Do comfort care patients get oxygen?

SierraBravo · Mar 12, 2015

The only time I would put a hospice/comfort care patient on O2 via NC is to comfort the family if they request it. It's not doing anything because someone who is actively dying is likely breathing through their mouth anyways, and you're not going to put a mask on a comfort care patient.

RNNPICU, BSN, RN · Mar 12, 2015

Depends on the situation. Sometimes just the flow of oxygen makes there breathing a little easier and can help them pass. I would always make sure you have orders that include administration of oxygen for comfort with parameters. When pts are intubated and have a terminal extubation, many times a NC with a few L O2 are used for comfort only, not meant to provide support. Using a non-rebreather would not be for comfort that would be providing respiratory support

melizerd, ASN, RN · Mar 12, 2015

Depends on your facility. When I have comfort orders they include O2 if the patient or family feels they need it. A liter or two on nasal cannula won't prolong anything.

allnurses Guide · Mar 13, 2015

I had this patient who is actively dying and basically "comfort care" meaning treatment was stopped and measures to improve comfort are placed. If the patient's O2 is dropping from a previously >92% level, but is not showing any discomfort or respiratory distress, should I be hooking him up to oxygen? Hooking up to oxygen could be seen as prolonging the dying process, no?

It really depends on the exact language used in the POLST? Go to the chart and it will tell you what you need to know.

Hppy

JustKeepSmiling, ADN, BSN, RN · Mar 13, 2015

Depends. Keep in mind too that just because oxygen is applied does not mean the lungs are perfusing in a comfort care situation. In certain end stage/MODs situations, the lungs are not capable of adequate gas exchange.

Tenebrae, BSN, RN · Mar 13, 2015

Comfort cares, does it have potential to provide comfort to the patient or their family

It would depend on the circumstances. If it was a patient in end stage COPD or lung cancer and had the potential to provide some measure of comfort (whether actual or perceived) then yes I would give them the o2 if it was charted.

I had another situation where the family were asking for it, it was not clinically indicated for this patients type of cancer and the doctor did not order it.

Its like using buscopan when patient is actively dying to address issue of secretions. Usually its more so the family can feel that their loved one is still taken care of than any actual benefit however we still give it if charted

Leonardo Del Toro, RN · Mar 13, 2015

I definitely think O2 is a comfort measure. I would always leave the O2 at least 3L but some Docs don't think that way. So you have to follow Doc's orders no?

melizerd, ASN, RN · Mar 13, 2015

I definitely think O2 is a comfort measure. I would always leave the O2 at least 3L but some Docs don't think that way. So you have to follow Doc's orders no?

Call the doc and advocate for the patient. I'm in a hospital on an oncology floor. We do a lot of comfort/hospice care.

imintrouble, BSN, RN · Mar 13, 2015

If the patient is comfort care, why are you doing VS? At the most we take those vitals daily. Not at all if we have a choice.

We try to dissuade the family if they request. Just because we're faced with personal ethical decisions.

I'd only put O2 on a patient if they were struggling to breathe.

An O2 sat is only a number. Look at the comfort care patient, to see if they're not comfortable.

ArtClassRN, ADN, RN · Mar 13, 2015

If it makes the patient more comfortable.

toomuchbaloney · Mar 13, 2015

I had this patient who is actively dying and basically "comfort care" meaning treatment was stopped and measures to improve comfort are placed. If the patient's O2 is dropping from a previously >92% level, but is not showing any discomfort or respiratory distress, should I be hooking him up to oxygen? Hooking up to oxygen could be seen as prolonging the dying process, no?

This is a good and common question.

The first thing I will answer is NO, adding oxygen is not likely going to prolong someone's dying process.

As mentioned, hospice professionals spend comparatively little time considering "numbers" when assessing their patients. We really don't care what the Pulse Ox is, or the blood sugar, or really even the BP most of the time. Sometimes we do but not always. Here is a question; why do you suppose numbers aren't that terribly important to us most of the time? When do you suppose that hospice professionals ARE interested in those type of numbers?

The answer to those questions really revolves around the philosophy and goals of care. We are focused with laser precision on comfort (what the patient wants, what the patient demonstrates, and what we advocate to them from experience and knowledge base). If the patient is dyspneic we treat that with O2 and both pharm and nonpharm nursing intervention. If the patient is actively dying we don't need to check their BP to know that they are dying, we expect the VS to be wacky. We don't need to check the Pox to know that it is going to crash and that we can't correct that. They are dying.

This is a very different mindset from the function of most nurses in most other settings.

We are not trying to "fix" anything in hospice. We are interested in palliating noxious symptoms. A falling pulse ox is not a symptom of discomfort, it is a symptom of organ failure that may or may not be uncomfortable.

I worked many years in critical care, emergency, and transport nursing. I was a master of numbers and the more ways we were monitoring patients and gathering numbers the happier I was. Fortunately, before switching to hospice I spent considerable time in community and public health. That experience caused me to learn how to talk with and listen to/hear what my patients were telling me rather than focusing on their numbers.

So, philosophy aside; the comfort care orders that were established for this dying patient should have included standing orders for oxygen and a pharmacological treatment for dyspnea, not for low pulse ox. As well, the comfort care orders should discontinue all labs, VS, other diagnostic procedures, dietary restrictions, etc. The patient ought to be allowed the things of comfort desired and defined by him/her within the confines of the law and visitation of family and friends should be encouraged and not limited in any fashion.