Does Oxygen need to be prescribed?

[seasoned hopeful]

I had a patient yesterday who had used O2 eariler in the day. His :eek: O2sats went down to 84%. I put up the head of the bed and checked it again and it did not go up. At that point I got the nasal canula off the wall, turned up to one liter and put it on him. I was told after by my instructor that That had to be doctored ordered to put on and to take off. Is that true?

[Jonathank]

As I understand it, yes. You either need a specific order for that pt. or a standing order that applies to the pt.'s situation.

[caliotter3]

Specific order indicating route and amount for that patient or standing orders. Most places have standing orders for the nurse to apply up to 2L per minute. Anything above that must have a specific order.

[OpenHeartLPN]

The student area is grey, but in an emergency it oxygen does not have to be ordered to give. An order should be obtained after patient is stabilized ASAP. To be safe don't go over 2L to prevent harm to COPD patients. There are lots of other factors though ie. does the patient have heart problems, what is patients norm?

I don't know your schools policies but I would bet you did the right thing even by their standards if he had oxygen earlier he probably still had an order for it *(did you check after the fact?) I would qualify 84% as an emergency.

[Italia23]

i could be wrong, but in the case of an emergency i am pretty sure you don't need to wait for the md's orders. if your pts 02 was at 84%, i am pretty sure that would warrant immediate oxygen. the only reason i could see for not giving the pt 02 stat would be if they had copd. i have always been told to apply the 02 because the pt could end up with hypoxia which could potentially be life threatening. but i am still learning! i could be wrong!!!!

[Seas]

As a student, I think you should have called the primary nurse for this emergent situation.

[redtailhawk]

O2 is a medication... do you have standing orders to administer?

[BrynnLeann]

Where I am at, the policy & procedure manual lets nurses put 2L np on no problem. In case of an emergency (imminent code blue/code 25), we put oxygen on as high as it goes. In other cases, the doctor usually writes an order such as "Keep O2 sats >92%", meaning that we use the oxygen delivery method and rate at what is necessary to keep the patient satting at an appropriate level. We also titrate oxygen down without doctors orders when necessary. For example, if they are put on 2 L np in emerg for chest pain, and their chest pain is resolved and stable, we'll remove the O2 and just keep an eye on their sats.

I think it really depends on what unit you work on, and what type of hospital. I'm at a community, not tertiary, hospital so we don't have 24/7 access to doctors.

84% is quite low and I think I would have reacted to the situation exactly as you had.

[solneeshka, BSN, RN]

Always assess the patient, not the machinery. If pulse ox is 84%, ask them to take a few really deep breaths; some people have occasional bouts of apnea that can make their pulse ox low for a minute, but once they snap to and take a couple of good breaths, they're back up in the 90s. Also move the pulse ox to another finger, preferably on the other hand; sometimes the equipment just doesn't work right on some fingers. If still at 84%, then for the love of all that is holy, of course put some oxygen on!!! Even if the patient has the worst COPD you've ever heard of, put that oxygen on and tell them to breath and breath deeply!!! (O2 tx is bad for COPDers over the long haul, but in the short run, if their sats stay in the mid to low 80s then they are going to be dead, which is also not good for them :)). As soon as you get the O2 on the patient and they are breathing deeply, call to the desk, tell them Mrs. Jones has a sat of 84, could then please call the primary nurse to the room. Once the patient is stabilized, then yes, get a doctor's order. Oxygen is considered a drug and you need to have some sort of order to administer it. Any acute care facility should have a policy on this (many responders have commented already about common standing orders), so check out what the policy is for the facility you are at this semester, and make a habit of knowing it wherever you have clinicals in the future.

You did the right thing by getting the patient O2. Your instructor was right that you should also have gotten an order, but the correct chronology was O2 first, order second. Your instructor should have used it as a teaching opportunity, not a reprimand. You did good!!!

[~Mi Vida Loca~RN, ASN, RN]

With students I am not sure the protocol you would have to go with school policy, buy I know in both hospitals I have been in (different companies) O2 is one of those things you can give first and get order after if it's an emergent situation.

[anonymousstudent]

84% is quite low and I think I would have reacted to the situation exactly as you had.

Me too!

[RosesrReder, BSN, MSN, RN]

Slap the NC on, monitor, assess and call the MD for an order (or whatever he/she wants).

Everywhere I have worked there are specific oxygen orders upon admission for everyone, even if oxygen is not expected.

Ex:

"Keep 02 sats greather than or equal to 88%" "Titrate to keep 02 sats above 92%".