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My mum is 76 and has COPD. She has been become increasing SOB and i know thats to be expected but its so hard to get home o2 in nz because the criteria is so almost unreachable. On my pulse oximeter she has been low to mid 80s and same on the doctors but when the respiratory nurse CNS came to visit her pulse oximeter says 91 meaning shes borderline meeting the criteria(she had started a course of prednisone a couple of days before). has anyone had this issue with different pulse oximeters? its silly that the difference can mean she may not get it. She is in bed all the time because she is so SOB she cant do anything else. The nurse said she doesnt look unwell enough when she probably feeling slightly better on prednisone. Any thoughts?

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Yes readings can vary. Factors that may vary include position eg lying down or sitting hunched vs sitting upright, taking shallow breathes vs after taking a few big deep breathes & cold hands vs warmer hands.

Do you have an emergency plan for when the reading is below a certain number?
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not an official one but she doesnt want to go to hospital i guess ill have to wait til she passes out
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Hopefully the prednisone starts to make her feel a lot better & she can be up & active again soon 🙏
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'" its so hard to get home o2 in nz because the criteria is so almost unreachable."

I don't understand this; oxygen supplementation is based on standards determined hopefully by a pulmonologist. Although I don't have a citation for this, Medicare is involved in determining those standards.

DME suppliers provide the oxygen and supplies.

My recollection of a mid 80's Sat Rate is that it's well below acceptable and your mother should be on supplemental oxygen.
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Leah, are you in the UK? If so, I think Countrymouse would be a good source of information. In the US, a sat rate in the 80s, even at night, would indicate the need for oxygen.

I'm not sure the issue is different Pulse Oxes, although it could be. But night respiration is different from daytime, as is actively moving vs. being stationary.
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Countrymouse Jul 2022
New Zealand - similar structure to the health system but a lot less overcrowded and chaotic!
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Anything over 90-92% is considered OK. I know when I had covid, the one number that the dr was most concerned about was my O2's. As sick as I was, my Osats never dropped below 93%. SO even though I felt like I was not oxygenating properly, I was. I was told to go to the ER if it dropped into the 80's and I couldn't get it back up after a few deep breaths.

I just did a sleep test and I am positive that I will wind up with some kind of CPAP machine. Not thrilled, but maybe that will help me feel less logy all day.

Not sure--but altitude may have something to do with it? We lives at 5500 miles above sea level, and when I am at sea level, I oxygenate at a high 90. Dunno if that's an issue.
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In "most" cases an O2 sat level of 95-100 is "normal" but you need your own MDs input on this. An O2 sat below 90 is of concern. But there are some patients who are normally much lower than the norm because of underlying conditions. Every patient is as unique as his or her own thumbprint. You Mom's MD knows her and will tell you what to expect. Of more concern is the shortness of breath and what the nurses HEAR in her lungs. They are able to assess "breath sounds" one of the basics of vital signs. That your Mum is already on prednisone means that she is dealing with some concerns. I cannot know if this is due to underlying Chronic Lung Disease due to obstructive disease or other age related concerns.
In short, discuss with doctor. Ask what actions to take if Mum falls below a certain number he finds acceptable. More than that, do know that Mum is the best to discuss her own "subjective" symptoms with you. A feeling of "shortness of breath " is of concern and requires assessment.
You should be getting numbers close to what the RN is getting on your home oximeter, so may be time to change that out if you are not. Most who use at home devices such as BP monitors do not understand that they should take this device to MD office in order to ascertain that it is working and is giving numbers close to the professional's devices.
Wishing you good luck.
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What did the CNS ask your mother to do while she was checking her O2 sats?

The rise is more likely to be the benefit of the prednisone than dodgy readings. Having said that, 91 is still not exactly great, and if it was 91 provided your mother sat tight in her chair and wasn't, for example, asked to walk to the bathroom, get into bed, or fetch herself a drink so that the nurse could observe what happened then it really isn't great and you should argue. Ask for another assessment including one or two activities of daily living.

Your best bet might be to take readings over the next few days and keep a journal of what your mother was doing. E.g.
Monday:
on waking
walked [distance] to the bathroom
recovery allowed 3 minutes
seated on perching stool to wash
recovery allowed 3 minutes
walked to the kitchen with rest interval(s)

etc etc etc

You don't have to make it this detailed - the aim is to build up a picture showing what happens during a reasonable standard day.

There are negatives to O2 as well as benefits. I'm not familiar with best practice in NZ, but if they try to avoid hooking people up to concentrators there probably are good arguments for it. Would it be practical for her to use one in her home?

How long have the steroids been prescribed for, has the doctor explained all that?
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Leahst Jul 2022
The steroids are only a short course of about 5 days. The doctor did the referral for home o2 based on her readings (84)she got at the surgery which were the same as mine at home using a different pulse oximeter. The referral gets assigned to the hospital community nurse who came around and did her reading which was 91. Mum doesnt leave her room, she has a commode and she wont go have a wash or brush her teeth. We are waiting on the process to get her someone to shower her etc. it would be practical for her to have a concentrator at home we have more than enough room etc. Im a qualified paramedic(not practicing atm) so i do understand a lot of medical things, Im just not experienced in elderly care in the home. ive definatly seen people more short of breath than my mum, im hoping to get her things in place to avoid emergency trips to the hospital as much as possible.
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Leahst, is your mother declining to wash or move around the home *because* she feels so short of breath and ill with it? If so, that's dreadful - the community nursing team can't just decide that she's fine because "oh well she didn't want to get off the bed anyway."
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Leahst Jul 2022
yes its such a big effort for her to get up and go to the shower/toilet because of her shortness of breath let alone trying to have a wash(i do help though). she will have a couple of stops on the way to try catch her breath. the nurse who visited said she doesnt look sick enough, but she was just sitting in her bed and had been on prednisone a couple of days. i think she did feel slightly better on prednisone, any relief is a great relief to her.
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Readings by your Pulse Oximeter will vary, just like a B/P reading varies.
Sometimes is is the actual oxygen in the blood, or the actual blood pressure of the patient that varies. Other times it is the setting, the machines used and the expertise of the person taking the reading that vary.

It is important to get an accurate reading over time, record this on a medical file you are keeping at home, then show the doctor. The readings plus other observations will be what determine the treatment your mother's doctor orders.

Your concern is that your Mom may not be getting enough oxygen. Put her STATS in writing, present that to the doctor.

"A normal level of oxygen is usually 95% or higher. Some people with chronic lung disease or sleep apnea can have normal levels around 90%. The “SpO2” reading on a pulse oximeter shows the percentage of oxygen in someone's blood. If your home SpO2 reading is lower than 95%, call your health care provider." per online.

Over oxygenation can also be problematic. You can enter: "Can too much oxygenation harm a patient". Then pick the articles that you can best understand what they are teaching. MacinCT confirms what I found:
"CMS criteria for home oxygen or increasing the flow is 88 for 5 minutes".
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Leahst Jul 2022
thanks your for your reply, i understand over oxygenation etc im just concerned shes not getting enough to supply her organs to function. I know home o2 wont take away her disease or even her shortness of breath. Her doctor was very adament she should be on oxygen based on her findings but the hospital has a respiratory team that has the final say.
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just an update, mum is finally getting home o2 today. we went through hospice pallative care.
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