Barb: You're right, the therapy goal may not be, in her case, to titrate her off oxygen, but to do exactly what you identified. This would be to assist her and other staff to identify when she should take a break and incorporate her breathing strategies (PLB, diaphragmatic breathing, not holding one's breath, trunk posture and positioning, etc.) to get her Sats back up to a predetermined level without always going to the oxygen or increasing it when caring for her.
By taking the Pulse Ox prior to, during and after activity, that info can give us a wealth of knowledge. If a person desaturates with activities greater than 2 METS, well you now know that objectively and adapt breathing strategies accordingly. Pulse Ox is a good tool if you use it wisely and use it as an adjunctive modality with other vital signs such as heart rate. Ron's recommendation of using one's perceived exertion tool has correlative value as well. Arley Johnson MS, OTR/L Site Manager, Rehabilitation Services, Pennsylvania Hospital Good Shepherd Penn Partners O: 215.829.5018 P: 215.422.0174 C: 215.776.4305 -----Original Message----- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Barbara H. Hale Sent: Wednesday, March 04, 2009 9:15 AM To: OTlist@OTnow.com Subject: Re: [OTlist] What Would YOU Do? My 85 yr old mother post CVA X 2 had oxygen PRN ordered while receiving home health. She has had a DNR order for 2 years She is in a dementia unit in an assisted living facility. Home health was checking her and pushing the oxygen stressing out all the staff causing everyone to overreact to having the oxygen off. She was almost ejected from the assisted facility to a nursing home. PT was walking her with oxygen etc. I felt that I had to put her on Hospice to get everyone to leave her alone. If she has low oxygen it does not mean she is in distress. She recovers from shortness of breath easily. She forgets to put it on, needs reminders. I believe it is about what the goals are as well. The focus seems to be on keeping everyone on the oxygen for the payments Medicare will provide?..........minimizing interventions at the end of life seems like the kindest response in my case. Taking stats with the pulse ox for what reason? Are we going to be able to change the stat? Will this be a short term or long term improvement once the therapy PT/OT is dc'd? Resp. tx just pumps it up! One resp tx told me she could die in her sleep, as a way to encourage me to take her for another sleep study. I responded with, "Wouldn't that be a blessing?" that is what I pray for - for myself. TN is where I live. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
