A 57-year-old male with fatigue after climbing stairs and pale conjunctiva. He refuses hospital. Which action is appropriate?

• A. Agree with his assessment and allow him to refuse treatment
• B. Encourage him to go to the hospital and monitor his vital signs
• C. Agree with his assessment and but request he speak with medical command
• D. Encourage him to go to the hospital and administer oxygen

Answer: (D)

Pale conjunctiva with exertional fatigue raises concern for conditions that can impair oxygen delivery, such as anemia or cardiac and pulmonary issues. Providing supplemental oxygen is a safe, low-risk way to support tissue oxygenation while you assess and arrange further care. Encouraging transport ensures ongoing evaluation for potentially serious problems, and administering oxygen helps address possible hypoxia during that process.

In this situation, giving oxygen now and urging the patient to go to the hospital is the prudent approach because it reduces immediate risk and buys time for definitive diagnosis, rather than simply accepting a patient’s refusal or delaying assessment.