Oxygen levels possibly hurt pt?! - page 2

I was switching my patients nasal cannula over to a nonmask rebreather with a PCA tech. The pt must be on oxygen at all times so I had someone help me. When the PCA switched patient over from nasal... Read More

  1. Visit  07302003 profile page
    1
    People that sick will de-sat down into the 60's - you just want to know that they come back up. Think about what his sats were like at the nursing home, or at home - probably pretty bad before he was hospitalized. You did the right thing, you were monitoring him, and a momentary de-sat is OK if it comes back up.
    But as you go out to practice, remember your experience with this patient and remember that a 100% non-rebreather is a bad thing in a full code patient - it usually is the next step before being intubated on a ventilator, when their O2 needs have increased dramatically. Also remember what that patient looked like breathing - were they doing a lot of work, breathing fast, using chest muscles, again, all bad signs.
    I'm an ICU nurse now, but when I was in nursing school I would have like, panic attacks over every little thing I did wrong. And obsess. I was sure I was going to be kicked out of the program and my LIFE-WOULD-BE-OVER. And I was in my 30's at the time. Like, if I dropped a pill onto the med cart and put it back in the cup, I found with nursing school they obsessed more over "how to do things properly" than critical thinking and how to keep your patients safe, which I learned as a new nurse, and learn more about every day.
    As you become an RN and practice you will be able to spot those patients "circling the drain" and those with a poor prognosis, and when bad things happen you'll talk about it with your co-workers, and they will support, not blame (assuming you take action with a patient when you need to!).
    Take care, and good luck!
    samiam4 likes this.
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  3. Visit  PeepnBiscuitsRN profile page
    0
    Nothing you did 36 hours prior to the man's death could have caused his death. From what you listed on his menu of problems it sounds like this guy had many cards stacked against him. He sounds like the patients we see on our floor- rough shape. I've had patients de-sat into the 60's before, and certainly I go and check on them to make sure they're ok, generally by the time I'm in their room, they're back to the 90's. As for the insulin you gave- 238 is pretty high for a blood sugar, and it's not always that a patient knows exactly how much they're going to eat when their meal tray arrives.

    Nope, sounds like you did what you were supposed to do and...if you look at it spiritually or cosmically, maybe he did just what he was supposed to do as well. I know that's a cop out sometimes, but I'm just trying to get at you didn't cause this man's death.
  4. Visit  Esme12 profile page
    0
    If this is in reference to the patient you talked about the other day.....even the brief desaturation would not cause his death, but, you should have told your instructor the whole story. The patients comorbidities and age had more to do with his death. Like I said before, patients die. This you can't control......You changed his O2 and did what you were supposed to do and re-check the sat to be sure he was ok before leaving the patient's room. It wasn't, you corrected the source of the problem, his sat returned to baseline, end of story.

    But......I am not so sure that while you are learning that you should be taking non licensed personnel as your back up without checking with the RN or your instructor first.....AND....if you think you did something wrong, made a mistake.....you MUST own up to it ASAP for if what you did was wrong, the quicker you reverse what was done, the less potential harm to the patient. Never hide a mistake, it could cost someone their life. In this case, you did not cause the patient harm.
  5. Visit  samiam4 profile page
    0
    07302003 the way you were in nursing school sounds exactly like me. Esme12 I actually didnt think that I made any mistakes until I was home and reflecting on my day. I do contact my teacher when I feel like I made a mistake. But, when I found out about his death that's when I started to over analyze my every move and started to realize my day in clinical had more mistakes than I thought...I just recently thought of the O2 incident. I guess I didn't really think about it bc I corrected the problem quickly that day in clinical.
  6. Visit  Esme12 profile page
    1
    Well, that's why there really wasn't a mistake....good thinking on your part but I would still not rely on the PCT to give you good advice. You didn't "cause" this patient to die.......people die, it's ok.....move on. If you find you are having trouble talk to your instructor or seek counselling to develop better coping skills. With time you will become more confident. Good luck!
    samiam4 likes this.
  7. Visit  nyrn5125 profile page
    0
    If for a few seconds he was getting 12l nc and not the NRB that is not something you should worry about. What you should be concerned about is that you are a student and a PCA is putting high levels of oxygen on a pt when their sats are in the toilet. Where was the RN with the LICENSE?
  8. Visit  psu_213 profile page
    1
    First, take a deep breath...

    I have yet to meet a pt who cannot go a few seconds without supplemental O2 and the switch from NC to nonrebreather (NRB) could be executed by you alone and the PCT was not necessary to exucute an 'immediate' switch. The few seconds not getting the O2 via NRB while the NC was still hooked up most likely did not have any lasting harm on the pt (by your OP it sounds like it was only a few seconds and they recovered from theis period without the supplemental O2).

    It is a fairly standard practice to turn down/remove O2 from a pt to see if they can tolerate RA. Sometimes this causes them to desat....the sometimes go down to the 60s before O2 is put back on. Point is, that sometimes we put them, intentionally, in a position where they do have all the O2 they need to meet their needs (for a very short time).

    One other thing: There is a lot more to a person's O2 needs than just the sats and sometimes it can be harmful to put the pt on such a high level of O2. Consider this a critical thinking question: why was the pt being placed on a NRB mask?
    samiam4 likes this.
  9. Visit  fiveofpeep profile page
    2
    If the patient was that oxygen dependent that they desatted to the 60s in less than a minute, they had a lot more going on then you accidentally mixing up the oxygen. It's only natural to be concerned that you have harmed a patient, but that patient sounded really sick and them dying had nothing to do with you. Now if you had left the room and not come back and returned to find the patient dead, that would be another thing.

    There's already so many things that happen as a nurse that will make you feel bad. Why go out of your way to try to scrounge up other reasons to question yourself and feel bad?
    AICU RN and samiam4 like this.
  10. Visit  caliotter3 profile page
    3
    Figure out how you are going to deal with this, then deal with it. If you agonize and agonize to the point of it showing in your behavior while at clinical, you will be giving your clinical instructor reason to doubt your abilities to continue. Believe me, you don't want to do that!
    GrnTea, SandraCVRN, and samiam4 like this.
  11. Visit  samiam4 profile page
    2
    Today, I learned more about my patient before he passed away. Apparently he started to complain of chest pain. An EKG was ordered and found that he went into Atrial Fib. Also his lab values were all over the place. I believe it said he had an increase in BUN and creatinine. Also, if I remember correctly, his postassium levels were high. My instructor said that it looked like his body was shutting down- due to his lab values......
    GrnTea and fiveofpeep like this.
  12. Visit  Esme12 profile page
    2
    Multisystem failure. Multiple organ dysfunction syndrome (MODS), previously known as multiple organ failure (MOF) or multisystem organ failure (MSOF), is altered organ function in an acutely ill patient requiring medical intervention to achieve homeostasis.

    The condition usually results from infection, injury (accident, surgery), hypoperfusion and hypermetabolism. The primary cause triggers an uncontrolled inflammatory response. In operative and non-operative patients sepsis is the most common cause. Sepsis may result in septic shock. In the absence of infection a sepsis-like disorder is termed systemic inflammatory response syndrome (SIRS). Both SIRS and sepsis could ultimately progress to multiple organ dysfunction syndrome. However, in one-third of the patients no primary focus can be found. Multiple organ dysfunction syndrome is well established as the final stage of a continuum Systemic inflammatory response syndrome + infection sepsis severe sepsis Multiple organ dysfunction syndrome. Currently, investigators are looking into genetic targets for possible gene therapy to prevent the progression to Multiple organ dysfunction syndrome. Multiple organ dysfunction syndrome - Wikipedia, the free encyclopedia

    Multiple organ dysfunction is a continuum, with incremental degrees of physiological derangements in individual organs; it is a process rather than an event. Alteration in organ function can vary widely from a mild degree of organ dysfunction to completely irreversible organ failure. The degree of organ dysfunction has a major clinical impact. The term MODS is defined as a clinical syndrome in which the development of progressive and potentially reversible physiological dysfunction in 2 or more organs or organ systems induced by a variety of acute insults, including sepsis, is characteristic.
    Medscape: Medscape Access requires registration but it is free and is an excellent resource.
    Purple_Scrubs and samiam4 like this.
  13. Visit  psu_213 profile page
    4
    Quote from samiam4
    My instructor said that it looked like his body was shutting down- due to his lab values......
    I really dislike this phrase (the italics part). If you ever watch the 'true' medical shows on TV (e.g. Mystery Diagnosis) they use this phrase way, way too often. In this case, you had a pt who was very sick. In addition to his respiratory issues it sounds like he also developed increased cardiac issues and AKI--not sure if the kidney issue was secondary to poor cardiac function or vice versa. Not to minimize his death, but there is a lot of interesting patho going on. Regardless, it was his chronic illnesses that caused his death, not a few seconds without supplemental oxygen.
    Last edit by psu_213 on Feb 22, '12 : Reason: clarification
    GrnTea, Altra, AICU RN, and 1 other like this.
  14. Visit  blueheaven profile page
    0
    You didn't make him sicker. He was dying. If you can't get through this, please talk with someone about it. A friend of mine with PH was on 100% non rebreather and talking to me and in a manner of minutes he was gone when he had an episode of coughing.


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