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o2 @ 2L

Nurses   (3,990 Views 16 Comments)
by Cat_LPN Cat_LPN (New Member) New Member

Cat_LPN works as a staff nurse.

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I am aware that this is probably a REALLY dumb question ;)

I have a COPD pt who wears her o2 despite her really 'needing' it as she would be 95% on RA- she says she's always used it at night at home and 'feels SOB' without it. When she thinks she's 'SOB', she really isn't and o2 sats are WNL so I usually just give her something for anxiety. Anyways, she's been wearing her o2 at night and during the day increasingly as well. Her labs are showing an increase in co2, today it was 41cf, last week it was 34H. Doc didn't make any changes to her orders.

Maybe this is a long shot, but I'm just wondering, could the 'unnecessary' o2 be a result? I don't know if she's a retainer, I couldn't find anything in her hx about it. COPD seems pretty mild, and pt is a bit of a hypochondriac with a family from hell. Can it be detrimental to a pt to have o2 at 2L with normal sats?

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NurseLoveJoy88 has 6 years experience and works as a RN.

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I don't see a problem with the wearing the O2 at night. She may have orthropnea.

Is it possible the doc can decrease it to 1 liter during the day.

I also want to had that the spo2 looks at the oxygen carried by the hemaglobin in the blood. That is not the best indicator of whether or not someone is SOB or not.

The resident is telling you that she is short of breath and that would prompt me to give o2 as ordered, and to do as you did by giving anti-anxiety if that is causing the SOB.

This is tough one. I'm eager to see what others think.

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classicdame works as a Hospital Education Coordinator and adjunct nursing.

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this is one of those questions without a real answer. There is no absolute number for everyone. I had pneumonia earlier this year and had 98% sat rate at one point, but still felt air hunger. This is a question for her MD. But I applaud your assessment.

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NurseLoveJoy88 has 6 years experience and works as a RN.

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Also what does her other ABGs look like ?

Is she in resp. acidosis with full or partial comp. ?

If she is in acidosis I suppose it may be a great idea for the doc to re-evaluate the excess use of oxygen during the day.

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AnnieOaklyRN works as a RN, Paramedic.

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People forget patients can feel air hundry because thier co2 is high and not just because thier oxygen is low! Dont forget the other part of the puzzle! In EMS we can measure conrinuos co2 which is very helpful and I wish more hoapitals would do this as well!

Happy

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Cat_LPN works as a staff nurse.

5,993 Visitors; 297 Posts

Also what does her other ABGs look like ?

Is she in resp. acidosis with full or partial comp. ?

If she is in acidosis I suppose it may be a great idea for the doc to re-evaluate the excess use of oxygen during the day.

Labs weren't ABGs- this was from a CMP.

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NurseLoveJoy88 has 6 years experience and works as a RN.

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Labs weren't ABGs- this was from a CMP.

Oh okay. I agree with another poster. This is not black or white. I would continue to assess and try different interventions.

With COPD patients we do have to be careful. Too much o2 can suffocate them.

Kudos for digging deep and trying to figure out what the problem is. :nurse:

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Teleflurry has 11 years experience and works as a Registered Nurse.

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You can have a perfectly normal 02 sat with a severly comprised patient. Increase I'm co2 would be chronically high because she has copd, and it's comes down to whether you look at her Abg and can see if she's compensated or uncompensated . We've intimated quite a number of folks who had The proverbial "normal sats" - but were so acidotic that their blood could melt concrete.

Plus if she's that anxious - it's a clue in on her respiratory status being impaired. Anxiety is such an early sign.

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Teleflurry has 11 years experience and works as a Registered Nurse.

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Oiy Vey this auto spellcheck! Intubated.

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AgentBeast has 5 years experience as a BSN, RN and works as a Registered Nurse.

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The O2 is probably unnecessary. I would try educating the patient on pursed lip breathing and the orthopneic position.

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tewdles has 31 years experience.

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The blow of the O2 from the NC is likely helping to dissipate her SOB (which in COPD pts is often unrelated to the O2 sat). She will likely benefit from a small fan to move the air around her head/face.

Her sense of dyspnea and air hunger is probably more related to the work of breathing and her emotional status much of the time. These patients are frequently very anxious and benefit from a POC that actively treats this symptom. Ask the doc about her nebulized meds. She may benefit from nebulized morphine. Is she on a steroid? How is she sleeping at night? Is she eating ok? These folks often suffer in many other areas because of their ongoing respiratory distress and the work of simply breathing.

Many of the techniques we use in hospice and palliative care are also helpful to patients who are not in the last year of life.

Good luck.

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6,267 Visitors; 517 Posts

With COPD patients we do have to be careful. Too much o2 can suffocate them.

I can not type everything again but here is the link to the other threads and the ATS position on COPD patients. The Long Term Oxygen section might be of interest.

https://allnurses.com/general-nursing-discussion/copd-98-o2-569625.html

Her labs are showing an increase in co2, today it was 41cf, last week it was 34H.

Has she had an ABG lately? What is her renal output? Is she on corticosterioids?

Not knowing anything else about this patient it is difficult to make any assessment. What other medical conditions? Right heart failure? Cor Pulmonale? What is her EF? Anemia? Is she on nitrates? Was she qualified on ambulation? 6 minute walk? At rest? At sleep? By ABG? Does the patient still smoke? Does she have a hx of arrhythmias? CAD?

There are other conditions that can qualify a patient for oxygen and remember the pulse ox is just a guideline. Know its limitations and the factors that make up the Oxyhemoglobin Dissociation Curve. 95% for you may not have the same PaO2 for me. Know what carrying compacity is. The pulse oximeter should be there to support clinical findings and not be an end to the assessment. I can not imagine anything that could cause more anxiety for a patient than someone who says you SpO2 is find so stop saying you are short of breath. It is the same as saying the patient may not need a bronchodilator regardless of their SOB because you don't wheezing. That one has been challenged many times with a PEFR or PFT lab. But then it was not too long ago when patients were told they didn't need pain medications either because their surgery wasn't that big of a deal or the textbook signs weren't present.

Does she have a rescue inhaler for SOB prn or scheduled? Is she on maintenance inhalers? Have these been evaluated for effectiveness with good technique or a PFT?

The O2 is probably unnecessary. I would try educating the patient on pursed lip breathing and the orthopneic position.

Too many variables or factors to consider before saying her SOB is not real or she doesn't need O2.

If she has some of the other conditions I mentioned, there are risks in withholding oxygen from someone who is short of breath.

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