LTC- resident in clear distress

[anonymous1919, LPN]

You enter your residents room and notice they are having respiratory problems. Their breathing is rapid and shallow and the pulse ox says low 80's. What do you do? Call the doctor and get an order for oxygen? Put oxygen on and then get the order? What if the doctor refuses the order and you put it on? Do you chart you applied oxygen before getting an order?

Just interested to know what you do as a nurse in this situation, thanks.

[TheCommuter, BSN, RN]

I've worked at multiple nursing homes and LTCFs. All of them have standing orders to apply oxygen if the resident's O2 saturation dips below 90 percent.

I'd apply the oxygen first and then call the doctor to report the change in condition. After all, some nursing home doctors are notorious for not returning calls for several hours, and sometimes they never even call back. What would you do if the physician never returned your call while your resident is sitting there in a deteriorating state?

[anonymous1919, LPN]

I've worked at multiple nursing homes and LTCFs. All of them have standing orders to apply oxygen if the resident's O2 saturation dips below 90 percent.

I'd apply the oxygen first and call the doctor to report the change in condition. After all, nursing home doctors are notorious for taking hours to return calls, and sometimes they never call back. What would you do if the physician never returned your call?

Call 911 lol but glad to know there are standing orders. I'm sure that applies to all nursing homes, it only

makes sense.

[DianeS, RN]

Interesting question as this just happened to me on Sunday night. My CENA (Bless her heart :redbeathe) came to me and said "____ don't look good". I walk into the room and the resident is pale and diaphoretic. O2 sat is 60% on room air. I yelled for help (bless my CENAs they are great) and immediately put oxygen on her. Sat came up to around 72%. Then I called the doctor for an order to send to the hospital. Interestingly enough, I had just spoken to the doctor an hour earlier on the same resident as she had gone LOA and missed some BP meds and her BP was high and she was nauseated when I assesed her. The doctors at my facility are great, no problem with getting the oxygen or hospital order.

I guess you would have to know if the doctor would stand behind you or not. Or, I look at it this way, if I don't intervene, the patient may die.

See what the other nurses in your facility think. But, yes, I would put the oxygen on and then get the order.

[JulieCVICURN, BSN, RN]

I've only worked ICU and we have a lot of autonomy so I don't know if this is legally correct, but I would absolutely not wait for a doctor's order to put on oxygen. I also would not leave the room to make any phone calls. I'd get a CNA or another employee to assist me and have another RN make the phone calls and make sure a resident in respiratory distress is not left alone.

It seems to me like if you know based on pulse ox that the patient's sat is 80%, it would constitute negligence to not apply oxygen.

[txspadequeenRN, BSN, RN]

how about 911??? there is probably a underlying problem if you have a patient in resp distress.... most of the time or a least a doctor with any kind of common sense wont refuse to put o2 on a patient unless they like lawsuits....when i worked in ltc i got o2 on them ...called 911...then paged the doctor...most of the time they were already transported before the doctor called back .....

[jnrsmommy]

I had a situation similar to this one night. Long story short, pt fell and sustained a compound fx. We called the ambulance first, then called the NP on call. Pt had been gone for over an hour when the NP finally called back, then proceeded to try and chew me out for sending pt out w/o her order, "You should've gotten an xray first, but you seem to think you can give yourself orders." At which I told her "In case you forgot what compound fracture means, the bone is through the skin, and I saw that. I figured you would want your pt to be taken care of as quickly as possible, instead of waiting for you to call me back an hour later." She hung up on me, but I know I did the right thing.

[Zen123]

Apply O2. Give Aerosol tx if they have PRN order. Check MAR/Hx of COPD etc..and Code Status! Call Nursing Supervisor. Call Dr.

I had a resident who went on resp distress; DNRCC with Hx of Asthma/COPD...etc. I applied O2 + Aerosol tx; check MAR for Hx and Code Status. Contacted Dr. He did not want her sent out; ordered PRN Morphine. Contacted Family

to update on changed of condition. She passed away peacefully 2 days later..provided Comfort Care.

[imintrouble, BSN, RN]

I would apply oxygen, then let the MD know when I finally reached him. I don't know a single MD that would not apply O2 with sats in the 60s.

It's hard in LTC, when there's a rule for everything.

[leslie :-D]

Apply O2. Give Aerosol tx if they have PRN order. Check MAR/Hx of COPD etc..and Code Status! Call Nursing Supervisor. Call Dr.

I had a resident who went on resp distress; DNRCC with Hx of Asthma/COPD...etc. I applied O2 + Aerosol tx; check MAR for Hx and Code Status. Contacted Dr. He did not want her sent out; ordered PRN Morphine. Contacted Family

to update on changed of condition. She passed away peacefully 2 days later..provided Comfort Care.

this is the best answer.

it's imperative to check code status, and to check the prn meds.

911 isn't always the way to go.

if pt isn't a dnh, then yes, you call ambulance and then dr.

otherwise, you can be charged with delay of treatment.

leslie

[canoehead, BSN, RN]

I had a situation similar to this one night. Long story short, pt fell and sustained a compound fx. We called the ambulance first, then called the NP on call. Pt had been gone for over an hour when the NP finally called back, then proceeded to try and chew me out for sending pt out w/o her order, "You should've gotten an xray first, but you seem to think you can give yourself orders." At which I told her "In case you forgot what compound fracture means, the bone is through the skin, and I saw that. I figured you would want your pt to be taken care of as quickly as possible, instead of waiting for you to call me back an hour later." She hung up on me, but I know I did the right thing.

Compound fracture is two breaks on the same bone. Open fracture is when the bone breaks through the skin.

She hung up on you? I can't imagine.

[SunnyAndrsn]

All of the facilities I have worked in, O2 is part of the SHO, thus apply the O2 first. As others have said, check code status, utilize PRN orders, and then update the MD. Of course, if the pt. is a full code--call as soon as possible and utilize your co-workers as well.

Also, we have a standing order to send anyone with an obvious fracture to the hospital. Thus, if the pt. is on the floor with an obvious hip fracture, we would call 911 and then the ER to let them know why we are sending the pt. We do NOT move the pt.

The NP mentioned above was a jerk!