Felt like a complete idiot at work yesterday

Nurses General Nursing

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I go into my patients room and find him to be S.O.B and have anxiety. He is already on 2 liters of 02 via NC as ordered. I tell him to deep breath while I call the doctor. His pulse ox was 85-88. While I'm calling the doctor my supervisor remains with him. So I get an order to increase o2 to 3 liters. I come back to increase the o2. As I trace the o2 tubing I find that the patient was never connected to the o2 concentrator in his room instead he was connected to an EMPTY portable 02 tank which caused him to become hypoxic. I felt sooooo dumb and went through calling the doc for no reason at all.

The patients room was so cluttered and 02 tubing everywhere. Next time I'm going to trace the tubing and make sure he's connected to either the concentrator or a Filled o2 portable. Oh well. Totally felt like an idiot.

:nuke:

Specializes in Trauma Surgery, Nursing Management.

I agree with the postings thus far. Don't beat yourself up about it, and learn from it. You will only be a better nurse for it.

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Specializes in ER, Trauma.
I go into my patients room and find him to be S.O.B and have anxiety. He is already on 2 liters of 02 via NC as ordered. I tell him to deep breath while I call the doctor. His pulse ox was 85-88. While I'm calling the doctor my supervisor remains with him. So I get an order to increase o2 to 3 liters. I come back to increase the o2. As I trace the o2 tubing I find that the patient was never connected to the o2 concentrator in his room instead he was connected to an EMPTY portable 02 tank which caused him to become hypoxic. I felt sooooo dumb and went through calling the doc for no reason at all.

The patients room was so cluttered and 02 tubing everywhere. Next time I'm going to trace the tubing and make sure he's connected to either the concentrator or a Filled o2 portable. Oh well. Totally felt like an idiot.

:nuke:

It's a mistake only if you don't learn anything from it. Otherwise, it's a "learning opportunity." Besides, if mistakes were against the law, we'd all be in jail! That's what I tell my boss. Sometimes 8 or 9 times per shift!

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You and all of us will make similar mistakes. Many ACLS mock codes have the pt's O2 sat's stay low. The "student" is frantically thinking check ET placement, order a stat C-X-ray, etc., as the frequent ACLS's flyers giggle and roll their eyes and say "CHECK THAT THE O2 TUBING IS HOOKED UP TO THE OUTLET!!!!!

An intelligent experienced co-worker had a pt. whose finger stick glucose wouldn't go down in spite of several doses of regular insulin. I relieved her for lunch and somehow (I don't think it was my brilliant nursing intelligence, I think it was pure luck) I thought to check her IV fluid. We work out patient surgery, 99% of our pt.'s are on LR. This pt. had had a colonoscopy and was on D5NS.

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Even if the tubing was connected, why would you take the time to call the Dr. if the pt's sat was in the 8os? Turn up the O2, put on a mask if needed.

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Even if the tubing was connected, why would you take the time to call the Dr. if the pt's sat was in the 8os? Turn up the O2, put on a mask if needed.

It's probably always a good idea to report a change in status to the MD just to CYA. Without the patient's history it's hard to tell but low sats can be indicative of a bigger problem: PE, early CHF, maybe the patient was COPDer and she didn't want to raise the liter flow without an order.

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Specializes in critical care, PACU.
Even if the tubing was connected, why would you take the time to call the Dr. if the pt's sat was in the 8os? Turn up the O2, put on a mask if needed.

It's probably always a good idea to report a change in status to the MD just to CYA. Without the patient's history it's hard to tell but low sats can be indicative of a bigger problem: PE, early CHF, maybe the patient was COPDer and she didn't want to raise the liter flow without an order.

yes but it's also important to utilize nursing autonomy and save the patient while calling the md. I am shocked the supervisor didnt increase the O2 or change to a VM or NRB while the RN called the doc. :uhoh3:

emergency protocols are there for a reason. when my bp tanks you can bet that Im grabbing dopamine and starting a bolus while I have someone page. if my patient is desatting Im gonna try something first and then call the md.

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Specializes in Peds Medical Floor.
Our instructor told us a story (that I think will stick w/me for the rest of my life!!!) about a young pt w/a severe asthma attack coming in to the ED. They worked on her for a long time, and no amt of O2 would help -- her pulse ox kept dropping. She ended up passing, and as they were cleaning her up, they realized that the O2 tubing wasn't connected to the wall. :eek: With all the commotion and everything running around, no one noticed it.

Don't beat yourself up over it!!

Scary! And sad. :( What happened to the staff?

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Specializes in Critical Care.

My only question is why didn't you turn up the O2 before calling the doctor? Don't feel bad about doing what you did, but I wouldn't of waited to call the doctor before turning up the O2. Not to mention for turning it up to 3 liters.

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Specializes in Critical Care.
It's probably always a good idea to report a change in status to the MD just to CYA. Without the patient's history it's hard to tell but low sats can be indicative of a bigger problem: PE, early CHF, maybe the patient was COPDer and she didn't want to raise the liter flow without an order.

You should still raise the O2 THEN call the MD. And COPDer? She turned it up to 3 liters, that wouldn't cause a problem. Even putting them on a NRB would take a little time to knock out their drive to breath. By then you would've called the MD and gotten further orders. Its like telling someone to call the MD to get orders before starting to code someone.

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Probably one of the most challenging things when being a new nurse is getting priorities right and developing a keen sense of medical logic. Turning up the O2 is a prime example. Knowing what is a serious disaster versus what you can simply do better the next time can be confusing when first starting out. Thank God for those kind mentor-type experienced nurses!

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Specializes in Med/Surg, Geriatric, Hospice.
Probably one of the most challenging things when being a new nurse is getting priorities right and developing a keen sense of medical logic. Turning up the O2 is a prime example. Knowing what is a serious disaster versus what you can simply do better the next time can be confusing when first starting out. Thank God for those kind mentor-type experienced nurses!

Yes, from the sound of the post, I took at that the OP is a very new nurse. She did what she knew. (Don't really know why the UM wouldn't have increased the o2, however..)

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You should still raise the O2 THEN call the MD. And COPDer? She turned it up to 3 liters, that wouldn't cause a problem. Even putting them on a NRB would take a little time to knock out their drive to breath. By then you would've called the MD and gotten further orders. Its like telling someone to call the MD to get orders before starting to code someone.

I totally agree but I was making a point to the poster that I originally quoted as to why I would have called the doctor if his sats were in the 80's, on oxygen or not. The OP sounds a little new and I remember being scared out of my mind to do anything without an MD order first when I started.

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