Had a question on quiz about pulse oximeter.

not now, RN · Nov 23, 2004

I've been taught that if it's below 90% you're supposed to check to make sure it's on properly. If it is have them deep breath and cough.

So no, 88% isn't exactly good. It's not exactly horrible either.

youngRNstudent · Nov 23, 2004

88% is not good (unless you have COPD, then it is acceptable)

Typically, the patients pulse ox needs to be at least 90% to be WNL

Tony35NYC · Nov 23, 2004

Yes, 88% is bad. 90% is good for an adult pt and 95% is good for a kid.

CarVsTree · Nov 23, 2004

The question says that the patient had a 88% from the pulse oximeter reading?
Is 88% good or not?

I've been taught and the hospital I work at seems to support that 95 and above is normal for a healthy adult.

Comprimised pts can have any number below that. If it gets much below 88, they're days (or maybe even hours) are numbered. Their body is working way to hard just to stay oxygenated.

UTRN2005 · Nov 23, 2004

I was taught that 92% and up was normal for an adult. Often below 90-92% MDs will have orders for O2. But regardless of whether you were taught 90% 92% or 95% as your normal 88% is low.

Truly_Blessed · Nov 23, 2004

We were taught anything below 90% is abnormal.

HappyNurse2005, RN · Nov 23, 2004

if you get an 88% i'd do a few things. first, check on another finger. if still 88%-if they are on O2, check the connection to the wall (that happened in our clinicals-the NC was not attached to the oxygen, so a pt -not mine-was having 88% sats or so)

love, rose

UM Review RN, ASN, RN · Nov 23, 2004

Is 88% good or not?

For some COPDers, it might be the best they can get.

But if you find someone like that, I'd make sure they have O2 @ 2 L on, and keep monitoring them. If they're telling you, "Oh, that's a good number for me," and don't seem to be in distress, that's your clue that you have a COPDer. Monitor them so they don't get any worse. If they have Neb treatments ordered, they might need one.

However, if the patient is having sternal retractions, shortness of breath and has no O2 on, and is alert and oriented, there are several things you want to do immediately.

Call the Respiratory Therapist. Monitor O2 sats continuously. Get vitals and be ready to call the doc.

While someone else runs to get the O2 tubing, reposition the patient. Get the patient up at the top of the mattress, and crank them up to a high Fowler's. Don't forget to crank the legs flat.

This is truly one nursing intervention that many people overlook. Make sure the patient isn't slouching or slumped in the bed as it encroaches on their lung capacity. A lot of breathing is mechanical. I've seen many patients improve dramatically within a few minutes of performing this intervention.

Oxygenate. If the nasal cannula full blast isn't effective, try a Venti-mask. If that doesn't work, do a non-rebreather. (Hook up the O2, and remember to let that blow the bag up before you apply it, otherwise it's useless.)

Now have the patient lean forward slightly so you can LISTEN to their lungs. What do you hear? Crackles? You have a CHFer, so crank up the O2, get the doc on the phone and ask for Lasix. Be ready fast, because CHFers go downhill scarily fast. Wheezes? Rhonchi? No air moving much at all? Could be a few things, but an Albuterol/Atrovent Neb treatment might help.

Breathing is also very psychological. That is, if the patient believes no air is getting in, their resps will increase, become more shallow, and they really won't get any air. Teach the patient how to get more air by breathing slower ("Count to 10 with me as you inhale and exhale") and deeper. Remind them that they don't have to "feel" the air to be actually getting air.

This too, is a nursing intervention. It's based on trust. The patient has to trust you in order to let go of their own reflex to breathe faster and do this successfully. These patients have my utmost respect, because it's like trying to tell a drowning person not to thrash.

Not successful yet? Call a Code and prepare to intubate.

Anyhow....just thought I'd share a little. Anyone else have something to add?

Brotherbob, BSN, RN · Nov 23, 2004

Good post by Angie.

I usually administer oxygen if sat is below 93. I always administer o2 on chestpain. Make sure you always ask about lung disese/COPD. 88 in a non COPD pat. is not good, needs to be adressed.

I am still new in ER and had this CHF pat. the other day and It scared me how fast things happened. He went from sat 95 and joking to 82 and panic in just a few minutes. If you suspect CHF, make sure you have a working IV in and prepare the CPAP.

FutureIsBlue, LPN, LVN · Nov 23, 2004

Thank you for your replies,

The answer I put for that question is right. *a sigh of relief*.

Thank you again.:-)

mauser · Nov 23, 2004

One more piece of advice - a wise RN told me to "treat the patient, not the machine."

So in addition to the pulse ox dropping, how was the patient? If he seemed okay, it could be the placement. Not that that helps you on a quiz - but it will on the floor!