Comfort care measures.

  1. A few days ago an issue arose and I'm just wondering if I made the right the decision..

    One of my residents is actively dying. He has a DNR/DNH and the family wishes for him to receive comfort care only.

    His son questioned me about the need for oxygen. I took the residents Sp02 AND it was 91% on 2L of oxygen via nasal cannula. The resident did not appear uncomfortable or in respiratory distress but I think it would be best to keep the oxygen on as his Sp02 wasn't so great. He(the son) started to become very defensive and accusing me of not respecting his father's wishes for end of life care and saying that the oxygen is keeping him alive.

    I told the son that the oxygen is a comfort measure and without it his father would start having symptoms of respiratory distress. I made my supervisor aware of the above situation and documented the crap out of it too.

    Was I wrong here to refuse to take the oxygen off and go against his son's(HCP'S) wishes?
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    About Forever Sunshine, ASN, LPN, RN

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  3. by   newrnltc
    I agree with you that O2 is a comfort measure. Its cruel to allow someone to be in pain, gasping for air, getting acidic and distressed/anxious in their last days, which could turn out to be weeks... even months! I have hospice patients that have been around for over a year! Now iv fluid and gt feeding is another story. But pain management and comfort care, dealing with emotional issues, keeping the skin good, making the best of the final time on earth is what's palliative care is all about!

    I imagine unless this guy's heart is made of stone once he sees his pops turning blue, his hands grasping at you and suffering he will change his tune. Whatever happens its good you documented. This probably requires an interdisciplinary meeting with MD, SW, family and staff. I don't think the son has his facts straight.
  4. by   CapeCodMermaid
    I agree with you. Supplemental oxygen is not an extraordinary life saving measure. It won't prolong his might make his remaining days a little less horrible.
  5. by   newrnltc
    Also, even if the resident is okay with facing end of life, we probably all wish to go comfortably in our sleep not getting cyanotic and thrashing about while everyone looks on not doing a thing. Remember DNR doesn't mean don't do anything and ignore the well being of the resident.
  6. by   JZ_RN
    Oxygen will not "keep him alive" or "extend life" if he is dying. It will only keep him from having painful respiratory distress and a quick and uncomfortable increase in cognitive decline. Oxygen is definitely COMFORT CARE. I almost always prop my patients up a little when they are actively dying, clean the mucous from their mouths, give them a cool water swab in the mouths, clean linens, a clean gown, prop the pillow up for comfort, leave the lights low, and spend time talking to them even if they're unresponsive. Without oxygen a lot of them get air hunger and start to struggle. That's the OPPOSITE of comfort. The oxygen definitely isn't "saving them" but it does make their passing a lot less stressful and painful. No one wants to go from 02 deprivation and start struggling, wheezing, coughing, tossing, turning, and not able to breathe, it's not humane to let someone do that if you can help it.
  7. by   amoLucia
    newrnltc said it irght...DNR does NOT mean DNT (do not treat). O2 is comfort care. My problem is with gurgling pts. I WILL SUCTION! This to the argument of some hospice nurses (and some others). Fine---they can come in and listen and do the care for the pt struggling to breath and drowning in his own fluids. I can't and as long as I am at the bedside, I will do what I feel is appropriate to keep the pt comfortable.
  8. by   Forever Sunshine
    That above instance at work really made it click to me that DNR does not mean sit back and let them go. I always had that phrase "DNR does not mean do not treat" in my head. But when you actually use it and stand up for it it makes sense to you.

    I did not take the oxygen off. My philosophy in nursing is I treat my residents as how I would want my family treated. I have a statement typed up as well as a detailed nurses note incase I am questioned about this by administration. I made sure my ass was well covered. I even went to back myself up and I read every document in the residents chart with a fine tooth comb.

    Amo I too have suctioned a hospice patient(a different one). She was gurgling on her own phlegm and started to become cyanotic around the lips. I'm sure the suction machine isn't comfortable but I see it as a comfort measure.
  9. by   *LadyJane*
    Yes, of course it's a comfort measure to have o2. Morphine also helps with this, too, Did he have it prescribed?
  10. by   VivaLasViejas
    And what about atropine? A couple of drops SL works for the gurgling too, and isn't uncomfortable or frightening like suctioning can be.

    Good on you, OP, for sticking to your guns! You are someone I'd want as my nurse if I were ever in that situation.
  11. by   Esme12
    A little blow byO2 will not prevent his death but it can keep him comfortable. Good JOb!
  12. by   CompleteUnknown
    You didn't do anything wrong at all! Sometimes oxygen doesn't do much to relieve the air hunger in these situations but it's definitely a comfort measure and if the resident wasn't distressed by the cannula, why on earth not? Morphine often helps too.

    Sometimes the resident finds having something on their face irritating or uncomfortable or they get more restless or try to pull at the tubing - in those situations I'll often sit a mask near their face so they get a bit of blow by, like Esme said.

    We generally don't check O2 sats on people who are dying but rather treat any distress we see.

    Unless the cannula was distressing the resident, I'm finding it really hard to imagine why the son was opposed to the oxygen....... Did he believe you when you explained it was for comfort or did he still think it was keeping his father alive? I've had family ask me why oxygen is being given, but I've never been in your situation, thank heavens.
  13. by   Forever Sunshine
    I don't think he believed me at all. He just kinda huffed and puffed it off and then I ducked out of the room.

    I kept the cannula very loose. It was not distressing the resident in any way. Only reason I checked his O2 sats was to have my ducks aligned.
  14. by   vanursegrad
    I've heard 2 arguments. One is that O2 is for the onlooker's comfort and not for the patient's comfort. I have also heard that O2 provides improved comfort for air hunger. I have worked with physicians from both backgrounds. Morphine can alleviate air hunger too and some patients may become restless or uncomfortable with the face-mask or nasal cannula. So really, as long as the patient appears comfortable, and the family is satisfied then I am as well.