Rapid response

On 2/16/2020 at 1:52 AM, KalipsoRed21 said:

That all may be true, but oxygen is often given at end of life care. It relieves the psychological distress of family seeing their loved one struggle to breath.
But as far as the OP’s question goes, I think comfort care in a hospital is a hard thing to accomplish. To much liability. Plus, how old of a nurse was the one who called the rapid response? Rapid responses are to get a quick second opinion of a concerning situation. They are a great resource for nurses to ensure that the patient is safe and proper care was being administered. Now I would bet MOST hospital employees are not familiar with hospice and comfort care only measures. So I can see where steroids and albuterol would make the patient appear more comfortable to staff and thus they would consider it a reasonable action.

Actually treating the patient's dyspnea would be a much better alternative to trying to trick the family into thinking it's been treated., particularly since the patient is still your primary obligation.

The rate of progression of the different processes that occur in the dying process have varying timelines, but when the hypoxia and hypercapnia components align in an optimal way, altering that to reverse the natural hypoxia is more harmful than beneficial.

Dyspnea results from hypercapnia and/or a sensation of physically constrained ventilation, hypoxia by itself does not produce dyspnea, it results in a decreased sense of awareness which includes a decreased sense of dyspnea. Artificially keeping a patient's oxygen levels higher than they would be otherwise, which then results in an increased ability to sense suffering, is not good practice, however common it may be.

2 hours ago, MunoRN said:

Actually treating the patient's dyspnea would be a much better alternative to trying to trick the family into thinking it's been treated., particularly since the patient is still your primary obligation.

The rate of progression of the different processes that occur in the dying process have varying timelines, but when the hypoxia and hypercapnia components align in an optimal way, altering that to reverse the natural hypoxia is more harmful than beneficial.

Dyspnea results from hypercapnia and/or a sensation of physically constrained ventilation, hypoxia by itself does not produce dyspnea, it results in a decreased sense of awareness which includes a decreased sense of dyspnea. Artificially keeping a patient's oxygen levels higher than they would be otherwise, which then results in an increased ability to sense suffering, is not good practice, however common it may be.

Interesting information. But I would say this is often a missed education for hospital staff...nurses and physicians. End of life care is not a common practice in a hospital. I worked at several in several states, I didn’t meet a nurse with ANY hospice or CMO measure experience until I started home care. I’ve been in home care for 2 years and due to the fact that I don’t do hospice I’m still not given any education on it. Anyone can scream to the heavens as much as they want about what is good practice vs what is common practice, but without the institutionalized education, good practice will not be what is done.
Even knowing what you have said, I would still use oxygen if that was the order given to me from the MD. I have no qualms about speaking up, but I‘M still ultimately going to do what is ordered. I need employment for another 30 years.

I share this as a current hospice RN case manager. To clarify, a rapid response is not the same as calling a code. And since it can fall into the same lines as respiratory distress if someone is choking to death, a DNR does not prevent someone performing the Heimlich maneuver or similar if the choking is caused by an object which can be expelled.

I take care of a number of patients with lung cancer, and from a point of view when families call our 24x7 number with the expectation for a nurse to come out for respiratory distress, it's similar to a rapid response (granted, in our geographic area, nowhere near as fast as anyone would like given rural home environments typically off the beaten path.

Thanks to all for your comments and condolences. I have been busy with plans to lay my WW2 vet dad to rest with military honors.

I now realize he was in a gray area when rapid was called. The nurse who callled was in her late 20's I would guess. I took him home that day and the steroids did give him a "little bump" so he was able to easily tolerate the 25 minute ride home. I was just seeking input from this great resource we enjoy here.

As a recently retired hospice RN Case manager, I often would provide 02 in the home in response to family concerns, to give the family " something to do" when they would call the office in a panic as their loved one had a frightening ( to them) change in respiratory status ( found this could often prevent 911 calls instead of calls to hospice) or per patient request. Some were COPD pts who alrady were on home 02 sometimes for years.

Again, thanks immensely for all the helpful comments.