COPD- 98% O2 sat?

GreyGull · May 24, 2011

My apologies I meant pulmonary airways...thanks for providing such great literature to make this "evidence based practice".

Extensive research went into those guidelines which are updated frequently just like the AHA does for cardiac issues.

Many don't realize that the treatment for COPD and Asthma is an international collaboration. If you note for these guidelines the American Thoracic Society (ATS) and the European Respiratory Society worked closely together. Canada also has a huge Society addressing COPD and Asthma as does New Zealand/Australia.

ATS

http://www.thoracic.org/index.php

ERS

http://www.ersnet.org/

Canadian Thoracic Society

http://www.lung.ca/cts-sct/home-accueil_e.php

Australia/New Zealand

http://www.thoracic.org.au/

There are also other countries with their own Associations and they present their research with the others at international conferences.

Just like the AHA with its journal Circulation, each of these societies have professional journals to keep others up to date on the advances in pulmonary medicine. Those who like to state up to date on what other countries are doing may be envious in knowing that some technology and meds may not become available in the U.S. for many years.

They also address many other pulmonary diseases and will work with other associations such as the AHA when issues overlap or guidelines pertain to other disease processes which in some cases it is hard to treat just one disease process without addressing the other.

Examples:

http://www.thoracic.org/statements/

If you have an interest in pulmonary diseases, I do recommend attending an ATS conference if it is offered near you.

For those who have an interest in COPD and Asthma, there are educator courses available which are worth the time.

I'll grant that "thinking has changed" regarding CO2 retainers and oxygen. However, my empirical experience with hospice - thus very end stage - lungers is that they will often c/o dyspnea and look restless and anxious when their pulse ox climbs too high and have gotten relief by reducing the oxygen a bit.

By reducing the oxygen you may also be reducing mentation. When a patient is dying, the number on the pulse ox is not always indicative of what the tissues are receiving. This is similar to when we use ScvO2 monitoring in the ICUs. The SpO2 might be great but the ScvO2 might not be.

In fact, when we do have patients in hospice or with comfort care orders, we do not number watch. We watch for signs of discomfort and will usually treat that through other means of pharmaceuticals since we know the body is probably no longer able to oxygenate the tissue or organs as a healthy person would.

If the patient is alert enough and wants to remain awake, we may nebulize fentanyl with a breath-actuated nebulizer. This also seems to give them some relief of the dypnea they feel which is difficult to relieve without making them almost unconscious with other medications.

steelydanfan · May 24, 2011

Extensive research went into those guidelines which are updated frequently just like the AHA does for cardiac issues.
Many don't realize that the treatment for COPD and Asthma is an international collaboration. If you note for these guidelines the American Thoracic Society (ATS) and the European Respiratory Society worked closely together. Canada also has a huge Society addressing COPD and Asthma as does New Zealand/Australia.
ATS
http://www.thoracic.org/index.php
ERS
http://www.ersnet.org/
Canadian Thoracic Society
http://www.lung.ca/cts-sct/home-accueil_e.php
Australia/New Zealand
http://www.thoracic.org.au/
There are also other countries with their own Associations and they present their research with the others at international conferences.
Just like the AHA with its journal Circulation, each of these societies have professional journals to keep others up to date on the advances in pulmonary medicine. Those who like to state up to date on what other countries are doing may be envious in knowing that some technology and meds may not become available in the U.S. for many years.
They also address many other pulmonary diseases and will work with other associations such as the AHA when issues overlap or guidelines pertain to other disease processes which in some cases it is hard to treat just one disease process without addressing the other.
Examples:
http://www.thoracic.org/statements/
If you have an interest in pulmonary diseases, I do recommend attending an ATS conference if it is offered near you.
For those who have an interest in COPD and Asthma, there are educator courses available which are worth the time.
By reducing the oxygen you may also be reducing mentation. When a patient is dying, the number on the pulse ox is not always indicative of what the tissues are receiving. This is similar to when we use ScvO2 monitoring in the ICUs. The SpO2 might be great but the ScvO2 might not be.
In fact, when we do have patients in hospice or with comfort care orders, we do not number watch. We watch for signs of discomfort and will usually treat that through other means of pharmaceuticals since we know the body is probably no longer able to oxygenate the tissue or organs as a healthy person would.
If the patient is alert enough and wants to remain awake, we may nebulize fentanyl with a breath-actuated nebulizer. This also seems to give them some relief of the dypnea they feel which is difficult to relieve without making them almost unconscious with other medications.

You pretty much said it all. The pulse ox is only a guideline, it may or may not give you a true reading about oxygen delivery OR use.

If your pt. is anemic, they may have a pulse ox of 98%, with an awful paO2. It's all about o2 uptake, NOT delivery. So, if you think they are not respirating, send 'em too the ER for an ABG, and sort it out there.

Kitiger, RN · Mar 22, 2021

On 5/23/2011 at 4:18 PM, GreyGull said:

What are you nebulizing to dilate the pulmonaries arteries? While there are meds available for home use, this would then present a whole new set of problems to this situation.

Or, the nebulizer was given by oxygen at 6 L which also can make someone feel better.

Even with a Pulmoaide or some electrical nebulizer, the additional flow can make a difference just like a fan blowing on high even in the middle of Winter can do more than meds for some patients.

Guidelines for COPD have changed dramatically since the 1970s and we now have enough EBM to dispute the "hypoxic drive" theory.

The ATS/ERS have also reworded their guidelines to reflect these changes and have also change their wording to now state:

Note that it states SaO2 and not SpO2. SpO2 is an excellent monitor but one must also be away of other things that can make the SpO2 inaccurate this includes smoking and certain medications.

Too many patients have been needleesly harmed by the misinformation passed along from the days of "never more than 2 L or greater than 88% SpO2 will knock out the hypoxic drive of a COPD patient without taking any other factors into consideration.

The difference in the disease processes for what constitutes COPD also makes "wheezing" not always a common factor which is why doctors now write "shortness of breath". The mechanism of some medications such as Atrovent should also be understood. For these reasons Asthma and COPD now are taken into consideration separately.

Source from which I posted the above quotes:

http://www.thoracic.org/clinical/COPD-guidelines/resources/copddoc.pdf

Another good read with tons of information is the EPR 3 Guidelines for Asthma.

http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

Also review the many other reasons that can cause shortness of breath such as low BP, fever, glucose irregularities, pain, irregular heartbeats and infection. Many of these things can be ruled out with a simple but thorough assessment but at least you will have covered all the bases rather than becoming distracted by one symptom.

I learned something new today. Thank you. ?

allnurses Guide · Mar 22, 2021

On 5/23/2011 at 9:31 AM, payang0722 said:

What else should I have done? I am so poor in assessment. I know this is tough being a new graduate/new nurse. Thank you so much in advance for your response.

How is the culture where you work? Is there someone there you can bounce things off? That way you could get answers in realtime and notlosing sleep, At our facility every new hire has a designated support person for their first year. I currently have two chicks under my wings,

Hppy

CharleeFoxtrot, BSN, RN · Mar 22, 2021

Folks, a spammer bumped this post (spam post looks deleted thank you Mods!) it's from 2011...just FYI

caliotter3 · Mar 23, 2021

May be from 2011 but I still find it more appropriate than wasting site resources over candy in a vending machine. That is why I oppose automatically closing old threads as has been done in the past.

Hannahbanana, BSN, MSN · Mar 23, 2021

On 5/23/2011 at 12:31 PM, payang0722 said:

ordered routine neb q 6hrs for shortness of breath...Now my question is, do u still give nebulizer treatment to a COPD pt. routinely even when there is no wheezing?

Yes, absolutely. The scheduled nebs will help prevent her from getting the bronchospasm that you hear as wheezes. That's the point.

Hannahbanana, BSN, MSN · Mar 23, 2021

Everything old is new again ....