COPD pt's and 2L o2 - page 3
This past weekend, as I was beginning my shift, a pt was c/o SOB.... The tx nurse had found her in bed red to the face (note: not cyanotic) and saying she couldn't breathe. All licensed nurses rushed... Read More
Dec 12, '06Joined: Dec '05; Posts: 63; Likes: 4Quote from ZASHAGALKAJust to clarify, neb tx with air?? How does that work? u guys have a system or somthing?The goal for these patients is a 'liveable' SaO2, or indirectly, SpO2. That would be about 88-92% for most COPD pts.
You give enough O2 to reach that point, no matter how much O2 that is.
For someone that lives on borderline hypercapnia, raising sats much higher then that CAN serve to shift the curve towards ever increasing hypercapnia, to the point that CO2 narcosis can develop, depressing respiratory drive.
Most of us in the trenches have seen that. For example, the 'copd' pt that was given a neb tx with high flow O2 instead of air, with the result being subsequent intubation. It's a phenomenom of note, and has been noted, and preached to us all.
The POINT of the precaution is the over-use of O2 in those patients. OVERUSING O2 in a copd pt would be trying to force a perfect sat, or using O2 indiscriminately, without evaluating how it is affecting their saturation.
At THAT point, it is dangerous. Just like any 'drug' there is a therapeutic effect and a toxic effect, depending upon dose. That doesn't mean you withhold the drug because you are afraid you might give a toxic dose. It means, you give the drug at its therapeutic dose, whatever that might be for that patient.
You don't just draw up an indeterminate volume of a drug and give it to a patient in need. On the other hand, you don't withhold a drug either for fear of toxicity. Rather, you determine the dose necessary to treat the problem. The same is true here. You give ENOUGH O2 to treat the problem. Not less. Not more.
Dec 12, '06Joined: Jan '03; Posts: 1,894; Likes: 4,306I was wondering the same thing. ours isnt set up that way. Good to know tho. We only get the occasional copd-er.
Dec 13, '06Joined: Oct '04; Posts: 927; Likes: 588Just want to say, what a cool thread! I was taught not to crank it up past 2L for a COPDer too. Never thought of the things others have posted. I always learn the coolest things on this site!
Dec 13, '06Occupation: SICU/MICU RN Joined: Jun '04; Posts: 235; Likes: 8There's no set rule of NC O2 that I was taught not to give a COPDer. I was taught in school, that for a CO2 retainer, use caution in giving O2 b/c you can knock out their respiratory drive as others have discussed. However, keep in mind these patients can go bad and need higher flows of O2. Don't with hold the oxygen they need as others have mentioned also- you wouldn't not give pain medication to a patient screaming in pain, b/c you might knock out their respiratory drive from giving 2 mg of morphine, same thing applies with oxygen. But, if you have to give them O2, give it in a form that is better for COPDers. If they need higher flow of oxygen, use a venti mask.
Dec 13, '06Joined: Oct '06; Posts: 35; Likes: 5I have never seen a COPD patient stop breathing from too much O2, but I have dealt with many that stopped breathing due to lack of O2, the most they will do is sleep all day if you crank up the O2.
Dec 14, '06Specialty: Med/Surg ; From: US ; Joined: Jan '06; Posts: 59; Likes: 7thank you everyone for all your input. some of the replys were a lil over my head, but overall i received so much info...so much i didn't know.
Dec 14, '06Occupation: RN Specialty: 15 year(s) of experience ; Joined: Oct '02; Posts: 4,763; Likes: 844I learned in school and from an RT that COPD pts should not have O2 @ >5 lpm. However, I've seen some hospice pts on 15 lpm per MD orders. They've gone on for months that way.
Most COPDers should have antianxiety meds ordered.
Dec 14, '06Occupation: 20+ yr RN Specialty: 15 year(s) of experience in Critical Care ; From: US ; Joined: May '05; Posts: 7,520; Likes: 4,030Quote from cozmo_blozmoThis is just not true. I HAVE seen CO2 retainers stop breathing from too much O2. And, while they DID 'sleep all day', it was by being sedated after subsequent intubation.I have never seen a COPD patient stop breathing from too much O2, but I have dealt with many that stopped breathing due to lack of O2, the most they will do is sleep all day if you crank up the O2.
CO2 narcosis is a very serious complication of too much O2. That isn't to say withhold or be 'cheap' with the O2, but instead, to give the RIGHT amount. Not less. Not more.
That requires evaluating our treatments. THAT's why evaluation is part of the nursing process.