Ok, when I first started working in my unit I noticed that nurses would here and there place patients on oxygen (like 2L) whenever their sats dropped a little WITHOUT an order. In nursing school, we were always taught to get an order for O2. Usually, the RNs will put them on 2LNC as needed, without an order.
To me, I don't see what the big deal is, since it's in the best interest of the patient. I asked a few nurses about it, and they said yes, technically you SHOULD have an order, but no one takes the time to actually get one. Occasionally we'll have MD orders that say something like "titrate o2 to keep >95%".
Anyway, my question, do YOU get an order for O2 or use your judgement and do it "as needed"?
loriangel14...you mentioned in your small facility you call the md in the morning if someone's condition is declining. i'm just wondering why you would wait until the morning. i'm not trying to be a jerk about this, was just very surprised to read this post. no nurse should be hesitant about calling a doc on call no matter what time it is...they are getting the big bucks & that is what they are there for; we are there for the patients & their well being.
Specializes in cardiac, ortho, med surg, oncology.
watch out for those copders, you have to monitor their oxygen use, you don't want to kill their drive to breath.
hypoxic drive is considered the equivalent of an urban legend.
"in the may 98 issue of clinical pulmonary medicine is an article titled acute respiratory failure in chronic obstructive pulmonary
disease" by schiavi. in it the author concludes that...... "....the traditional idea that oxygen induces hypoventilation by suppressing hypoxic ventilatory drive at the level of peripheral chemoreceptors is no longer tenable."
sept. 97 issue of critical care medicine, "debunking myths of chronic obstructive lung disease", by dr. john hoyt. "[color=white]"there are examples of mythology that float about in the atmosphere of medical information that desperately need to be debunked because they influence the care of patients. one sample of medical mythology is the commonly told story that the administration of oxygen to a patient with chronic obstructive lung disease will shut down the patient's hypoxic respiratory drive and lead to apnea, cardiorespiratory arrest, and the subsequent death of the patient.
it is not clear where this fallacious information comes from, but it seems to enter the medical information database at an early age, almost like a computer virus corrupting the appropriate function of the equipment. in addition, this myth becomes very difficult to extinguish during the career of the physician, even with clear factual information of long standing. the danger here is that this medical mythology will inappropriately influence treatment decisions in patients."
I remember studying the COPD vs O2 in school, but have forgotten all about that need for assessment. Thanks. :bowingpur
PS. That's what I like about this board.
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Golden rule: don't deny the hypoxic Pt oxyen. COPD'er or not. This fear of "knocking out a Pt's hypoxic drive", while it may occur on occasion, is often unfounded. I've treated COPD'ers that have been secretely boosting thier home O2 for YEARS with out concequence. Remember, central and peripheral chemo receptors detect BOTH O2 and CO2. So, yes a Pt with obstructive lung disease and hyperoxemia may experience hypercapnea, but CO2 narcosis is not something that occurs very acutely, the pt will become more and more lethargic over time. They may require additional assesment, but with normal monitoring it's very easy to avoid.
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To answer the original question, supplemental oxygen is a prescrption drug, so yes an order is necessary. But most places will have a standing order, or some sort of protocol in place.
We have standing orders to titrate O2 to maintain sats >/= 92%. If a person is having chest pain, I will put 2L on them regardless of sats. If the patient is a CO2 retainer, the MD is typically aware of this and will prescribe a range, such as 85-89%, or a set flow rate, such as 4L.
Specializes in Med/Surge, Psych, LTC, Home Health.
Kinda depends. If a patient is suddenly in obvious distress, then I'm going to slap O2 on them and then call the doc and let them know what is going on. If their O2 is a little low, say 91, but they aren't in any obvious distress, then I might slap o2 on them, wait and see how they do, and then let the doc know in the morning.
loriangel14...you mentioned in your small facility you call the md in the morning if someone's condition is declining. i'm just wondering why you would wait until the morning. i'm not trying to be a jerk about this, was just very surprised to read this post. no nurse should be hesitant about calling a doc on call no matter what time it is...they are getting the big bucks & that is what they are there for; we are there for the patients & their well being.
thanks,
jerenemarie
usually if the charge determines they are critical they are shipped our larger site (or as we call it, the mothership)for assessment/further treatment. we are a small hospital that admits mostly palliative, med-surg, seniors waiting for nursing home placement and rehab. we have no other departments and one doc, night shift is two rns in the whole building, no security or anything. rural eh?
Every place I have worked has always had standing orders for O2...I have put it on patients without writing the order for it, but I would always make sure I wrote it afterwards.
.......... We have no other departments and one doc, night shift is two RNs in the whole building, no security or anything. Rural eh?
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Wow, I though our little 5 bed ICU, critical access hospital was small! I bet its a nice place to work though. We still have to chase the occasional moose out of the ambulance bay however.
Awesome place to work.People usually freak when they hear that 2 nurses are alone all night. We are always lobbying for a third nurse to be added. 26 beds is a lot for 2.
In my unit at the hospital, we nurses have quite a lot of autonomy. If I think a pt were to need O2 titrated, i'd think nothing of doing it, and lettin the Dr. know the next time I talked with him. My Dr's here would be quite irritated if I were to call over something unless I think a bigger problem is on the verge of brewing. Then I call immediately with condition update.
jerenemarie
76 Posts
loriangel14...you mentioned in your small facility you call the md in the morning if someone's condition is declining. i'm just wondering why you would wait until the morning. i'm not trying to be a jerk about this, was just very surprised to read this post. no nurse should be hesitant about calling a doc on call no matter what time it is...they are getting the big bucks & that is what they are there for; we are there for the patients & their well being.
thanks,
jerenemarie