are we too dependent on assistive devices?

chickie · Oct 8, 2004

Yes, I also find the pulse oximeter reading frustrating. I have called a respiratory therapist for assistance when my patient appears to be in respiratory distress - wheezing, using accessory muscles, complaining of increasing shortness of breath and in almost every instance their reply has been "well, the oximeter reading is 96%"

namely, the pulse oximeter.....drives me crazy.
too many times, i've gotten readings of 96% on ra but the patient's rr is 40/min, diaphoretic and using accessory muslces to breathe.
but the feedback i get from other nurses is "but his o2 sat is 96%".
so are we too dependent on machinery, thus forgetting patient presentation?
everything is electronic now.
yet i insist on taking my own vital signs, and assessing the patient and not the machine.
the other day i had a resident say the same thing "her o2 sat is 93%" and with much exasperation, i told him to "look at the damned pt."
so this resident got his superior for assistance.
this patient had bil pneumonia. :stone
sometimes i wish they would just do away with all of these electronic conveniences, as some have lost the skill of doing their own assessments.
BIG pet peeve of mine.
leslie

weetziebat · Oct 8, 2004

Lets don't forget the dang ear thermometers. Now matter how I shove them in the ear, I get a temp of 93, if I'm lucky.

I've also seen the pulse oximeter register in the 80's on a patient who looked better than me. But, yes, a lot of people take them as gospel.

UM Review RN, ASN, RN · Oct 8, 2004

Yep, it happens. Had one Pt. in full-blown CHF at 0300 and even as I'm calling the Doc for some lasix, another nurse is frantically trying to convince me to stop the call "because look, his sats are 96%!"

Sometimes it's just more accurate to get a set of ABGs.

meownsmile, BSN, RN · Oct 8, 2004

I agree, the pulse ox thing is rediculous. Might i remind that the stupid thing is on the the end of the finger and if your patients peripheral vascular system is compromised you arent going to get a decent reading. And all this said,, my hospital has a problem with people getting put on o2 per NC and seems noone ever takes the time to wean them down and see if they really need it. o2 is a drug, hello, to much o2 will cause a patient not to breath to their fullest capacity and become dependant.

Sorry pet peve here,, get the o2 off the patient if they DONT NEED IT.

zambezi, BSN, RN · Oct 8, 2004

Just because the saturation is good dosen't mean the patient isn't working hard. Bottom line, you go by patient presentation. The point of these tools are that they are another piece of the puzzle/picture...we don't treat only numbers, we treat the patient!! His/her sats may be acceptable...even by abg...but that dosen't mean that there isn't a problem.

I had this same situation this week!! Sats ok, abgs not great but adequate (pH 7.55, PO2 58 on 4L ox, HCO3 23ish, can't remember the rest but nothing that we could actively treat) --thought they would be worse by how the patient looked. The patient was sob, coorifice with audible wheezing, and using all of his accessory muscles to breathe-not comfortable for him and not comfortable for me to watch. On lasix and natrecor gtts and dieuresing >300 ml/hr at this point. I went back and fourth with calling as it was 100 am, but I called, told the doc all my numbers (which he agreed were acceptable--better, actually, than all of these numbers throughout the week) we increased his solumedrol and within a few hours he was greatly improved...So I am glad that I called...but if I had gone by "the numbers" we probably would have been in the same place or worse by am...Just my two cents!

P_RN, ADN, RN · Oct 8, 2004

Another is "but the IV pump wasn't beeping." Never mind that the site is cold hard and swollen. It must be OK if the pump says so.

NeuroICURN · Oct 8, 2004

I agree completely with what Zambezi said.

Also, what did your waveform look like? Was it a good reading?

Definately, just because a person's sats are ok, doesn't mean they are. I've seen people who can hold their sats, but still need intubated. However, they probably won't hold them for long. People can only go so long working that hard.

I agree that sometimes people only see the vitals, and forget to look at the pt!

leslie :-D · Oct 8, 2004

or on those pulse ox's where it shows the pulse rate, it may read 220 bpm, meanwhile the patient is sitting there is great spirits...and another will insist on calling the md!! :chuckle

oh nooooooooooo, don't take the pulse yourself. that would be just too much thinking. :rolleyes:

talaxandra · Oct 8, 2004

This is one of my biggest pet peeves - I don't care what the machine says, look at the d**n patient! I learned this early on, when I yelled "Code!" because a cardiac monitor showed asystole - locked up to see the patient gazing calmly, if somewhat perplexedly, at me.

Half the time it goes the other way, too - someone called a code last week because the dynamap reading was 78/35. No, don't do a manual BP, don't tilt the bed, don't look at the patient (sitting up chatting and comfortable), call a freaking code!

I have so many elderly patients come in, wholly comfortable, with sats in the high 80s, low 90s, and it's panic stations - O2, gases, respiratory evaluations and physio referrals. Now I'm all for a proper assessment, but before we had oximetry we looked at the whole patient, rather than treating by the numbers.

And I think that's my biggest concern. As we increasingly rely on machinery people are depending less and less on their clinical assessment skills. I remember (insert doddering fogy voice here) when my hospital had one oximeter, on the respiratory ward. If you went to borrow it they'd ask if it was an emergency. Now we have five on my 34-bed ward, and everyone takes a pulse with the machine, checks everyone's sat...

Like P_RN said, checking IV sites every shift seems to have fallen by the wayside because we're pump-alarm reliant. One of our consultants donated a bladder scanner to the ward (she hates her patients being catheterised unless it's absolutely necessary), and now we're inundated with calls from other wards to do bladder scans (the scanner isn't allowed to be loaned unaccompanied after it came back brokenand cost $3000 to fix). "Have you palapated the abdomen? Is the patient in distress?" "No, but we want to check." Aaargh!

I'm not saying we should ignore the information we get from the machines, but it should be taken into consideration as part of the data, not the sole factor. People get fixated on the figures - our renal transplant patients have hourly CVP measurements, and half the time hydration is based on that number, regardless of BP, PR, output... Hmm - so accurate, via a CVC, on the ward, with inexperienced staff who don't even check patient position of always know to re-zero it. Heaven forbid someone check a JVP!

PS Has someone pointed this thread out to Ted? I think he might enjoy the change of pace!

Long Term Care Columnist / Guide · Oct 8, 2004

Oh, don't even get me started........I never trust technology completely, especially the automated blood-pressure machines. I've seen so many post-ops who were alert, oriented, and comfortable "bottom out" according to the machine, and then when I took the BP manually it was within normal limits! :angryfire You've got to look at the big picture.....how does the patient look and feel? Are they making urine? What's their heart rate? And don't just use the oximeter---FEEL the pulse with your own fingers to find out if it's thready and weak, irregular, bounding etc.

Sure, it's convenient to use the equipment when you've got those frequent vitals on two or three post-ops, but IMHO an inaccurate BP is worse than not doing one at all.......wouldn't you hate it if you sent someone into fluid overload by giving them IV boluses that weren't necessary in the first place, or conversely, if you gave them some IV Lopressor based on an inaccurate reading and their BP crashed? Maybe I'm a bit conservative when it comes to using technology, but I live by the motto 'when in doubt, check it out'. And I've never regretted it. :)

allnurses Guide · Oct 8, 2004

I'm always skeptical of automatic bp's or oximeters or yes those darn tympanic thermometers.

Usually I'll take a manual bp to check out an odd bp or if I get a post-op patient I'll at least do the first bp manually.

Never trust a machine.

steph