Published Jul 26, 2009
Pt has dx of chronic lung disease. RR 50, HR 140 irreg, skin pale and cool, confused to person/place/time. Orders include O2 NC 4L/min, bedrest, soft diet, PFTs in the AM.
Correct sequence of action is:
1. Semi-fowler position
2. ask staff member to stay with pt
3. call MD
4. give O2 NC at 4L/min
Can someone help explain why i shouldn't give the O2 before calling the MD, even tho it's already ordered?
hypocaffeinemia, BSN, RN
Pt has dx of chronic lung disease. RR 50, HR 140 irreg, skin pale and cool, confused to person/place/time. Orders include O2 NC 4L/min, bedrest, soft diet, PFTs in the AM.Correct sequence of action is:1. Semi-fowler position2. ask staff member to stay with pt3. call MD4. give O2 NC at 4L/minCan someone help explain why i shouldn't give the O2 before calling the MD, even tho it's already ordered?
This is the picture of someone that needs to be intubated pronto. Forget the nasal cannula-- this is the point where you reach for the non-rebreather and make sure you have an ambu bag at the head of the bed as you will likely be using it soon.
This is why questions like these in nursing school are so silly. You may never understand or agree with the exact rationale.
I can only assume by "call MD" they mean "call an MD that's actually on campus and is proficient at emergent intubations", because paging some internal medicine attending that's at home or in an office somewhere isn't going to do you a lot of good.
thank u hypocaff!
Technically, O2 is considerd a drug and would need a Dr. order to administer. Remember, I said technically.
Although it was ordered, the physician needs to be updated on the pt's condition to verify that the order still stands or needs to be changed.
Technically, most MD's prefer their patients kept alive. Only technically.
morte, LPN, LVN
these questions oft dont make any sense......so you should leave the patient with no supplemental o2 (agreed, it wont do much good) and call the doc......who is going to take how long to get there? argh
I give a patient O2 and I'm a CNA .. if the patient needs it. I just let the nurse know.
Music in My Heart
Of course you would administer the ordered oxygen before notifying the physician. You could rightfully expect an ass-chewing if you called the doc to report the patient deteriorating and you hadn't even complied with an existing order to give the O2.
Ask your instructor what is their reasoning. Theirs is the only opinion that counts for the moment.
Daytonite, BSN, RN
can someone help explain why i shouldn't give the o2 before calling the md, even though it's already ordered?
ghillbert, MSN, NP
Strongly agree - the "chronic lung disease" is what stood out to me too. Increased work of breathing in a chronic emphysema patient is not helped by adding O2 most of the time. Nor is intubation in a chronic lung patient necessarily a good idea.
The patient in the scenario was very clearly severely hypoxic-- see the altered mental status with tachypnea and tachycardia. The chronic lung disease is relatively irrelevant in this acute situation. I don't care about O2 reducing their respiratory drive when their RR is 50. Intubation on this patient is necessary not only to maintain airway (look at the neuro status), but also to at least attempt some aveolar recruitment and get some full FiO2 100% breaths down.
The alternative to not intubating the patient in respiratory failure (regardless of chronic lung disease) is to start preparing your post-mortem kit.
As an aside, the "O2 decreases a COPDer's respiratory drive" may be popular wisdom, but it isn't supported by evidence nor should it take precedence over acute hypoxic issues. We can always control the patient's respiratory rate.
The question being asked by the OP required the rationales for why the sequence of nursing actions was to
not debate the need for the type of medical intervention needed.
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