O2 therapy - need Dr's order?

[moshimoshi]

I have a post-op patient with impaired gas exchange. He is not doing TCDB, the pulse oximerty indicates his SaO2 is less than 90%. In ABG, PCO2 is high. He is somewhat cyanotic. Can a nurse start an O2 therapy, say with nasal cannula or whatever appropriate? Or do I need to call a Dr and get an order before staring O2 therapy?

[General E. Speaking, RN, RN]

I have a post-op patient with impaired gas exchange. He is not doing TCDB, the pulse oximerty indicates his SaO2 is less than 90%. In ABG, PCO2 is high. He is somewhat cyanotic. Can a nurse start an O2 therapy, say with nasal cannula or whatever appropriate? Or do I need to call a Dr and get an order before staring O2 therapy?

I would put 2 liters on him and promptly call the doc...

[hrtprncss]

start 2lnc while u page the md just in case the pt's co2 is high cuz of chronic copd just to cover urself, but in reality you'd be better off starting the 02 than using the excuse of a doctor not present to order the 02....if ur patient is going into impending resp failure then push the code blue button and bag the patient, then ur covered. just my thoughts

[whipping girl in 07, RN]

Start the oxygen, call the doctor, and why won't the patient TC&DB (can't or won't)?

[moshimoshi]

start 2lnc while u page the md just in case the pt's co2 is high cuz of chronic copd just to cover urself, but in reality you'd be better off starting the 02 than using the excuse of a doctor not present to order the 02....if ur patient is going into impending resp failure then push the code blue button and bag the patient, then ur covered. just my thoughts

I am a nursing student. Help me understand, please. What do you mean by bag the patient? Thank you!

[Aneroo, LPN]

I am a nursing student. Help me understand, please. What do you mean by bag the patient? Thank you!

Use an ambu bag and manually breathe for them.

I agree with the two liters via NC while calling MD. Does he have an IS? -Andrea

[jmgrn65, RN]

How High is the co2, and how low is the sats? Is the patient alert and oriented? Starting 2l nc may make things worse with the copd, usually is not a problem to start o2 and then call the MD, it is tricky with copd pt.

[moshimoshi]

How High is the co2, and how low is the sats? Is the patient alert and oriented? Starting 2l nc may make things worse with the copd, usually is not a problem to start o2 and then call the MD, it is tricky with copd pt.

PCO2 is 50 mmHg, SaO2 is 85%. It is an emphysema patient but still early stage. Pt is alert and oriented. I understand from reading the textbook that risk of pt stop breathing by giving too much O2, but isn't 2L NC safe since it is low? Should I call MD because he is an emphysema pt?

[hrtprncss]

never be afraid to give 02 therapy for fear of co2 retention especially if pt is already cyanotic and symptomatic....you always have bipap and vent to fall back on.

[Hopalong]

PCO2 is 50 mmHg, SaO2 is 85%. It is an emphysema patient but still early stage. Pt is alert and oriented. I understand from reading the textbook that risk of pt stop breathing by giving too much O2, but isn't 2L NC safe since it is low? Should I call MD because he is an emphysema pt?

I usually start o2 at 2l/min, have CNA or family encourage Incentive Spirometer use, and call M.D. ASAP. I also ask for EKG as they might be having a silent M.I. 2l/min usually fairly safe for short term use, unless they get diaphoretic, and R's decrease. Basic M/S.

[gwenith, BSN, RN]

never be afraid to give 02 therapy for fear of co2 retention especially if pt is already cyanotic and symptomatic....you always have bipap and vent to fall back on.

And the winner is.................:)

Bottom line - do not let the fear of POSSIBLY causing a respiratory arrest stop you from giving O2 when it is needed. Hypoxic drive patients are usually fairly rare and have characteristics that usually indicate what they are - not the least of which is being asymptomatic with a low 02. PCO2 of 50 is not that high for a hypoxic drive. If you are unsure then use a mask that has a guaranteed percentage delivery and keep the O2 you are giving to 24% - which is roughly what you would get at 2 LPM via nasal prongs. Go by your Sats - get them up to 90% but not a lot higher while you contact the MD.

[rn/writer, RN]

never be afraid to give 02 therapy for fear of co2 retention especially if pt is already cyanotic and symptomatic....you always have bipap and vent to fall back on.

Do not withhold O2 from a symptomatic patient. Yes, a person with a hypoxic drive might go into respiratory arrest (doesn't happen as often as you might think), but then you go ahead and ventilate them.

Also, check your unit's P&P book. Chances are there are standing orders to cover this situation and I'll bet they're a lot like the advice that's been given here. 2L O2 n/c, get v/s, and call doc. An EKG, as one poster mentioned, is an excellent idea as well.