Do comfort care patients get oxygen?

anon456, BSN, RN · Mar 21, 2015

There was a patient I had in nursing school who was very old and and had COPD. She wanted to go home and die. She also wanted BiPap with oxygen, and that request was granted to her. As an asthmatic I can tell you that air hunger is a horrible thing to experience. If the dying person wants oxygen, let them have it. Also let them have a lot of pain meds and anxiety meds to get them through. The application of O2 will not prolong their life by very long- they will still die of their disease eventually but will be more comfortable through the process.

allnurses Guide · Apr 5, 2015

I had a pt we were admitting for comfort care, mostly nonresponsive. I left his 02 on just because.... no real reason other than he seemed comfortable and I didn't want to change anything. RT was unhappy with me when I started to send him to the floor with it on, and they removed it on arrival. Pt died in about 10 minutes, RT told me the 02 was the only thing that had kept him going. I think it was just his time.

Anna Flaxis, BSN, RN · Apr 5, 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?

I doubt it prolongs the dying process, but seriously, what is the point? If the patient is actively dying, you shouldn't be monitoring VS anyway, so you wouldn't know the pulse ox was dropping. If the patient is unresponsive and showing no signs of air hunger, then placing O2 is unnecessary. In fact, the cannula on the face can be a noxious stimulus for some people. I'd have left it off.

gassy2be · Apr 5, 2015

Yes, 2L NC. It's part of the bundled order for comfort care/withdrawal of care which also includes morphine and Ativan.

KelRN215, BSN, RN · Apr 11, 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.

I agree. In pediatrics, families are often so used to seeing their kid on the monitor all the time. It's hard for them to let that go. We would try to dissuade them from leaving the child on the monitor but, often, the parents wanted to see what was going on. So what we would do is leave them on the monitor but turn all the alarms off. No temps or BPs taken. Usually we could get the parents to the point where they'd be willing to take all monitors except the O2 sat monitor off. It still didn't offer much useful information- we saw kids whose sats dropped from 90s to 80s to 70s to 60s over days and others who did it in minutes.

O2 via NC isn't going to prolong anything. I don't see a problem with using it for comfort.

_Skittles_ · Apr 28, 2015

I just had this happen - it was sudden and the experience was traumatic to the family. It seemed to give them comfort that we were "doing something" to make the pt more comfortable beyond the standard meds. Honestly the o2 isn't really helping if the pt's circulation is shutting down and O2 isn't harmful and is usually left up to nursing judgement.

Galendria · Apr 28, 2015

I work in a state where patients can ask to be DNR--comfort care without a terminal diagnosis, so the amount of supportive care we give is quite varied...from traditional comfort care for the dying patient with liberalized diet, no labs, daily v/s, no accu-checks, etc to more traditional care for a hospitalized patient where they might receive IV antibiotics for a UTI, a heparin drip, respiratory treatments, etc. Its really up to what the patient and/or their family want and what their goals are at that point in time.

On the flip side, I have sat at a close family member's bedside while they spent a week in the ICU fighting before we decided to switch to comfort care. Toomuchbaloney's post was right on in that numbers aren't really important anymore. My family and I appreciated the nurses who focused on what my family member needed, and what made her comfortable. Sometimes too family members who have lost all sense of control will ask the nurse to do something. And if that something is small (like oxygen via NC), doesn't hurt the patient, and is covered by a doctor's order, nurses can make the family member feel they contributed by honoring their wish. In the end, I asked the nurses to turn off the bedside monitor because watching the numbers go down, knowing what they meant as a nurse, was just too much to take.

AnthonyD · May 5, 2015

If the patient has been on O2, or is baseline O2 dependent, I leave it on. If the patient or family requests O2, I will put it on; it can certainly be a comfort. If they don't tolerate the cannula, I take it off.