oxygen in dying hospice patients

heron, ASN, RN · Oct 27, 2015

To re-iterate, OP, O2 @ 2L probably does not prolong life significantly, in most cases.

perfectbluebuildings, BSN, RN · Oct 28, 2015

I should clarify that I do not work in hospice, but in pediatrics acute care. I have seen some patients in the end stages of CF who will hang onto that nonrebreather mask @ 100% O2 like a lifeline, and seem to be much more comfortable with it, than with no O2 at all; once they lapse into a coma I don't know what they feel, but we usually leave that mask on them if they seemed to want it before they lapsed into a coma. I don't know if it's more of a comfort thing or psychological thing or what. But I do know that 2L O2 doesn't feel like anything for them, and I doubt would really make any difference to anyone with any disease once they are dying. I think use of O2 really depends on the patient and their individual dying process.

KelRN215, BSN, RN · Oct 28, 2015

When someone stops breathing, it doesn't matter how much oxygen is being delivered by nasal cannula. It's not going anywhere.

mtjoanna · Oct 28, 2015

In my experience, the oxygen is occasionally helpful to the dying person. If they have been on oxygen for a long time, there sometimes seems to be an anxiety/restlessness when the tubing is removed--having it present feels "normal/safe" to them. We don't automatically apply it but don't automatically d/c it either. If the resident fights the cannula at all, off it comes and the concentrator is removed from the room. If they are calmer with it, we keep it on.

Ranax · Oct 28, 2015

Exactly. Comfort measures. Some family are pacified that their dying family member will die more easily with less pain. Belief is one will asphyxiate, which is a horrible way to die. Can you imagine a death certificate that says cause of death: suffocation?

MinneNurse, BSN, RN · Oct 29, 2015

You said this was something a couple of your nursing friends were discussing and that you are a student, are these nursing friends your classmates? Why don't you all (or just you if they are not your classmates) ask one of your instructors? I imagine you will get the same "it depends" answer, but they may direct you to information/resources on this topic. Do you take a course that addresses end of life care? If you do, you will find in that course - and in your future experiences - there is no solid answer, which I will say it does sound like you a fishing for one. At some point you should at least be taking a course that elaborates on oxygen therapy and that might give you more of an explanation as well. I mean this all nicely because I do understand how nursing school can be incredibly overwhelming and there are so many variables/possible situations.

bmel · Oct 29, 2015

First semester student here. Still not too deep into the program, just taking patho, intro to nursing roles, nursing concepts and practice and starting clincals! Like said I am sorry if I came across as "fishing for an answer". I appreciate everyones response! I personally asked one of my professors and got the same response, "comfort measure". But I decide to hop on the internet and explore. Of course like you said, there are different scenarios, and it all really depends. Once again, I appreciate everyones feedback!

Jensmom7, BSN, RN · Oct 29, 2015

First semester student here. Still not too deep into the program, just taking patho, intro to nursing roles, nursing concepts and practice and starting clincals! Like said I am sorry if I came across as "fishing for an answer". I appreciate everyones response! I personally asked one of my professors and got the same response, "comfort measure". But I decide to hop on the internet and explore. Of course like you said, there are different scenarios, and it all really depends. Once again, I appreciate everyones feedback!

You aren't going to get much exposure to Hospice in school, but an important point to remember is that Hospice is less concerned with diseases themselves and more with symptoms being experienced.

If O2 provides comfort and a feeling of relief to the patient (and by extension, the family), we don't really worry about which disease is causing it.

MinneNurse, BSN, RN · Oct 29, 2015

Well I didn't necessarily say you are going to get a lot of experience in hospice while in school (not everyone goes to hospice before they die) but you may certainly experience patients dying and needing or at least discussing possible end of life cares. If you don't directly experience this others in your clinical will and you may hear about those experiences. And I would hope you will eventually take a course that discusses oxygen therapy and I think that information alone (with a focus on end of life or not) will bring you more clarification on oxygen therapy. I don't know what type of program you are in but we learned some basics in first semester and elaborated more in our second semester. And I didn't mean to imply you had a motive behind looking for a specific answer. Nursing students tend to always look for the answers (I think prereq courses reprogrammed our thinking this way) and what nursing school taught me is there's a lot of gray area. I was simply trying to say, like others, there are many answers/no definite answer and your future experiences (in class and out) might make that more understandable :) Best of luck to you in nursing school!

Jensmom7, BSN, RN · Oct 29, 2015

It's a shame palliative care and by extension, hospice, is not more discussed in school. I suppose the thinking is that the RN grad will be exposed to it eventually out of school.
It's been a while since my nursing classes, but I do not specifically remember going over this. The closest I had was a fellow student (who happened to be a paramedic, so likely more comfortable with death) have a patient expire (expectedly) while we were in clinic. We still didn't go into much detail about it except post-mortem care.

Part of the reason is that when you're in school, you need exposure to the acute and critical care side of Nursing. You need to learn all those lab values and disease pathways, and why this treatment is important in that situation.

Hospice is a 180 degree mind flip from all of that. I look at labs and tests with an eye for decline. An albumin of 2.3 and Na of 125 makes you think of a Dietary consult, and possible G-tube. Me? Expected due to patient decline.

NurseGirl525, ASN, RN · Oct 30, 2015

I didn't read the whole thread, but this has been my experience with O2 and those actively dying in a nursing home while on morphine. The patient has air hunger and the O2 is a comfort measure for the patient so they don't experience as much air hunger. It is not keeping them alive as 2L is not that much. We had a woman actively dying for a couple of days, when she was very close to the end, the son had the O2 removed. The patient died peacefully in her sleep.

So, it's just not for the family, it's for the patient. I watched her have air hunger and it was uncomfortable for her so the O2 was put on as a comfort measure. As I said, when she was very close it was removed at night and she died in her sleep.