taught this or what system, precisely, was inhibited by "too much" O2.

RazorbackRN, BSN, RN · Dec 8, 2006

This past weekend, as I was beginning my shift, a pt was c/o SOB.... The tx nurse had found her in bed red to the face (note: not cyanotic) and saying she couldn't breathe. All licensed nurses rushed in the room (4 LVN's & 2 RN's). Her vital signs were stable, she was COPD and her o2 sat was 82% on 2L/via N/C. The began to increase her o2, I kept repeating (She's COPD! ), both RN's said it was okay and increased her o2 to 8L/face mask to get her o2 sat up....I'm a new nurse...but someone correct me if I'm wrong...COPD pt's are NOT to have more than 2L o2...right?? This causes more damage.
Is it common for nurses to do that?
They took the pt via 911, of course she came back 3hrs later. The pt was having an axiety attack...something a lil Ativan could've relieved. :icon_roll

So, had this been your patient, what would you have done? Just given Ativan?

Regardless of the reason (COPD or anxiety), if her sat was 82%, she's not oxygenating efficiently. Thus, you would supplement it with O2 until you could stabilize her and then worry about the residual effects.

ZASHAGALKA, RN · Dec 8, 2006

The goal for these patients is a 'liveable' SaO2, or indirectly, SpO2. That would be about 88-92% for most COPD pts.

You give enough O2 to reach that point, no matter how much O2 that is.

For someone that lives on borderline hypercapnia, raising sats much higher then that CAN serve to shift the curve towards ever increasing hypercapnia, to the point that CO2 narcosis can develop, depressing respiratory drive.

Most of us in the trenches have seen that. For example, the 'copd' pt that was given a neb tx with high flow O2 instead of air, with the result being subsequent intubation. It's a phenomenom of note, and has been noted, and preached to us all.

The POINT of the precaution is the over-use of O2 in those patients. OVERUSING O2 in a copd pt would be trying to force a perfect sat, or using O2 indiscriminately, without evaluating how it is affecting their saturation.

At THAT point, it is dangerous. Just like any 'drug' there is a therapeutic effect and a toxic effect, depending upon dose. That doesn't mean you withhold the drug because you are afraid you might give a toxic dose. It means, you give the drug at its therapeutic dose, whatever that might be for that patient.

You don't just draw up an indeterminate volume of a drug and give it to a patient in need. On the other hand, you don't withhold a drug either for fear of toxicity. Rather, you determine the dose necessary to treat the problem. The same is true here. You give ENOUGH O2 to treat the problem. Not less. Not more.

~faith,

Timothy.

CapeCodMermaid, RN · Dec 8, 2006

I'd be willing to bet you patient was hypoxic as hell and you perceived it as anxiety. With an Spo2 stat of 82 percent what would be worse than withholding oxygen besides applying a pillow directly to the face. Co2 does not regulate respirations, it is hydrogen ion concentration. If these gomers need oxygen you have to give it to them to atleast crank the Sp02 some where into the A minus percentile.

If these GOMERS????????????? You're in the wrong place, buddy, if you call all old people with COPD gomers!!!!! :nono: :nono:

psalm_55 · Dec 8, 2006

Titration. Titration. Titration.

Titrate O2 delivery with SpO2. Giving what is needed while not exceeding the patient's baseline or usual spO2.

so, yes we can give higher concentations of oxygen.

and remember that early signs of hypoxia are restlessness and anxiety. think about it: how would you feel if you couldn't breathe?

RunnerRN, BSN, RN · Dec 9, 2006

I wonder what came first here, the low sat or the anxious feeling? In my mind, it doesn't matter what the underlying patho is, if a pt has a low sat and is gasping for air, you give them Os. You can always intubate if they suddenly stop breathing because you gave them too much O2 (not that I've seen it happen, but you could). I'd rather save the brain cells.

augigi, CNS · Dec 9, 2006

You have received excellent answers from everyone. I would just reinforce that you need to know what saturation this patient usually sits at - many people walk around with O2 sats in the 80s and are just fine. HOWEVER - treat the patient and not the numbers!! Pain is what the patient says it is, and SOB most definitely is what the patient says it is. They know! If the patient is distressed, treat the patient.

Trauma Columnist · Dec 9, 2006

I agree with those posters that say COPD patients need oxygen. They can still be hypoxic even if they have COPD. This scenario provides us with the fact that this patient had a change that cued the nurses to activate 911. Once it has been determined that the pt needs to go to the ER, oxygen is the primary intervention available. Go for it...if you knock out their drive to breathe, you can bag them, intubate them, etc..

st4wb3rr33sh0rtc4k3 · Dec 12, 2006

This is what exactly happen to me today...

A patients sat went down and the previous shift nurse, turned the o2 to 4.5L... Oh goodness!!! When I checked his sat it was 86%... I turned it up to 4L, and it stayed... When I turned it down, it went up a little...

I called the NP who said, no titrate it down... She was so right... By the end of my shift I got it down to 3L

goats'r'us, ASN, RN · Dec 12, 2006

it's ok to crank the 02, what's really important is knowing where your goal is.

it's fine to give whatever o2 is necessary to bring up their levels from 82, as long as you realise that you're not aiming for an SpO2 of 100%, coz that's what's gonna stop them breathing!