COPD- 98% O2 sat?

Hello everyone,

How nice to have an online community like this!
Anyway, I worked yesterday (my 3rd.week! I'm surviving) pm shift at the snf. We had a lady who has COPD & complained to me at around 5.30 pm that she can't breath. Checked O2 sat...it was 98% on 2L...I checked the MAR & the MD's order is to keep O2 sat at 90-92%...We put down O2 at .5L & asked for an order for nebulizer (she has some wheezing)...After 30 mins O2 Sat went down to 96%, still difficulty breathing but not as labored as before..I called MD again, & ordered routine neb q 6hrs for shortness of breath...Now my question is, do u still give nebulizer treatment to a COPD pt. routinely even when there is no wheezing? Please I need some advise. Btw, when I went home at 11.30pm, she said she's feeling better & O2 sat still between 94-95%. What else should I have done? I am so poor in assessment. I know this is tough being a new graduate/new nurse. Thank you so much in advance for your response.
I work in ltc and copd patients do have routine nebulizer treatments around the clock, every 4 or 6 hrs.

Here is a nursing video that may help you feel more comfortable in auscultation of breath sounds and abnormalities.http://www.youtube.com/watch?v=GP8Gq...eature=relatedMarc

Yes, you do continue giving nebs despite lungs clear to auscultation. This prevents further bronchospasm.I'd also consider deep breathing/incentive spirometry, and possibly chest pt.

Quote from payang0722Hello everyone,How nice to have an online community like this!Anyway, I worked yesterday (my 3rd.week! I'm surviving) pm shift at the snf. We had a lady who has COPD & complained to me at around 5.30 pm that she can't breath. Checked O2 sat...it was 98% on 2L...I checked the MAR & the MD's order is to keep O2 sat at 90-92%...We put down O2 at .5L & asked for an order for nebulizer (she has some wheezing)...After 30 mins O2 Sat went down to 96%, still difficulty breathing but not as labored as before..I called MD again, & ordered routine neb q 6hrs for shortness of breath...Now my question is, do u still give nebulizer treatment to a COPD pt. routinely even when there is no wheezing? Please I need some advise. Btw, when I went home at 11.30pm, she said she's feeling better & O2 sat still between 94-95%. What else should I have done? I am so poor in assessment. I know this is tough being a new graduate/new nurse. Thank you so much in advance for your response.

You did the right thing by turning down the O2 and the nebs helped to dilate the pulmonary arteries which allow for more gas exchange. The fact that the lady felt better with less oxygen may mean that she is a CO2 reatainer. The pathophys behind COPD is that the central nervous system is less sensitive to CO2 levels. The peripheral chemoreceptors begin to somewhat regulate the respiratory drive but happen to be more sensitive to O2. The ladies body may have said we have too much oxyegen we don't need to breath which may have increased her CO2 leading to her feeling SOB. Too much O2 for COPD is a common mistake but congrats for saving a life and avoiding a trip to the ICU.

Quote from msnurse14You did the right thing by turning down the O2 and the nebs helped to dilate the pulmonary arteries which allow for more gas exchange.

Quote from sweetnurse63I work in ltc and copd patients do have routine nebulizer treatments around the clock, every 4 or 6 hrs.

Quote from msnurse14You did the right thing by turning down the O2 and the nebs helped to dilate the pulmonary arteries which allow for more gas exchange. The fact that the lady felt better with less oxygen may mean that she is a CO2 reatainer. The pathophys behind COPD is that the central nervous system is less sensitive to CO2 levels. The peripheral chemoreceptors begin to somewhat regulate the respiratory drive but happen to be more sensitive to O2. The ladies body may have said we have too much oxyegen we don't need to breath which may have increased her CO2 leading to her feeling SOB. Too much O2 for COPD is a common mistake but congrats for saving a life and avoiding a trip to the ICU.

I'll grant that "thinking has changed" regarding CO2 retainers and oxygen. However, my empirical experience with hospice - thus very end stage - lungers is that they will often c/o dyspnea and look restless and anxious when their pulse ox climbs too high and have gotten relief by reducing the oxygen a bit.In this case, however, it's harder to tell what worked, since she was also wheezing - the neb tx was more likely responsible for her improvement.

My apologies I meant pulmonary airways...thanks for providing such great literature to make this "evidence based practice".

In hospice we use a touch of morphine and anxiolytic to manage symptoms of respiratory distress when people are otherwise stable (and sometimes when they are not). It is important to remember that dyspnea makes people particularly anxious and that sometimes it is necessary to treat that anxiety before we can manage dyspnea very well. I know this is specific to hospice, but it can be helpful even to use non-pharmacologic anxiety management in COPD.

Quote from msnurse14My apologies I meant pulmonary airways...thanks for providing such great literature to make this "evidence based practice".