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| No. 20 | 
Jul 10, 2008, 05:49 AM
 Re: O2 is 81, what shoud you do? Originally Posted by joeyzstj  You yourself just mentioned in the above post that you keeps sats 75-90%. If you "keep" something in that range that says to me its sustained. I am asked to do things everyday by physicians.........some are very intelligent and some are completely insane. My point is, show me some literature, studies, books,...........essentially anything that states that allowing a neonate to maintain sats of 80% is an acceptable practice (Evidence based practice). I understand that neonates have frequent desaturations and understand very well the processes behind BPD, however I am (In all seriousness) very interested to read any solid research or studies that show this is acceptable, not someone just telling me "the doctor tells me to do it so I do". How about some physiology behind why this is acceptable? The orginal question in the post was about a Neruo ICU patient and its developed into a thread thats made me curious about this practice in your NICU. In all sincerity, I am very interested to learn about the logic behind this.
I worked on a cardiac PICU and the rationale we were given for keeping sats 75 - 90 was that if they have an abnormality within the circulation around the heart it was often the Patent Ductus Ateriosus that kept the baby oxygenated until surgical repair is possible. Now if you increase oxygenation this is one of the signals for the PDA to close, by keeping sats lower the PDA does not close.
The babes compensate by having a polycythemia.
 | | Advertisement Sponsored Links | | | | No. 21 |
Jul 11, 2008, 04:55 PM
Re: O2 is 81, what shoud you do? Originally Posted by joeyzstj You yourself just mentioned in the above post that you keeps sats 75-90%. If you "keep" something in that range that says to me its sustained. I am asked to do things everyday by physicians.........some are very intelligent and some are completely insane. My point is, show me some literature, studies, books,...........essentially anything that states that allowing a neonate to maintain sats of 80% is an acceptable practice (Evidence based practice). I understand that neonates have frequent desaturations and understand very well the processes behind BPD, however I am (In all seriousness) very interested to read any solid research or studies that show this is acceptable, not someone just telling me "the doctor tells me to do it so I do". How about some physiology behind why this is acceptable? The orginal question in the post was about a Neruo ICU patient and its developed into a thread thats made me curious about this practice in your NICU. In all sincerity, I am very interested to learn about the logic behind this.
There are several studies and journal articles out there on the results of hyperoxia in the premature neonate. Set aside a couple of hours and Google it.
| | No. 22 |
Jul 11, 2008, 06:49 PM
Re: O2 is 81, what shoud you do? Originally Posted by joeyzstj You yourself just mentioned in the above post that you keeps sats 75-90%. If you "keep" something in that range that says to me its sustained.
Yeah, in that post (not in previous posts) I said to "keep", to give an example of a situation, since you asked. In your previous post you said there was mention of "sustaining" and there was no such mention of that in the previous posts. Originally Posted by joeyzstj however I am (In all seriousness) very interested to read any solid research or studies that show this is acceptable, not someone just telling me "the doctor tells me to do it so I do".
Do a search on neonatal cardiac anomalies. There are way too many situations to mention here. I don't do it just because "the doctor told me to do it", I do it because the last thing I want is for a PDA-dependent baby's PDA to close before they can get to surgery.
| | No. 23 |
Jul 11, 2008, 07:17 PM
Re: O2 is 81, what shoud you do? Originally Posted by joeyzstj Just becasue someone doest jump at a problem doesnt make the problem not exist. 81% sustained for anyone is too low.
Sometimes my pts desat down into the 80s and all it takes is me shaking their shoulder and telling them to breathe.
Calm, intelligent, and common sense decisions are always better for pts than someone who 'jumps' at a number on a monitor.
Most critical care nurses know how to assess. Sometimes that means sitting back and watching your pt. Sometimes it means getting the intubation equipment ready.
To the OP. You should be able to answer both of your scenerios. I don't think the interviewer will expect you to know intubation meds or which pressor to use. They want to see your critical thinking, how you would respond, what you would anticipate...
| | No. 24 |
Jul 11, 2008, 10:27 PM
Re: O2 is 81, what shoud you do? Originally Posted by cardiacRN2006 Calm, intelligent, and common sense decisions are always better for pts than someone who 'jumps' at a number on a monitor.
Good advice. Look at the pt, no the monitor. If the pt is awake and pink, check first that the pulse ox is on. I have gotten a sat reading off of many a bed, (frighteningly enough).
| | No. 25 |
Jul 14, 2008, 01:45 PM
Re: O2 is 81, what shoud you do? Originally Posted by joeyzstj Just becasue someone doest jump at a problem doesnt make the problem not exist. 81% sustained for anyone is too low. I personally am very interested to hear your rationale behind why an Sp02 of 81@ on a Neonate, let alone an adult isnt a concern to you? Ive worked in critical care, Respiratory Therapy and with neonates and this is the first time Ive ever heard this one?
Perhaps you've not worked in a pediatric CV area?
Take a baby with a cyanotic heart condition, for example HLHS. An sp02 of 81% is perfectly acceptable, even desirable, as a "normal" sp02 could be damaging in the long run to this child.
This isn't something that is later corrected either (unless they're transplanted). They will more than likely live with sats in the 75-85% range all of their lives.
| | No. 26 |
Jul 15, 2008, 11:39 PM
Re: O2 is 81, what shoud you do?
To the original poster: assess the patient for distress, correlate sp02 rate with palpable heart rate to ensure good quality sp02 signal. Check oxygen delivery device and flow, is it enough for this patient? If not on oxygen, put them on a cannula to start, 2lpm lets say. Wheezing/Diminished/Coarse? Bronchodilator time! Etc...it takes good patient assessment skills and putting all the pieces together to provide a patient with a low sat with the correct treatment.
Don't always jump to give the patient medication/drugs just yet!
If the patient is QUICKLY deteriorating, thats another story, ensure proper resuscitation equipment is at hand. Drop HOB to supine, open airway, etc...follow ACLS or BCLS protocol.
| | No. 28 |
Aug 10, 2008, 12:25 PM
Re: O2 is 81, what shoud you do?
Elder, our neuro surgeons would have a fit if you nurse a patient head down because of the risk of increase ICP, to be honest in ICU if the patient was desaturating and hypotensive it would revert back to ABC.
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