How many liters of O2 is really safe with COPD? - page 2
Hi this is my first time posting I tried to search my question but the search was not working. I'm a newly licensed RN and I'm not working yet so I'm a little unsure of my knowledge. Ok so some... Read More
Nov 22, '11WOW GRN TEA where were you when I was in nursing school, that was great! I have my grid all made up. THANKS
Nov 22, '11now in hospice she is still on 15 liters and going down hill quickly. just 6 months ago i was taught with copd 2-3 liters max. so my question is am i way off base are the hospitals doing something different now?
i was taught that when on hospice or comfort measures, some copders will have a lot more o2 for 'comfort' reasons. they may feel better having all of that air blowing in, in a nutshell..
when someone is on comfort measures, the idea is not heroic lifesaving measures, but comfort. if 15 l makes them feel comfortable, let them have it.
Nov 23, '11Quote from Mardisbunfortuantely you've been taught wrongly, titration of oxygen for someone with COPD has to be determined by their gasses and not by any simple blanket rule.Thanks I was just really confused because that was just going against everything we were taught and since I'm not working yet I don't have any personal experience to draw from.
Nov 23, '11In an acute situation you can put a COPD pt on as much O2 as you need, contrary to what respiratory says or does. You just have to watch their CO2 levels and titrate the O2 down as soon as possible.
Nov 23, '11Nursing school does a terrible job at teaching this and many instructors don't understand it well either. So they keep teaching the old rule of never give more then a few liters. It's wrong to apply a blanket rule like that. In ANY emergent situation you give ANYONE as much O2 as they need.
And retaining CO2 is a ventilation problem. It has nothing to do with how much or how little O2 they are receiving.
Nov 23, '11From what i could infer from you post, they made her hospice. Im assuming she was a DNR/DNI. Bipap might help with the co2 in the short-term if she can tolerate it, but if she's retaining co2 that bad, next step is intubation and mechanical ventilation. Very hard with end stage COPD'ers to get them off that vent, hospice is often the best thing when its end stage.
Nov 23, '11Greentea....your grid brought back memories of a similar one a R/T in PICU drew for me many, many years ago....I had forgotten about it...
You are AWESOME!!!!
Nov 23, '11::[color=pink]blushing:: aw shucks.
seriously, though, thanks for the kind words.
i remember so vividly what it was like to be totally clueless and have somebody tell me something in the same language that confused me in the first place, over and over. then i was blessed with some really good clinical teachers in my first critical care job, and once the light came on, it stayed on. i learned to explain things in plain english and to keep trying other ways if i wasn't getting those "aha!" looks from my students. but i stand on the shoulders of giants.
i knew i was getting ok at some of this when driving home one night with my kids, aged 5 and 8, from a class i taught on f&e that i had to take them to, having no babysitter that evening.
my 8-yr-old said, "mom, what's kay?" "oh," said i, "that's k, the abbreviation nurses use for potassium." "ok," she said. "now i get it."
(now she's a college physics professor, but still.:d)
Feb 27, '13I just saw your post. I'm on 2 liters myself for COPD. My mother just went on Hospice for a severe heart condition. They have her on 15 liters of oxygen. I did learn in Pulmonary Rehab that you have to be careful when you increase the oxygen as the brain does tend to tell the body that it's getting enough. I know some have to be on more, but then you need to watch the extremities of the body as they may not really be getting the proper oxygen reguired. She has 3 arteries in her heart totally blocked and one that they could only get a balloon in so the blood is only dripping slowly to the two lower chambers in her heart.
Feb 27, '13To the OP,
I'm so sorry your family is going through this tough time. We have no way to determine all that has gone into the decision to place your grandmother on hospice care. Even if we did, it is not within the scope of this board to advise you on that.
As for the hypoxic drive theory and COPD patients, I have learned recently that this is more a theory but not so much based on science. I found a great blog site from an RT that provides multiple scholarly references explaining how the hypoxic drive theory has fallen out of favor as it does not hold up to rigorously controlled trials (but continues to be taught to students).
Regardless of the current science, if your grandmother is on hospice care, the focus there is comfort and oxygen is very comforting to a hypoxic patient regardless of their CO2 retaining status. I don't know how aware your grandmother is, but even minimally aware people can be comforted by the presence of their loved ones and that would be my advice to you.
Respiratory Therapy Cave: Hypoxic Drive Theory: A history of the myth
Feb 27, '13Quote from TiffyRNThe OP posted this in 2011-I'm sure her grandmother is no longer on hospice.To the OP,
I'm so sorry your family is going through this tough time. We have no way to determine all that has gone into the decision to place your grandmother on hospice care.