Hypoxia? Besides raising head of bed & giving O2?

SoldierNurse22, BSN, RN · Sep 17, 2014

What disease process are we talking about here?

Do you have standing orders for O2 in an event like this? Are there PRN orders for nebulizer or inhaler treatments? Of course, if you have folks with COPD, giving them O2 could be potentially deadly, so always keep the disease process in mind.

What exactly is the drug that's causing the O2 to drop? If you're dealing with decreased respiratory effort due to a narcotic, Narcan should be on hand.

Of course, if you have a patient who's really tanking fast and losing their respiratory drive, you need to call an RRT or a code. Unless the medical team has a set of orders in place for you to follow if a patient's sats or symptoms reach a certain point, you're in something of a bind and will need to call the team for the sake of your patient.

tsm007 · Sep 17, 2014

What disease process are we talking about here?
Do you have standing orders for O2 in an event like this? Are there PRN orders for nebulizer or inhaler treatments? Of course, if you have folks with COPD, giving them O2 could be potentially deadly, so always keep the disease process in mind.
What exactly is the drug that's causing the O2 to drop? If you're dealing with decreased respiratory effort due to a narcotic, Narcan should be on hand.
Of course, if you have a patient who's really tanking fast and losing their respiratory drive, you need to call an RRT or a code. Unless the medical team has a set of orders in place for you to follow if a patient's sats or symptoms reach a certain point, you're in something of a bind and will need to call the team for the sake of your patient.

I was thinking more like ER visits/initial assessments when you may not be sure the underlying diagnosis. I knew with COPD to be careful with O2. I hadn't thought about checking standing orders for PRN medications! Thank you. I'm just trying to think ahead what I would do or what I should be looking for if someone becomes hypoxic during an ER assessment - possible medical diagnoses pneumonia, pneumothorax, MI, CHF. Just wondering if there is anything else I can or should do, particularly if I do need to call a code? Hmm... Going to go do some more reading on calling a code and nursing actions. You've turned my brain back on. Thank you.

As for Narcan, I know textbooks say have Narcan on hand, but not exactly sure how that works in real life. Say you are giving morphine for a MI and they have respiratory depression from it, do you bring Narcan in the room with you. If so, confused since medications are pulled from a pyxus, where do you get it and you would still need a doctor's order to give it so "having it on hand" what does that really entail. Giving Narcan wouldn't be an independent nursing action? You would just need to be aware to call the doctor?

Esme12, ASN, BSN, RN · Sep 17, 2014

I was thinking more like ER visits/initial assessments when you may not be sure the underlying diagnosis. I knew with COPD to be careful with O2. I hadn't thought about checking standing orders for PRN medications! Thank you. I'm just trying to think ahead what I would do or what I should be looking for if someone becomes hypoxic during an ER assessment - possible medical diagnoses pneumonia, pneumothorax, MI, CHF. Just wondering if there is anything else I can or should do, particularly if I do need to call a code? Hmm... Going to go do some more reading on calling a code and nursing actions. You've turned my brain back on. Thank you.
As for Narcan, I know textbooks say have Narcan on hand, but not exactly sure how that works in real life. Say you are giving morphine for a MI and they have respiratory depression from it, do you bring Narcan in the room with you. If so, confused since medications are pulled from a pyxus, where do you get it and you would still need a doctor's order to give it so "having it on hand" what does that really entail. Giving Narcan wouldn't be an independent nursing action? You would just need to be aware to call the doctor?

Is this your first clinical? Take a deep breath! ((HUGS)) Remember to KISS your patients....Keep It Simple Silly.

Whenever there is an emergency take your own pulse first! This gives you a moment to collect yourself. BREATHE!!! DO NOT PANIC!.

Remember you are in a hospital. You have help at the ready! Use it!

Say....I need help in here !!!!

IN the ED you have the best case scenario. You have a MD at the ready. You say....I need help in here!!! In the ED we treat hypoxia first. We give O2. Many patienst will come with paramedics or via ambulance so treatment is already in process. In the ED you call for help you will have more than enough help to take over to assist you with the patient. Same with the ICU

MANY of these "PRN" meds are at the ready in a trauma room or emergency drug kit or code cart. Do not leave your patient....you call for help, a rapid response, or call a code. Each facility has their own "emergency" number to call...many of them are simple dial 999 or 55 etc on the phone....it rings (alerts) at the switchboard special so activation can begin....talk calmly and rationally. Tell them to call a code blue and be sure to GIVE THE CORRECT ROOM NUMBER! Shout out to the staff so they can hear you....I NEED HELP IN HERE or I NEED THE CRASH CART! Someone will hear and come to help.

Many of the specialty units are covered with "standing" routine orders and will say...as per protocol or as per ACLS protocol that cover nurses for emergency situations. That is a part of the uniqueness of a specialty unit...there is also an "understanding" with experience that you have with the MD's. If I as an experienced ICU nurse waited to call the MD at 3AM to get an order for ABG's the MD would have my head. That is what the rapid response team is for on the floors...your floating critical care nurse that follows a special protocol.

If the patient is choking....remember your BLS. If they have CHF help them sit up. Make sure their O2 is on at the proper flow. Remember a decrease in LOC can also be hypoglycemia. As far as meds....if a patient is on a pump for pain there is an accompanying order for Narcan if resps go below a certain rate or hypoxia ensues.

You don't have to remember anything except CALL FOR HELP! Don't wait!

You got this....((HUGS))

tsm007 · Sep 17, 2014

Is this your first clinical? Take a deep breath! ((HUGS)) Remember to KISS your patients....Keep It Simple Silly.
Whenever there is an emergency take your own pulse first! This gives you a moment to collect yourself. BREATHE!!! DO NOT PANIC!.
Remember you are in a hospital. You have help at the ready! Use it!
Say....I need help in here !!!!
IN the ED you have the best case scenario. You have a MD at the ready. You say....I need help in here!!! In the ED we treat hypoxia first. We give O2. Many patienst will come with paramedics or via ambulance so treatment is already in process. In the ED you call for help you will have more than enough help to take over to assist you with the patient. Same with the ICU
MANY of these "PRN" meds are at the ready in a trauma room or emergency drug kit or code cart. Do not leave your patient....you call for help, a rapid response, or call a code. Each facility has their own "emergency" number to call...many of them are simple dial 999 or 55 etc on the phone....it rings (alerts) at the switchboard special so activation can begin....talk calmly and rationally. Tell them to call a code blue and be sure to GIVE THE CORRECT ROOM NUMBER! Shout out to the staff so they can hear you....I NEED HELP IN HERE or I NEED THE CRASH CART! Someone will hear and come to help.
Many of the specialty units are covered with "standing" routine orders and will say...as per protocol or as per ACLS protocol that cover nurses for emergency situations. That is a part of the uniqueness of a specialty unit...there is also an "understanding" with experience that you have with the MD's. If I as an experienced ICU nurse waited to call the MD at 3AM to get an order for ABG's the MD would have my head. That is what the rapid response team is for on the floors...your floating critical care nurse that follows a special protocol.
If the patient is choking....remember your BLS. If they have CHF help them sit up. Make sure their O2 is on at the proper flow. Remember a decrease in LOC can also be hypoglycemia. As far as meds....if a patient is on a pump for pain there is an accompanying order for Narcan if resps go below a certain rate or hypoxia ensues.
You don't have to remember anything except CALL FOR HELP! Don't wait!

You got this....((HUGS))

Thank you! I found this article on Rapid Response too - How a rapid response team saves lives and it was helpful as well.

I am just trying to be prepared.

Esme12, ASN, BSN, RN · Sep 17, 2014

I know but you are going to exhaust yourself and sensory over load your mind. Read it be informed then BREATHE~ :)

Even as a nurse for 35 years I was in the ED and a girl came in with severe abdominal pain with her parents. As they walked into the ED I could plainly see the girl was in ACUTE DISTRESS.

As I took her to the only room open...the trauma room (and as it turned out divine intervention I needed that room after all)...I noticed her pain came is "waves" a little alarm bell went off but the patient had just said she started her period a couple of days ago. I thought "Kidney stone?". But the cyclical nature of the pain kept nagging me.

AS I helped her get undress and I went to remove her underwear I saw a baby crowning and the patient was pushing....what did I do? I called out "Hey Hey Hey Call L&D NOW! I need a doctor and the isolette in here NOW!"

As the parents needed to have their jaws picnicked up off the floor....they ended up a happy little family.

You can never be "really" prepared....but you can have confidence that you will know what to do and call for help.

Here.I.Stand, BSN, RN · Sep 17, 2014

^^^ What Esme said--get help. :yes:

As for the situations you are thinking of, just some thoughts. You gave morphine during an MI, the pt was opioid naive, and now his respiratory drive is depressed. Remember that if you give Narcan, it's not like a gentle "Wake up, sir," it's a powerful punch that will not only reverse the side effects, but it will reverse its intended effects of relieving pain and lessening cardiac O2 demand. Not something you want to do if the pt is having an MI. So what DO you do? Grab that ambu bag that should be at the bedside, put the mask on the pt, hook it up to the O2 and start bagging--as you're calling for help.

If the pt is hypoxic from a pneumothorax, there really isn't a nursing solution for that--he needs a chest tube immediately. Call for help. While you're waiting for the dr. to set up, DO give the pt pain medication--of the IV opioid variety. Chest tube insertions are very painful!! That is a very important nursing action.

If the pt is making respiratory effort but is hypoxic--think pneumonia vs. over-narcotized--yup they need O2. If your efforts are not working (where I am, we have basic nasal cannulas, oximizers, and non-rebreather masks in our supply room), call for help. Well you'd want to notify the MD anyway, but I mean get help now. The RT's are a great resource!! They are experts in this area. Ask them questions, learn from them, call them when in doubt. If they have any secretions, have the pt cough and deep breathe. Medicate for pain if the pt is in pain. It's very difficult to breathe effectively if you are in pain, especially if the pain is in the thoracic or abdominal areas--areas that assist with breathing.

Emergency drugs are generally covered by ACLS protocols. Narcan is one that might need to be at the bedside. Atropine is one we keep at the bedside a fair amount with our cervical spinal cord injuries, if they are having trouble w/ neurogenic shock (you'll learn about that if you haven't, but in neurogenic shock their BP and HR tank. We'll see people's HR drop down into the low 30s, seemingly with no warning.) If there isn't a specific order for it in the scheduled or prn meds, we'll override it from the Omnicell/Pyxis. If we have to give it we chart it as emergent per ACLS protocol; if we end up not giving it, we simply return the unopened vial to the pharmacy when the pt leaves.

Remember though, like Esme said, you won't be alone. If you have an emergency, call for help. Emergent situations are never one person's responsibility; it's a team effort. :yes:

classicdame, MSN, EdD · Sep 24, 2014

the one thing you DON'T do is leave the patient. You may need to initiate CPR. Get help via call button or just yell