O2 and chest pain

[redfoxLPN]

at the hospital where i work we are to have o2 on all patiens that come in with chest pain. i agree this is a good idea, but how do you keep o2 on a 48 yo who doesn't comply. then you get yelled at by day nurses for patient not having o2 on and they say they are going to "wright you up". one nurse even told me the "tape it to there face". yea if they are confused not if they are 'with it'. people do have a right to refuse. i explain to patients th eimportences of keeping o2 on, and even give enough tubing to get to the bathroom eithout taking it off. i do my best and i don't like it when someone else thinks or says i don't do my job. mayby i'm just ranting, but would like to know what is done at other hospitals.

thank you in advance.

spell check not working sorry about any errors.

[Virgo_RN, BSN, RN]

When they first come in, they usually have a couple of liters on, but if their trops are negative and they don't experience any further episodes of chest pain, I don't insist that they wear O2. Now, if they are having active CP, I will throw some Os on, grab a pressure, give nitro, etc., or if they are someone with severe disease awaiting CABG, I might be more insistent that they wear it. We don't actually have a policy that anyone admitted with CP has to have O2 on at all times. Like you, I educate, but if they won't wear the cannula, they won't wear the cannula. I can't force them.

[Tait, MSN, RN]

When a patient refuses I always do as you stated, explain, educate and then document.

Tait

[diane227, LPN, RN]

As above. Educate and document response. However, one issue. If you have someone who is confused and who's sats are really falling you may have to take it do their face.

If someone wants to "write you up" (God I hate that phrase), just hand them the form and tell them to go ahead.

[mlrockey]

Agree with everything previously mentioned. Your key here will be documentation.

If the nurse continues to be threatening then let them write you up. Chances are it isn't something that will turn into more than a slap on the wrist at best. Of course, this all depends on where you work, the policies & procedures, yada yada yada. Definitely have to consider all lab work, pt condition, etc.

[mama_d, BSN, RN]

Educate and document. That way your butt is covered. If you get written up, you can direct your manager to your charting.

[RochesterRN-BSN, BSN, RN]

If you have a patient who is confused/disoriented and really doesn't realize what they are doing....does your hospital allow soft wrist restraints? When I have worked the older patients who are confused in both medicine and in psych and they need IV fluids or O2 and continually try to rip out the IV or take off the O2 we get an order for soft wrist restraints. They don't have to be real tight/short but just enough so they can't get their hands to their face/other hand (if trying to pull out IV)....the other thing too is I have had patients that will pullout a NC as it hurts their nose (or the tubing hurts their ears) but will be compliant with a face mask of O2...some patients prefer and find it more comfortable..... that is an idea too. Either just a plain mask or venti mask, depending on the flow rate...

[Blee O'Myacin, BSN, RN]

If this person is AOx3, you can't force a treatment on him/her. That would be considered assault. Like the others have said, educate and document. In fact, I'd document each time I went into that room. My charting is a legal document, his angry press-gainey or letter to the hospital "writing you up" is not a legal document. Please don't worry about "getting in trouble", just make sure you keep an accurate record of what you are doing.

Blee

[SteffersRN87, BSN, RN]

i am very blunt and will flat out tell they patient that if they are in fact having a heart attack they could die without extra oxygen...

[redfoxLPN]

Thank you for all the advice. Will contunie to do my best.