oxygen in dying hospice patients

Nurses General Nursing

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hey everyone, new here to the forum! and i just have a question that i can't seem to wrap my head around. When patients are on their last days, the doctor removes the meds, and nurses are providing morphine, why are some patients also applied o2? I know commonly they receive 2l, so is that keeping the patient alive? if they were to remove it would they die shortly after? just curious because it was something a couple of my nursing friends were discussing. what are the real benefits of the o2?

I think OP isn't a nurse.

He says he's a student and changed his name.

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During the final hours as a pt is actively dying, their respirations are often shallow, abdominal or agonal in nature. At this point the O2 is mostly for the family. And if the noise or just the presence of the tubing is interfering with the vigil of the family, I will offer to turn it off and remove the tubing.

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Specializes in 15 years in ICU, 22 years in PACU.
comfort measure.

For the family

For the nurse.

Not for the patient.

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Specializes in Hospice.

How do you know that it doesn't provide comfort for the patient? True, if morphine is in use, air hunger is likely much reduced. We have no idea if it's completely suppressed, though. I think 2L doesn't hurt and might help.

Just because a patient doesn't respond to us doesn't mean s/he's not aware.

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Specializes in 15 years in ICU, 22 years in PACU.
How do you know that it doesn't provide comfort for the patient? True, if morphine is in use, air hunger is likely much reduced. We have no idea if it's completely suppressed, though. I think 2L doesn't hurt and might help.

Just because a patient doesn't respond to us doesn't mean s/he's not aware.

I will be the first to admit that I do not know what goes on in the mind of any person. I can only try to imagine the situation they are in and again imagine what I would be thinking.

If I were dying I don't think I would care what you were thinking and the less aware I was of my dying process the better.

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Specializes in Critical Care.

Well, I haver died before (that I can recall) but when you load me up to send me out in the morphine cloud, I'd appreciate 2L O2 via NC, for comfort.

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Specializes in 15 years in ICU, 22 years in PACU.
Well, I haver died before (that I can recall) but when you load me up to send me out in the morphine cloud, I'd appreciate 2L O2 via NC, for comfort.

So long as the O2 doesn't interfere with my CO2 build up, or put those nose things in too deep, or tie that thing around my neck too tight, or give me the really smelly O2 tubing.

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Specializes in Oncology.
How do you know that it doesn't provide comfort for the patient? True, if morphine is in use, air hunger is likely much reduced. We have no idea if it's completely suppressed, though. I think 2L doesn't hurt and might help.

Just because a patient doesn't respond to us doesn't mean s/he's not aware.

Go try and sleep with two liters nasal cannula on sometime. You can hardly feel the oxygen blowing. Certainly not enough to help air hunger. You are, however, very aware of the prongs in your nose and the tubing wrapped around your ears and chin.

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Specializes in Hospice.
So long as the O2 doesn't interfere with my CO2 build up, or put those nose things in too deep, or tie that thing around my neck too tight, or give me the really smelly O2 tubing.

Mavrick, when you're actively dying, CO2 buildup will probably be the least thing you'll worry about.

Comfort is as comfort does. Whether it makes sense to us or not. End of life care doesn't think along the same lines as acute or critical care.

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Specializes in medical surgical.

Take the oxygen off the patient. I got into it one night with another nurse. The patient was actively dying and fighting the tubing. I finally called her son to tell him what was going on and he came in. When he arrived the oxygen went off the patient. Of course, the other nurse acted very aggressively toward me. The patient was on hospice. BTW, I am a NP and have taken care of many dying people. Oxygen is only for show for the family. BUT I interfer when it is causing my patient distress.

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Specializes in Complex pedi to LTC/SA & now a manager.
Take the oxygen off the patient. I got into it one night with another nurse. The patient was actively dying and fighting the tubing. I finally called her son to tell him what was going on and he came in. When he arrived the oxygen went off the patient. Of course, the other nurse acted very aggressively toward me. The patient was on hospice. BTW, I am a NP and have taken care of many dying people. Oxygen is only for show for the family. BUT I interfer when it is causing my patient distress.

But I bet he didn't die because the O2 was removed. ;)

If it causes distress (whether the tubing, dried nares or whatever) it's not worth it. My dad died with supplemental blow by O2 because he tolerated it and looked more comfortable (may have been the morphine or the combo)

Oxygen at 2 LPM is not extending the life of a hospice patient. Removing the 2LPM O2 via NC is not going to kill them regardless of their diagnosis.

If the patient feels better (patients may be conscious and responsive when actively dying) with oxygen then leave it. If it's annoying them and they don't like the tubing on their face remove it. His/her condition is going to progress without 2LPM oxygen. Neither choice is going to cause sudden death. Neither choice is going to extend a hospice patients life in perpetuity.

Some times the supplemental oxygen is comfort for the family and care givers. Occasionally it's for patient comfort. It's not life saving or life support in either scenario.

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Go try and sleep with two liters nasal cannula on sometime. You can hardly feel the oxygen blowing. Certainly not enough to help air hunger. You are, however, very aware of the prongs in your nose and the tubing wrapped around your ears and chin.

You are spot on. The tubing and prongs can cause significant discomfort, and no one knows if the actively dying patient is feeling it or not. Therefore it should not be used for family/ nurse comfort.

( Hospitalized with pneumonia, I couldn't sleep with the prongs cutting into my nostrils, asked for scissors and cut those suckers down.)

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