O2 for comfort measure and living wills

Specialties Hospice

Published

I need the hospice nurses' input. I have a terminal resident who has been comfortable. I work P/T, not always on same unit. Resident was offered and given O2 for comfort one evening, and today family and POA was questioning why and stating it was prolonging her life. They did not have an advanced directive to refer to. I did explain that o2 was to decrease O2 demands on the heart , thereby providing comfort.

Is O2 really prolonging life and therefore "inhumane" as the family member stated?

Thanks!

PS- I posted this in the wrong forum because I have three teenage daughters shadowing me for use of the computer! Sorry, if a moderator reads this, please move it to Hospice!

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Specializes in Oncology/Haemetology/HIV.

I take care of many Hospice and DNR patients, and O2 is frequently indicated for their care.

1. O2 use decreases the demands on the respiratory system, to provide O2 (increased respiratory rate/effort to obtain O2 on its own). The patient will not have to fight or gasp for air, causing discomfort

2. O2 makes the patient more comfortable.

3. If the administration of O2 is comfortable to the patient, what is inhumane about it?

4. While our role as nurses in a hospice situation is not to prolong life at discomfort to the patient, neither is it to shorten life at the discomfort of the patient. We are to treat the disorders of the patient that aid his comfort-this means treating pain, nausea & fatigue, financial, emotional and spiritual concerns. Lack of O2 make cause pain, HA, fatigue and confusion (impairing pts safety and emotional well being.)

I have had patients on hospice that had surgery (G-tubes to drainage for SBO), blood transfusions, palliative chemo or radiation (w/altered doses to make side effects more tolerable), and pericardial windows for severe superior vena cava syndrome, in some instances. I have not always agreed with some of their decisions, but respect their rights.

DNR does not mean do not treat!!!!!!!

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Caroladybelle stated it well. O2 is considered a comfort measure. That's why we don't need any certain pulse ox level to apply it in hospice. If it makes the patient more comfortable, they can have it. BTW, Roxanol is given not only to reduce pain, but to reduce air hunger.

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We used O2 often when I was in hospice. This decreased the O2 demand on the heart and lungs. The O2 we used was either nasal O2 or face mask, though most patients would not keep face masks on. We did find a great need for Ativan as a that resulted from the anxiety that low O2 levels created.

We also found a great need to educate family members that O2 was not prolonging life, but providing comfort, like roxanol for pain and air hunger.

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When the patient is actively dying and is unconscious and cheyne- stoking does O2 still have a benefit. I remember being told that a breeze from a fan is just as effective. I ask this because I don't think I'd want my last memory on earth to be the sound of an oxygen concentrator rattling.

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Those concentrators can be horribly loud! That is a really good question and I'm going to ask some very experienced nurses what they think.

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If your patient is actively dying I have found while I was doing Hospice that o2 was wonderful. I never had a patient that it didn't help some, but if it irritated them, hell take it off, use a fan, it is a no brainer. I still believe that the patient is able to hear what is being said, a big NO NO to discuss within the patients hearing range. Q patient is special and has their own individual needs. So if is doesn't make a difference to use o2 and the patient is indicating non verbally that it is bothering them, take it off, then put it on if indicated. The family will be your big concern at the time, so you also have to tx them as well. They need to feel when it is all said and done, that their loved one was given the best care. Another pearl to utilize if they are gurgling, which disturbs q one around but the patient, is to get an order for atropine eye gtts to adminster SL, this will quite the gurgling and not cause the family with them to become frightened, espically if they think their loved one is going to drown. Suctioning is uncomfortable and is not necessary to put your patient through this unless you are 100% sure that this will add comfort. Good Luck Tex

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Specializes in Med-Surg, Rehab, MRDD, Home Health.

Another old post I found and liked, would like to revive and see what

you curresnt Hospice nurses think about O2. I utilize O2 quite a bit for

my patients, I truly believe it is a comfort measure as well-discussed in

this old post. I do not wait until a patient is actively dying to utilize O2,

but instruct and encourage O2 use, not only for comfort, but also as

an energy boost. Your thoughts are appreciated!

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If your patient is actively dying I have found while I was doing Hospice that o2 was wonderful. I never had a patient that it didn't help some, but if it irritated them, hell take it off, use a fan, it is a no brainer. I still believe that the patient is able to hear what is being said, a big NO NO to discuss within the patients hearing range. Q patient is special and has their own individual needs. So if is doesn't make a difference to use o2 and the patient is indicating non verbally that it is bothering them, take it off, then put it on if indicated. The family will be your big concern at the time, so you also have to tx them as well. They need to feel when it is all said and done, that their loved one was given the best care. Another pearl to utilize if they are gurgling, which disturbs q one around but the patient, is to get an order for atropine eye gtts to adminster SL, this will quite the gurgling and not cause the family with them to become frightened, espically if they think their loved one is going to drown. Suctioning is uncomfortable and is not necessary to put your patient through this unless you are 100% sure that this will add comfort. Good Luck Tex

Thank you so much EmptytheBoat for bring this back! I am an RN in a skilled nursing center, and we are often called upon to address these same issues with our dying patients. (Hospice care is available to our patients, but not always accepted). Tex said it so well...if a patient is actively dying, whether or not you use oxygen should depend solely upon the patient's comfort. If it makes them feel better, USE IT!!! If it helps the family, and it is not disturbing the patient,even tho it's not helping, USE IT!!! Utilize morphine or Roxanol for air hunger as well as pain, SL Atropine for excess secretions, and unless the secretions are disturbing to the patient and can be removed quickly, I discourage suctioning the patient....in most cases, the physical and emotional cost to the patient far outweighs any benefit. I have yet to have any family member disagree.

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When the patient is actively dying and is unconscious and cheyne- stoking does O2 still have a benefit. I remember being told that a breeze from a fan is just as effective. I ask this because I don't think I'd want my last memory on earth to be the sound of an oxygen concentrator rattling.

This is a good point. The hospice where I used to work did not use anywhere near as much O2 as we do and I don't think that our patients died any less comfortably. The hospice that I work for now uses O2 on just about every patient. When a pt is cheyne stoking and breathing through their mouth, O2 via nasal cannula is not doing a bit of good and most people that are actively dying do not want a face mask on. I've just gotten into the habit of using it for just about every patient. I think it does make the family feel better most of the time because they feel like something is being done. Just my thoughts.

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Specializes in Med-Surg, Rehab, MRDD, Home Health.

Right-on doodlemom! You are doing something to help the family transition,

the hum of the O2 concentrator may have a soothing effect as well for

all and/or hide the deadly silence.

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I disagree with those that say a pulse oximeter reading is inappropriate for hospice patients on O2. One of the reasons for using a pulse oximeter is to determine if O2 administration is efficacious and/or the machine is working correctly. If pulse oximeter readings indicate that the the Sp02 has not improved upon oxygen administration, then the machine may not be operating correctly, the oxygen may not be applied correctly, there may be a blockage in the respiratory tree, the oxygen concentration may have to be increased, and etc. Further, when administrating narcotic angalgesics to the hospice or other patients, a pulse oximeter is mandatory to determine if the side affect of respiratory depression necessitates reducing doseage or, to the contrary, oxygen delivery can be increased.

It should, also, be remembered that patients that have COPD should have low levels of O2 delivered as their stimulus to breath is from low SA02 or low S02 rather from high carbon dioxide levels in other patients. Giving too much 02 to COPD patients, therefore, can cause them to stop breathing, therefore.;)

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