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Forum Name: Miscellaneous Chest Diseases

Question: COPD


 cawilson - Sun Feb 25, 2007 5:26 pm

I am a nurse and have a patient with severe COPD. What is the highest level I can turn the O2 concentrator up to? His SPO2 was in the low 80's. He was on 2L and I gradually turned it up to 4L. When his O2 was not coming up, I put it up to 5L, but only briefly, I'm talking about 5 minutes. He had even dropped into the 70ls a few times. I know that there is a mechanism in the brain that shuts off when you get too much oxygen. I also worked in a hospital where I was told that a patient with COPD could have it up to 5L. However, in school, we learned not to go over 4. What is the correct answer. And, does it do any damage to put it up to 5? Yes, I sent him to the hospital. I work in a nursing home.

Thanks
Cherie
 Marceline F, RN - Sat Mar 03, 2007 5:45 am

User avatar Cherie,
I very much appreciate your post, and the fact that it represents a sincere desire to do the right thing for the patient and to understand WHY it is the right thing. A COPD patient can have a tendency to retain CO2 at a higher than normal concentration, which is bad, when oxygen is administered at greater than 3 - 4 L. This can lead to respiratory distress, and ultimately acidosis and respiratory failure. There are many physicians who stand adamantly on not administering more than 3 L of oxygen to their patients at any time - even when the finger Sat is at 88%. It may be that for that patient, that is where they "live". However, not all COPD patients retain CO2, so, in some cases the attending MD may request as much as 5 L oxygen to be administered. It would be the prudent thing thing ( to protect your patient, and to protect your license), to ask the attending physician what his or her preference is regarding the amount of oxygen to give the patient Then request a set of parameters of what are the acceptible O2 saturations for this patient, and record that with the daily or shift vitals. This way you have a way of identifying what is an abnormal for THAT patient, and alert the MD as needed.
Hope this is of some value.

Marceline
 cawilson - Thu Mar 08, 2007 3:05 pm

Thanks for your reply. I guess I was unaware of the retaining the CO2. As it turned out when he went to the hospital, he had right-sided heart failure and COPD exacerbation. He had not been doing well anyway. He won't stop smoking either, so what are ya gonna do...

Thanks again,
Cherie

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