oxygen orders vs nursing perceptions

[Meliss214]

I received orders from the Dr to give a pt with COPD and lung ca 15 L of oxygen because the pt is experiencing respiratory distress and the ativan and morphine were insufficient. The pt was previously on 5 Lof 02 until the family bumped up the oxygen to 8 L which allowed the pt to sleep. But my supervisor wants the pt to go down to 5L of oxygen because of the COPD. How would you handle this situation?

[Vtachy1]

I received orders from the Dr to give a pt with COPD and lung ca 15 L of oxygen because the pt is experiencing respiratory distress and the ativan and morphine were insufficient. The pt was previously on 5 Lof 02 until the family bumped up the oxygen to 8 L which allowed the pt to sleep. But my supervisor wants the pt to go down to 5L of oxygen because of the COPD. How would you handle this situation?

I would increase the morphine instead of the oxygen. Have you read the Hospice and Palliative care guide books? Morphine will be more effective in controling respiratory distress and air hunger.

[Meliss214]

Thanks for responding. The pt and his wife prefer increasing the oxygen instead of increasing the morphine dose.

[tewdles, RN]

Perhaps the patient is enjoying the increased airflow by his nose and this is reducing his dyspnea. Try a fan blowing gently but directly on his face.

What position is he assuming in the bed or chair? Can you optimize that?

Are there other things going on that may be contributing to the dyspnea?

Use the entire nursing process and engage the entire team to plan for this patient. COPD patients can be particularly challenging when it comes to their comfort because "comfort" can be a very subjective thing. I have had Pulmonary Fibrosis patients on really alarming amounts (outside of hospice) of opiates, benzos, and oxygen.

IMHO, we need to listen to the patients. If the oxygen makes them feel better and the doc is okay with it...then let it flow.

[Esme12, ASN, BSN, RN]

This patient is on hospice. If this patient is more comfortable with the O2 and you have an order....leave it. Not all COPD patients are big CO2 retainers. The goal is to make the patient comfortable.

[applewhitern, BSN, RN]

Are you asking whether you should follow the doctor's orders, or your supervisor's orders? If your supervisor is telling you to do something different than what the doctor ordered, then maybe the supervisor should consult with the doctor about it. Then you wouldn't be in the middle between them all.

[AtlantaRN, RN]

i had a patient with pulmonary fibrosis that was on 15liters.....he did fine for about 2 weeks, then he passed. he also had been a smoker yrs prior and had copd.