COPD patient on 4 liters?

[Koyaanisqatsi-RN]

Isn't a constant 4/L of oxygen a little much for a long-term 86 year old COPD patient? What if she periodically just dozes off for awhile, wouldn't that also indicate perhaps a buildup of CO2? Just looking for a few opinions here.

Again, I'm not talking about an acute episode, patient cyanotic etc, I'm referring to a baseline level of 4L of oxygen being used at home, every day. Thanks for any help!

[Blee O'Myacin, BSN, RN]

An 86 year old might just doze off here and there. My grandma does and she's healthy for her age! She might have been anxious and "air hungry" at 2L. Sometimes it is a trade off with what is "proper" and what helps the patient acheive the highest quality of life.

[leslie :-D]

With or without copd, an 86yo is going to doze.

It is likely her baseline.

Any change in loc/mentation above and beyond that, would be indicative of further assessment.

If pt is OK, then 4l is fine.

I have never seen non-acute copd on anything more than 4l however.

You will discover that copd can present differently w/ea pt.

[Koyaanisqatsi-RN]

leslie ? said:

With or without copd, an 86yo is going to doze.

It is likely her baseline.

Any change in loc/mentation above and beyond that, would be indicative of further assessment.

If pt is OK, then 4l is fine.

I have never seen non-acute copd on anything more than 4l however.

You will discover that copd can present differently w/ea pt.

That makes sense, it's just that I had never seen anyone before this on more than 3, so I was just a little concerned!

[Jan_561]

Cover yourself. check MD orders, and document. and make sure MD is made aware of situation and doc that as well..just remember...cya

[leslie :-D]

Koyaanisqatsi said:

That makes sense, it's just that I had never seen anyone before this on more than 3, so I was just a little concerned!

It's a perfectly valid question/concern.:)

And, you will find few (hopefully only a few) that will still insist on nothing more than 2l...

Which urges me to remind you et al, to always, always, always assess the person behind the equipment.

Some get stuck only on the diagnostics/numbers w/o assessing how the pt is presenting.

I've had copd'ers w/sats in mid 90's, who were profusely diaphoretic and rr 50's.

Also had a few w/sats in mid 80's, who appeared fine...But I increased o2 anyway, and closely monitored.

You ask good questions, koya.

[puppytrix]

I have seen plenty of COPD patients in general, and I have seen many on 4L/min, and some more. Of course it is always whe least amount possible with keeping them at an acceptable level, but especially when it comes down to the end stages of the disease, these patients could be on any flow.

[APRN., DNP, RN, APRN, NP]

It depends upon whether this COPD person is a pink puffer or blue bloater. Are they a C02 retainer? Do they have restrictive lung disease? the diagnosis of COPD incorporates many original diagnosis such as asthma, bronchitis, emphysema.

[loricatus]

If she's a mouth breather and the O2 is via nasal cannula, this would be a recommended amount.

[montinurse, BSN]

I've seen an early 50-some year old COPD'er on 4L continuous! I dc'd him last week, hopeful that he could quit smoking, only to have him back 6 days later. This is something I'm going to have to get used to as a new med/surg nurse. The disappointment and frustration of my own thoughts of "if only they'd quit".

[FireStarterRN, BSN, RN]

Not every COPDer is a CO2 retainer. A set of ABGs would give more information about that.

In the case of a retainer, you have to keep the Sats lower than usual, such as between 88-92%