I am hoping to find an article or some other condensed information that may help with my patient care problem before someone irreparably harms this patient.
My patient is a 70 yo Female admitted to a SNF froma major university medical center with a primary diagnosis of non-small cell CA of the lung. She had been admitted to the hospital for resection of the LUL, but the procedure was not performed due to metastasis to the pleura and chest wall. She is now admitted to the SNF for mostly palliative care under the care of a local internist who did not know her previously. She is to be rehabbed to potential for ADl's, amb etc.
She was admitted with an order to titrate O2 to maintain sats = or > 92%. The hospital record indicates that she frequently de-satted there. The problem is that she also has a diagnosis of COPD. There is no indication that she is a retainer or even that her COPD was particularly an issue before the CA. However, as soon as the nursing supervisor saw COPD she requested that the order be changed to "O2 a 2 lpm prn for SOB" and the MD approved this. With minimal exertion (ie, bed to commode) she drops her sat It takes about 15 min for her sat to reach 90% again. I notified the MD of the problem and she increased the O2 order to 3 lpm continuously. The problem of exertion induced hypoxemia continues though less severe. At rest she was doing fine at 2 lpm with sats 92-94%.
I am only the LPN, but I keep up on my education. How can I get the supervisors and the MD to see that the original order was the most appropriate for this patient? She suffers enough from the pain of her advanced CA without being hypoxemic as well. Also she has an order for subQ heparin to continue "until she is ambulating ad lib" which I don't see ever happening. Any comments on that?
Thank you for asking the question through which I have received my answer. My hospice pt has end stage COPD/CHF and requires 10L O2 to maintain O2 stat above 93% without any complications in 2 weeks. Tried to decrease liter flow which resulted in decreased stats and air hunger/agitation. He is now very comfortable. Plan to provide education on this with both facility and hospice RN's.
With minimal exertion (ie, bed to commode) she drops her sat It takes about 15 min for her sat to reach 90% again. I notified the MD of the problem and she increased the O2 order to 3 lpm continuously. The problem of exertion induced hypoxemia continues though less severe. At rest she was doing fine at 2 lpm with sats 92-94%. 
She suffers enough from the pain of her advanced CA without being hypoxemic as well. Also she has an order for subQ heparin to continue "until she is ambulating ad lib" which I don't see ever happening. Any comments on that?
seasonedhospicern
2 Posts
Thank you for asking the question through which I have received my answer. My hospice pt has end stage COPD/CHF and requires 10L O2 to maintain O2 stat above 93% without any complications in 2 weeks. Tried to decrease liter flow which resulted in decreased stats and air hunger/agitation. He is now very comfortable. Plan to provide education on this with both facility and hospice RN's.