Does Oxygen need to be prescribed?

~Mi Vida Loca~RN, ASN, RN · Feb 27, 2011

I would imagine had you not done anything about a patient having an 84% O2 sat, or went looking for the nurse to tell them and stuff you would have been in trouble for not immediately reacting to that emergent situation.

I mean it's not like it was 91%

PinkNBlue, BSN, RN · Mar 5, 2011

You did the right thing by getting the patient O2. Your instructor was right that you should also have gotten an order, but the correct chronology was O2 first, order second. Your instructor should have used it as a teaching opportunity, not a reprimand. You did good!!!

Unfortunately, clinical instructors are ALWAYS right... no matter what.

I probably would have called for the primary nurse from the room just because I'm on edge as to what we can and cannot do with or without our RN or instructor. Clinical always has me on edge lol Good for you though. Definitely don't think it was the wrong thing to do.

allnurses Guide · Mar 5, 2011

Ah, Mi Vida, those of us who live at high altitudes think 90-91% is good! We have seniors who live at 88% and do fine. :lol2:

To the OP, you did the right thing. Yes O2 is considered a medication, yes you need an order, but you got the sequence right. Patient comes first. There are protocols almost everywhere for that, as well as that IS the standard of care (in court, what would a reasonable and prudent nurse do?). Your instructor may be erring on the side of caution, in that she doesn't want students just doing anything they think is a good idea; but in this case you were right (dang, that critical thinking kicked in! :yeah: )

~Mi Vida Loca~RN, ASN, RN · Mar 5, 2011

Ah, Mi Vida, those of us who live at high altitudes think 90-91% is good! We have seniors who live at 88% and do fine.
To the OP, you did the right thing. Yes O2 is considered a medication, yes you need an order, but you got the sequence right. Patient comes first. There are protocols almost everywhere for that, as well as that IS the standard of care (in court, what would a reasonable and prudent nurse do?). Your instructor may be erring on the side of caution, in that she doesn't want students just doing anything they think is a good idea; but in this case you were right (dang, that critical thinking kicked in!)

Yea after I wrote that I remembered that here we are good with 90+ but the other parts of the country want 94-95 +.

And yep have had many of seniors that the O2 was 88 and we just waited to see.

Although I would still think that 84 is more emergent than 91 when it comes to a student acting first and getting help next.

cjcsoon2bnp, MSN, RN, NP · Mar 5, 2011

As a student I would have done the following:

(1) Assess the pt. - Did this pt. appear to be in resp. distress? Sometimes the machine doesn't give you a good reading because I'm willing to bet if your pt. appears to be breathing comfortably; is warm and pink and has a good cap. refill then he/she probably isn't 84%.

(2) Elevate the head of the bed and encourage the pt. to take deep breaths.

(2) Check the pulse ox - Check the machine to make sure the connection is secure, make sure the patient's finger that the pulse ox probe is on is clean, dry and warm and if necessary switch the pulse ox probe to another finger, toe or earlobe (if the probe can work on the ear lobe).

(3) If you are still getting the low pulse ox reading then use the call light to get your nurse and stay with the patient.

(4) If you are aware of an order to titrate supp. O2 to keep the patients pulse ox above 92% or something then apply a nasal cannula and start at 1L, wait for a response and move up to 2L if necessary until the nurse gets to the room. (Most of my patients in my clinicals have had an order that says "Maintain O2 sat. at >/= 92%").

(5) If you are not aware of the order I would say that you could apply the supp. O2 because that is such a low pulse ox but as soon as the nurse gets to the room tell him/her what you did and see if the oxygen is still necessary, if it isn't then D/C it. If it is still necessary then the nurse needs to call the physician and obtain an order for the oxygen.

(6) As someone already mentioned, your instructor is always right (until you graduate and you realize that they aren't). You can try to explain your actions logically but if they say that your wrong then you just can't do it.

!Chris :specs:

allnurses Guide · Mar 6, 2011

Although I would still think that 84 is more emergent than 91 when it comes to a student acting first and getting help next.

Methinks we think alike:jester: :cool:

sauce · Dec 24, 2014

It's so dumb that it needs an order I hate getting pages at three am by a nurse cuz somebody isn't stating good for an order for an essential element for life. Aka oxygen

nurseprnRN, BSN, RN · Dec 25, 2014

It's so dumb that it needs an order I hate getting pages at three am by a nurse cuz somebody isn't stating good for an order for an essential element for life. Aka oxygen

Not quite sure what this inchoate note says.

Oxygen is a drug and must be prescribed (not "ordered"-- we are not in the military and we are not in a chain of command with a physician at the top and nursing subservient).

However, I would bet dollars to doughnuts that almost every response from someone who says,"Slap on the oxygen and get the OK second" is working in a place with physician-approved protocols that allow that already in place.

I hear you, but I have to agree with those who say you ought to have consulted a more experienced RN/patient's primary nurse stat before applying oxygen. There are, as noted above, a lot of people whose baseline SpO2 wouldn't be mine, but for whom an 84% is not, in fact, a bona fide emergency. There are some for whom supplemental oxygen is actually dangerous. And as several folks have pointed out, the nurse has to assess the whole patient and the methods used for SpO2 checking to have a clearer picture of what's going on. Your faculty is correct. As a student you just don't have the experience to make that call, but you do have time to get somebody in there who does, and you ought to have done that and then asked that nurse why s/he made the decisions that followed.