Hospice patient o2 needs

[Suzie070307]

Hi everyone,

I'm a new grad nurse working on a stroke/med surg/oncology unit. I've been on my own for about 2 weeks. Its been going really well so far until last night. I had a hospice patient who was on a dilaudid drip and getting Ativan and Haldol q4. They were checking vitals q12. My PCT came and told me that pt's o2 was at 45%. I rechecked and showed 99%. (it was increasing and decreasing the whole time) I spoke with the supervisor and said the 45% is not accurate and I need to assess my patient and not the monitor. She was sedated from all the meds and appeared comfortable. Her color was normal and she looked no different from the night before. The doctor charted a couple days prior that she had 1-2 days to live. So I was giving report to the morning nurse who scolded me in the hallway saying that I need to protect my license and I did nothing for this patient with an o2 of 45%. I told her that I spoke with the supervisor, assessed the patient and continued with the comfort care that we were giving. I applied 3L of o2 because the morning nurse made it seem like she should have it. She was breathing from her mouth and her o2 sats did not increase after applying, which I figured anyway. I know I am brand new and have a lot to learn but I also am not sure what else I should have done in this situation. o2 was ordered if needed for comfort only. She appeared comfortable. I asked the morning nurse what else should we do and she said you just take care of the patient on your shift and ill take care of the patient on mine.. Any input?

Thanks

[Here.I.Stand, BSN, RN]

It's possible that the 45% wasn't accurate. If the pt was on a continuous monitor and you could see the waveform (vs spot checking or even continuous oximetry that shows the number only), it's quite common for the number to drop. The pt's finger may be cold, peripheral circulation can be poor, but you can see that it's inaccurate because the waveform is poor.

That said, with a comfort care pt you absolutely treat the pt -- not the monitor. If her sat really is 45% but she looks comfortable, you don't need to place O2 on or give prn's for air hunger. Your license isn't in the remotest danger.

[MunoRN, RN]

If I was in your shoes and handing off a comfort-measures-only patient to another nurse who felt that something needed to be done about the patient's O2 sat of 45, I would hesitate to give them that patient, instead I would suggest they not take this or any other comfort care patients until they had the proper training.

[Been there,done that, ASN, RN]

The first problem is, vital signs were taken ( and incorrectly to boot) on a hospice patient. Any change in vital signs would not be addressed, this person is DYING. Vital signs no longer apply. You would use O2 if the patient was alert and complaining of shortness of breath.

The second problem is, your co-worker is ignorant and non- supportive of the hospice patient and new nurses.

[Suzie070307]

Thank you all so much for the feedback. I was really worried. I think I'll follow up with my manager when I go back to work too. We get quite a few hospice patients so it's very possible something like this will happen again.

[nursel56]

Best wishes! I just want to add that someone who speaks in such dire terms in public places, combined with her subsequent lack of interest in your follow-up questions is showing signs of a personality type that you'll want to be cautious about at least in your first few weeks/months there.

[MrNurse(x2), ADN]

The most troubling issue I read in that situation was the lack of support. Comfort measures only means that, eventually her O2 sats would go to zero, that is expected in a hospice patient. How new was the oncoming nurse?

[Suzie070307]

She's been there for probably about 15 years or so. She made me really doubt myself because of her experience.