Help! Placement trouble.

Nursing Students Student Assist

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Hi guys!

I'm a first year student and loving nursing.

At the hospital I'm at, I just feel really intimidated to ever say anything as I'm viewed just as a "newbie".

A pt today had an O2 sats of 85%. The nurse said "oh that's a little low' so I asked what we r gonna do and she said we might give some 02 once the visitor leaves. The nurse kind of forgot and I kept saying 'what about that patient??' About 30 minutes later we got the pt out of bed sitting and stats were now 93. The nurse was happy with that, but I wasn't because I know she's on endone too and I don't want the pt going down hill...what do I do in situations like that?? Tell the nurse in charge? They seem to look down at first years..

Thank you

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Specializes in Pedi.

Perhaps you ask the nurse her rationale/why she isn't more concerned. What is this patient's history? For some people, 93% is an ok O2 sat... for others, they'd be gasping for air. Was this patient in any distress? Are they a chronic COPDer who you DON'T want to give oxygen to? I have a patient now whose baseline sats are in the low-mid 80s, so neither a sat of 85% nor 93% would be at all concerning for this patient. He has nary a care in the world that these are his sats and he runs around playing in no distress and the MD is happy as long as his sat is > 82%.

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Specializes in Adult Internal Medicine.
About 30 minutes later we got the pt out of bed sitting and stats were now 93. The nurse was happy with that, but I wasn't because I know she's on endone too and I don't want the pt going down hill...what do I do in situations like that?? Tell the nurse in charge? They seem to look down at first years..

Thank you

To be brutally honest, "first-years" being looked down upon may be related to "telling the nurse in charge" about a situation you did not communicate with the primary nurse about. I don't know this patient but I am willing to bet that if the RN was comfortable with him in the mid 80s that he was non-symptomatic.

Think about what Endone is and how it works and then picture the patient that is becoming toxic on it. Does he present with a low O2 but a normal RR while talking to a visitor?

It's hard right now because you know just a small amount of basic information and you want to try and make it apply to everyone. Try talking to and learning from your RN instead of filling your thoughts with reporting her/him.

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To continue with the brutal honesty, some staff nurses don't know what oxygen saturation numbers mean or how to respond to them. Not saying yours didn't, because maybe she knew something you haven't told us. But someone on an opioid who's in bed is not breathing deeply and that can drop sats. A sat of 85% is NOT the same as an arterial oxygen of 85 torr-- it's much lower, and could be a problem. Getting the patient up in a chair, deep breathing, can help with sats and oxygenation and ventilation to decrease CO2. You will learn all the pieces of this particular puzzle in time.

So... save this away in the back of your mind and the next time you see someone who drops his sats to 85%, don't wait for the visitors to leave to give the oxygen the patient has ordered prn. This IS the prn. Say sweetly, "Mr. Smith, your oxygen reading's a little low, so I'm going to give you the supplemental oxygen your physician wants you to have, I'm going to listen to your chest, I'm going to sit you up a little better, and I want you to take 5 deep breaths every few minutes."

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Thanks guys, however I followed my instinct and ended up calling a MET CALL and doctors got to work on the pt straight sway. Wasn't gonna sit there quietly and worry about being just a 'student' who knows 'limited knowledge'. yes might not know a lot at the moment however saftey of patient should always be number one, and doctors congratulated me in the end.

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