Giving O2 without an order??

[strawberryfields]

Last night I had a patient sitting up in his bed at 0300 when I was checking up on everyone. At this time he is usually sleeping so I asked him if everything was okay and he said he couldn't breathe. I grabbed the pulse ox and it was at 75% he had no orders for oxygen but I went ahead and got him 2L of O2 NC. and raised the head of the bed. His oxygen went to 85% on 2L so I raised it to 3L and stayed by his side watching the pulse ox assessing his lung sounds, conciousness etc. It got to 95% and half an hour later I was able to move it to 2L and his oxygen stayed at 93% and he caught his breath and said he felt much better. I asked my supervisor and she told me to document everything and endorse to the AM nurse to call the Dr. in the morning.

I documented about 2L and moving to 3L all of the readings I got from the pulse ox and assessment of lungs and altertness/conciousness AND the fact that I am going to follow up with the dr. in the morning to get an order for PRN O2

My question is was it okay that I gave oxygen at 2L and then 3L when needed without a doctors orders? Is it okay that I documented that I gave oxygen and would follow up with the doctor to get an order? Because i made it clear I didn't have an order for this in my progress notes ... worried :| But I felt I did the right thing..

[MomRN0913]

Now you have me worried :/ sued for liability and lose my license even though we have an order now and the dr has seen him and he's fine?

There was no adverse event, the patient is fine, you can't be sued for liability.

I believe your actions were correct. We were told in Nursing school that giving o2 up to 4L NC is a nursing intervention. Of course, refer to your facility policy, but i think it be more likely for you to get sued for a patient sitting there SOB and not administering oxygen while you try to get a doctor on the phone. If this is not his usual, I would have called the MD, yes. But again, I believe that is learning experience. And yes, even though you should have called, but likely the MD would have complained about you calling at 3am while the o2 helped, but sometimes to cover ourselves, we have to grin and bear it.

Dont stress to much over this.

[tokmom, BSN, RN]

Yes I would of thrown on the O2, put out a call to the MD, and would of said to him...I put O2 on him is that ok? That would of been my verbal order. Then I would of called the supervisor lol.

I cant imagine any MD having a problem with giving you the order for the oxygen..unless the pt Is COPD.

And I would of told the doc that if this happened again I would be sending him out to the hospital..

COPDers still need O2 when in distress. Like others have said, narcosis can take awhile to develop. To turn it around, simply take off the oxygen. Hypoxia is immediate and is emergent. I would rather fix a narcosis that I have time to fix, then hypoxia that requires more intervention.

It also depends on this person's baseline, but what the OP posted was way to low even for a COPDer. They can tolerate episodes of higher sats, but the oxygen would eventually have to be turned down AFTER you fix the problem.

OP, I would have called after I put on the oxygen. People don't drop sats for no reason at all. The oxygen is just a band aid for the SOB. Not a true fix.