low oxygen levels

Posted
by jonie8693 (New) New

Hello, I'm an elementary school nurse and I have a student who has had 3 open heart surgeries for a heart defect, I don't know much else that is all the mom put on her medical history. One day I checked her oxygen level because she looked blue around the mouth and really pale and her oxygen level was in the 80's, her mom came to pick her up for something else nonrelated and I asked her about it and she said that was normal for her and she always runs in the 80's. She never has a problem with SOB and does physical activity without any trouble, so since I'm not a pediatric cardiology expert I was wondering if this is normal for some cardiac patients and why wouldn't they put her on O2?

Nicole5128, ADN, BSN, RN

Specializes in Emergency Medicine. Has 8 years experience. 60 Posts

That is definitely not normal. At least not to me. I know even ppl with copd will sat in the low 90s but for a kid with heart issues to be sating 80? In my ER they would get breathing treatments or something or we would put them on O2. I personally don't think it's normal but if it is I would be shocked

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 12 years experience. 1 Article; 13,949 Posts

Yes it's possible for a cardiac kiddo to be normal in the 80's. It depends on the condition and what surgical procedures. If you gave her oxygen and her normal is in the 80's you could have easily caused harm and/or oxygen toxicity. You need a care plan for this child as well as provider ordered VS parameters.

Exactly what "heart condition" is needed transposition of arteries,PDA, LVH, tetralogy of fallot, congenital pulmonary hypertension? You need more info to safely care for this child.

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 45 years experience. 7,899 Posts

Actually- it is QUITE normal for certain congenital defects. Single ventricle physiology, for example, requires a three step palliation/ repair (Norwood, Glenn and Fontan procedures) and for their entire life the child's sats will never be 'normal'. Many of our kids have sats (AFTER all three palliative surgeries) in the mid-70s to 80s. It is their baseline. Supplemental oxygen not only is ineffective but can be dangerous. (If they have residual pulmonary hypertension)

With the 'three surgery' notice- I would suspect that is what you are dealing with- a kid with a single ventricle.

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 45 years experience. 7,899 Posts

That is definitely not normal. At least not to me. I know even ppl with copd will sat in the low 90s but for a kid with heart issues to be sating 80? In my ER they would get breathing treatments or something or we would put them on O2. I personally don't think it's normal but if it is I would be shocked

Prepare to be shocked! The world of congenital heart defects sometimes defies 'reason'.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 12 years experience. 1 Article; 13,949 Posts

Actually- it is QUITE normal for certain congenital defects. Single ventricle physiology, for example, requires a three step palliation/ repair (Norwood, Glenn and Fontan procedures) and for their entire life the child's sats will never be 'normal'. Many of our kids have sats (AFTER all three palliative surgeries) in the mid-70s to 80s. It is their baseline. Supplemental oxygen not only is ineffective but can be dangerous. (If they have residual pulmonary hypertension)

With the 'three surgery' notice- I would suspect that is what you are dealing with- a kid with a single ventricle.

I knew one of you PICU experts would be by! I couldn't think of the conditions but I know it could be normal and albuterol or O2 could cause serious harm.

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 45 years experience. 7,899 Posts

Albuterol is not a big deal. But supplemental oxygen is really opening a can of worms.

Speaking of albuterol: Had a newborn with congenital third-degree heart block admitted the other night. Isuprel/ Dopamine/Dobutamine/Epi maxed out. HR 50s. We all took a time out to make sure we were not missing something to help this kid before we could get her to surgery- and the intensivist looks at the RT and says (jokingly)"Let's try a 20 mg continuous neb!" We almost did it- just to see!

FlyingScot, RN

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc. Has 28 years experience. 2,016 Posts

That is definitely not normal. At least not to me. I know even ppl with copd will sat in the low 90s but for a kid with heart issues to be sating 80? In my ER they would get breathing treatments or something or we would put them on O2. I personally don't think it's normal but if it is I would be shocked

As has been mentioned this absolutely can be normal for a child with a cardiac history and giving oxygen might, in fact, do them great harm. As an ER nurse you and your peers might find yourself facing this exact situation more and more frequently because with the advancement of diagnostics, surgical interventions and medications these kids are now surviving beyond infancy. What this means for you is when you have a child with low sats you need to know if they have a history of cardiac defects (especially cyanotic hearts), if they've been repaired and what their normal O2 saturation is. These are the kind of kids that consulting with their cardiologist should be one of the first things that you do.

jonie8693

12 Posts

Thank ya'll so much for your input!! I will defiantly get with her Dr. so that we can get a care plan and set some vs paramaters!

FlyingScot, RN

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc. Has 28 years experience. 2,016 Posts

Thank ya'll so much for your input!! I will defiantly get with her Dr. so that we can get a care plan and set some vs paramaters!

That's a great idea. Find out what her defect and repair was and look them up. Pediatric cardiology is absolutely fascinating. Once you do if you have any questions or just want to share what you've learned come back and post it here!

RescueNinjaKy

Specializes in Cath/EP lab, CCU, Cardiac stepdown. Has 3 years experience. 593 Posts

Hmm, now that we established that her saturation levels aren't too concerning and it's her baseline, what about her cyanosis? I mean if she's looking blue and pale, shouldn't something be done? I'm asking purely out of curiosity. I don't deal with pediatrics so if anyone can answer that would be great. Thanks!

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 45 years experience. 7,899 Posts

Hmm, now that we established that her saturation levels aren't too concerning and it's her baseline, what about her cyanosis? I mean if she's looking blue and pale, shouldn't something be done? I'm asking purely out of curiosity. I don't deal with pediatrics so if anyone can answer that would be great. Thanks!

One favorite patient of mine is called "Madame Blueberry' for her persistent cyanosis. It's not uncommon.