Anyone know of a good website regarding caring for patients with different diagnoses? I'm specifically looking at patients with COPD. I had a situation at work a few weeks ago, regarding a patient with COPD, who ended up on a vent. His sats were good, in the mid 90's. He was on a 100% non-rebreather, as he couldn't tolerate the Bipap.
He didn't have any mental status changes for me, although he was lethargic for my entire 12 hour shift. When nights came in and assessed him at around 2000, he was pretty much unresponsive. I was in frequent contact with the MD throughout the day, but more regarding cardiac issues, although he was aware he was lethargic. He was following commands for me though.
Anyways, while I didn't necessarily do anything wrong, I didn't push for an ABG or anything. He would have ended up on the vent either way, but family was very upset, feeling I didn't listen to their concerns.
Basically I am just wanting to do a little re-education for myself, to brush up on things, so in the future I can handle any situations with COPD patients differently.
Or any words of wisdom anyone has, that they care to share
BTW... I don't mean I don't know anything about it, I just want to brush up!!
Quote from Fribblet
What were his sats on room air?
I'm no expert on COPD, but being a 100% non-rebreather is a no-no I would think. Too much oxygen will suppress the drive to breathe.
How advanced was his COPD? Was he on home oxygen?
We never did sats on RA. This was in the ICU. He was transferred to us from the tele floor for breathing and cardiac issues. He was originally found with CP and a sat of like 75% on NC. No O2 at home though. He was ordered to be on the Bipap/ NRB by Pulmonology. He did end up dying within a couple weeks. He had so many co-morbidities, he was really really sick.
I've just gotten different reasoning from different people on putting COPD pt's on higher levels of O2, which is why I want to brush up a little. In hindsight, I can see where I could have handled things a bit different with this case, although at the time I thought I was doing the right thing. I'm new in the ICU as it is, so I am just trying to get take as much of a learning experience as I can from this situation.
Thanks for the links ladies. I will check those out!
Last edit by Simply Complicated on Jul 14, '10