I have a 2yo pt who is uncooperative with their Cpap mask. I've changed the mask, have tried getting pt to hold mask, play with with while off to get them use to it and for a while pt was wearing it for 2-4 HR. RT did come out to check on the settings and the machine and everything was okay. But for the past few weeks pt has been refusing the mask, removing it immediately. Last week during their well child visit Parent was told by PCP pt's tonsils were swollen and would need to be removed and this may be why pt refuses cpap. An appointment isn't scheduled until Sept to address this. I was told by the parent not to use Cpap until after the appointment as advised by the PCP. Pt does have a sleep study scheduled this week. In my nurses notes I've been documenting PCP is aware and per parent not to use cpap until scheduled appts and issue with tonsils are addressed. Is this correct to do or does the PCP need to write an order stating CPAP therapy to be held until after tonsil issue is address? I'm not sure what to do or even what to ask from the PCP. I appreciated any input.
JustBeachyNurse, LPN 1 Article; 13,952 Posts Specializes in Complex pedi to LTC/SA & now a manager. Has 13 years experience. Jul 4, 2016 You need to check with your clinical supervisor but you need a physician order to continue to withhold treatment. You cannot take a verbal order from a parentYou cannot document PCP is aware if you never spoke with the PCP. You can say per parent request. But you must notify the clinical nurse supervisor ASAP of this change in status and parental request. If the child becomes apneic overnight due to enlarged tonsils and your not following the CPAP order you will be the one on the hook. When your documentation is reviewed and it's clear you never spoke with the PCP only the parent all of your documentation may come under scrutiny.
bdbrdb 81 Posts Jul 4, 2016 I will speak with the parent tonight on getting a order for the Dr. I sent a message to the manager and I'm still waiting on a reply/call back.
Kitiger, RN 1,820 Posts Specializes in Private Duty Pediatrics. Has 44 years experience. Jul 4, 2016 After the tonsillectomy is healed, try this: Put just the mask on the child, with a fan blowing on his face. Keep it on for a couple minutes, then take it off and do something else. Every day. leave the only the mask - no tubing or machine - on for a minute or so longer, with the fan blowing. Eventually, add the tubing and machine.If you can start off slowly, you may be able to get him used to CPAP.
chopwood carrywater 207 Posts Jul 4, 2016 Does this CPAP have a humidifier and is it at a setting that will not dry out and irritate the oral mucosa?
bdbrdb 81 Posts Jul 4, 2016 Does this CPAP have a humidifier and is it at a setting that will not dry out and irritate the oral mucosa? Yes, it does have a humidifier and the RT said everything was correct.
