Oxygen... Comfort or Life Saving?

[TigerGalLE, BSN, RN]

Do you thinking putting oxygen on a patient is considered comfort or life saving? I had a "category 3" patient yesterday. Category 3 patients are not to recieve CPR or be put on the ventilator.... That morning he started gasping for air and appeared to be in agony. (I am still on orientation) So we checked his pulse Ox (which was 36).... Then applied 100% O2 with a NRB... She called the son and the MD... His O2 Sat climbed back up to 100% within a few minutes...

There were many disagreements on the floor as to whether oxygen is a comfort measure or a life saving measure... Now if they take the O2 off... the patient will surely pass....

The patient was still alive when I left yesterday... on the oxygen

[Ayrman]

Oxygen can fall under either catagory. As a comfort measure it can relieve the feeling of suffocation. If the patient's organs are failing all the oxygen in the world won't save them, but it can bring a measure of comfort, the same as administering Roxanol or oral atropine drops.

Oxygen is a basic necessity of life. To intentionally deprive someone of it is akin to depriving them of hydration in all forms - the end result will eventually be death.

CPR and ventilators are often classified as "heroic" measures. They are aggressive, deliberate interventions that are anything but casual. There is nothing heroic about administering oxygen, only the manner in which you go about it, as with intubation, vents, etc.

Ayrman

[TazziRN, RN]

It's both, actually. If the pt truly is ready to die, giving passive O2 is not going to prevent that.

[ginger58, ASN, RN]

It's both, actually. If the pt truly is ready to die, giving passive O2 is not going to prevent that.

As a palliative nurse I have to agree with you. Most interventions won't keep a person alive if they're programed to die.

Often the O2 is applied for the nurse's comfort, or family. What often works better is a fan directed at the patient's face.

[ginger58, ASN, RN]

Just another comment...was there any morphine ordered? Was this person with an end of life diagnosis or end stage something?

[Cattitude]

as a palliative nurse i have to agree with you. most interventions won't keep a person alive if they're programed to die.

often the o2 is applied for the nurse's comfort, or family. what often works better is a fan directed at the patient's face.

this is interesting. i just learned this myself in a palliative care class i took. that it's more for the comfort of the nurse/family..

[bellcollector]

Personally having most of my experience in geriatrics and palliative care I believe oxygen to be a comfort measure. Most of these pts are unconcious or at least unresponsive and can not say if O2 makes them more comfortable or not. I would rather error on the side of caution and assume it does provide comfort.

[TigerGalLE, BSN, RN]

Yes morphine was ordered IVP q 2hours.. and the oxygen did stop their gasping.. This patient had been on the floor for >2 months and had slowly been declining.. Also a very elderly patient. So death was inevitable and approaching soon. But I was just wondering if the O2 was prolonging their life because the O2 sat increased from 36 to 100% in about an hour... Esp with this patient being DNR... But the oxygen was mainly put on to keep the patient alive until the family could get there... Is this going against the DNR order? Even though it is "comfort" I think it did prolong their life... But I also feel it made them more comfortable...

[Ayrman]

DNR is very widely misunderstood as an order/concept. It simply means that once respirations and/or the pulse ceases that no efforts to restore them should be made. IOW no heroics.

Oxygen can/will depending upon the circumstances prolong life. So will hydration, warmth and other basic necessities. But simple mask- or cannula- delivered oxygen should not considered resuscitative, unlike delivery by forced pressure for where you seek to actively inflate the lungs, as with a BVM or demand valve.

Ayrman

[meownsmile, BSN, RN]

With a terminal patient i dont see oxygen as preventative. It is pallative and should be seen as comfort measures. Most DNR orders are for like someone already said cardiac arrest or respiratory arrest, not because their sats dropped. We dont withhold breathing treatments just because they are struggling and have terminal lung cancer. We give the treatment and hope it relieves their distress. I agree, if its ment to be their time no amount of oxygen is going to stop their process.

[TigerGalLE, BSN, RN]

So what about when the patient is a category 5... in our hospital that means you start taking things away... As in tube feeding, SQBS checks, labs... You continue to give them pain meds but no other meds. Do you take away the oxygen or leave it?

[rita359]

So what about when the patient is a category 5... in our hospital that means you start taking things away... As in tube feeding, SQBS checks, labs... You continue to give them pain meds but no other meds. Do you take away the oxygen or leave it?

I do not know what your policy for catagory 5 says but I would leave it. Alert patients with low O2 sats are very uncomfortable and feel they are gasping for air. Why add this to a dying patients feelings. We should provide comfort care.