I had a 90 something patient admitted for SBO. She did not speak a word of english so I could only base my asessment on objective data. She was NPO, had NG tube that drained ~400 cc over my shift, IV fluid @75 cc/hr. She was drowsy throughtout the shift (had sleeping pill & antipsychotic meds), chest clear, VSSA, abdomen slightly distended w/ faint BSX4. Voided twice in bedpan. I checked on her regularly and she seemed fine.
So I went on my break and told my covering nurse to do a set of vitals in an hour. When I came back the nurse told me that when she went to do her vitals her sats were 70% on 2L O2 via NP. She had coorifice crackles thoughtout her lung fields and bladder scanned for 400 cc. Raised O2 to 5L and sats remained in low 80%. Throughtout this time her VS continued to be WNL, RR was 20/min. Breathing fine, not using accessory muscles. Rousable to speech. RT was called and she was placed on high flow O2 mask @ 80%. Sats slowly rose to >95%. Resident paged & ordered chest x-ray, abx, lasix, and something else that escapes my memory.
I was shocked that such a fast change would occur within an hour. I was also wondering what happened - I know that it could not have been fluid overload - she wasn't getting much. She was also peeing fine and her NG output was Ok. Someone said that she could have aspirated - but how with an NG tube? She was in semi-fowler's throughtout my shift and I can't really figure out what happened. I left before the results of the x-ray came.
What do you guys think? I can't stop thinking about her and wondering if I missed something...
Specializes in Cardiac Telemetry, Emergency, SAFE.
Now - if she DID aspirate @ 1600 when she vomited - why would she show changes 8 and a half hours later? Her chest was CLEAR for 7.5 hrs and then BAM!
Thats why it sounds like fluid overload to me. When I hear crackles (a nonproductive cough starts suddenly or just plain SOB) and see low o2 sats, I stop fluids and call the doc right away for a diuretic, or a least an order to officially stop/lower the IVF. Ive often had that happen to my little old ladies and men ordered continuous fluids.
And I also have to ask. How long are your breaks? Im jealous:lol2:
Things can change in an instant with patients...and I'm still confused about your breaks. Where is this covering nurse coming from? How long are your shifts? We work 6p to 7a and we're lucky to get a 30 minute uninterupted break....I mean we don't have someone to cover you just eat quick when you can....a 2 hour break...and you can sleep?? WHAT????
Technically we are supposed to have 1 hour 45 min break in a 12 hr shift - but the unit/hospital culture is for 2 hrs. This is not just this hospital, but the three others in the city also. In fact, on one floor at the last hospital I preceptered, the nurses took 3 hour sleep breaks on nightshift on a surgical floor.
I can't remember any time where my break was cut short (unless I chose to or there is a code). I know I'm very lucky.
If the pt was a full code, I think you should have turned the O2 up as high as you could have. Since the pts O2 was 70 percent if the pt didn't have COPD or wasnt gasping for air or turning blue,I would have attempted to get the O2 up for about 5minutes. If after then, if the O2 wasn't showing any signs of coming up, I would've called a rapid response.
Crux1024
985 Posts
Thats why it sounds like fluid overload to me. When I hear crackles (a nonproductive cough starts suddenly or just plain SOB) and see low o2 sats, I stop fluids and call the doc right away for a diuretic, or a least an order to officially stop/lower the IVF. Ive often had that happen to my little old ladies and men ordered continuous fluids.
And I also have to ask. How long are your breaks? Im jealous:lol2: