Need help with test question

[Gaff1]

5. The patient is experiencing severe difficulty in breathing and their oxygen saturation level is 82. The nurse calls the physician annd after 30 minutes the physician has not returned the nurses call. What is the best action by the nurse?

a. the nurse has fulfilled his professional responsibility by contacting the physician so no further action is needed

b. contact the nursing supervisor and request the the patient be transferred to the ICU

c. re-contact the physician

d. increase the patients oxygen to 10 liters

Obviously the answer is not A. I am stuck between C and D. It seems like since this is an emergency situation the answer would be D. Please let me know what you think.

[tkm2005]

Remember your ABC's... An O2 saturation of 82% is ridiculous.

[Gaff1]

That's what I was thinking but my teacher just sent the answers saying C is correct... Is 10 L too much?

[PsychNurseWannaBe, BSN, RN]

You need to recontact the doctor. Have I seen 10 liters, you betcha, but you need a mask HOWEVER there are certain people who can not have that high like CO2 retainers. Since 10 L is very high, I would have chucked that answer out, plus oxygen is a medication, therefore you need to obtain an order.

I don't like that question. Waiting 30 minutes I feel is too long, since we are talking ABCs.

[CrazierThanYou]

You need to recontact the doctor. Have I seen 10 liters, you betcha, but you need a mask HOWEVER there are certain people who can not have that high like CO2 retainers. Since 10 L is very high, I would have chucked that answer out, plus oxygen is a medication, therefore you need to obtain an order.

I don't like that question. Waiting 30 minutes I feel is too long, since we are talking ABCs.

This is basically what I was going to say but Psych beat me to it. If the patient has a diagnosis of emphysema, then 10L of O2 would almost certainly send him/her into hypercapnia. Also, I was taught that nurses shouldn't adjust the O2 rate. Like Psych said, O2 is a medication and we shouldn't be adjusting it based on our judgement.

[Gaff1]

That makes sense. This is my first post and you have been very helpful. Thanks!!

[chevyv, BSN, RN]

The only way I would adjust the O2 rate is if there are standing orders. Calling the physician again is what I would do, but I doubt I would wait that long. I would also want to know what the pts normal sp02 level is. My son has a heart defect and is always in the 80's. That is his normal.

Sending the pt to ICU isn't going to happen via supervisor, but it may speed up a return doc call :)

[NikiCharles_01]

I would say C. Because of where I am since in my country nurses are not allowed to administer oxygen more than 4-6 L/min without doctors orders since oxygen is actually medication and if this was an actual situation what could be done is re-positioning of the patient in the meanwhile

[nurseprnRN, BSN, RN]

people often forget that oxygen is a medication and requires a physician prescription (patient-specific or per protocol). if someone has a spo2 of 82, that's very low and i'm not sure i'd wait half an hour to call again, but if these are only choices they give you, the others are unacceptable.

[CrazierThanYou]

I just had a patient yesterday at clinical. His O2 order was for 2L. He was an emphysema patient. I was setting up his portable O2 tank to ambulate him in the hall. I stepped out for a sec and wen I came back, I noticed his wife had cranked it up to 5L. She said "He probably needs more if he's going to be walking."

[athrun340]

This is basically what I was going to say but Psych beat me to it. If the patient has a diagnosis of emphysema, then 10L of O2 would almost certainly send him/her into hypercapnia. Also, I was taught that nurses shouldn't adjust the O2 rate. Like Psych said, O2 is a medication and we shouldn't be adjusting it based on our judgement.

interesting question crazierthanyou. My first choice was D too but after reading the responses, C made more sense. Afterall, D didnt say apply prb or nonbreather mask and increase O2 to 10 liters.. it just said increase O2 to 10 liters. Anyway, about "nurses shouldn't adjust O2 rate" part.. i just wanna share my experience because I've seen this scenario at work. I work as a pct at a hospital and one day we had a patient that was desating @ 77 .. it even went down to 56%. The nurse quickly put the patient on nonrebreather mask and increased the O2 to 15 liters. The pt's O2 sat quickly came up to 92-93%. He then called the doctor afterwards.

my question to RNs, is this action (increasing O2 because O2 sat is low then calling the doctor afterwards) an acceptable intervention or does it depend on your hospitals policy? do certain hospitals don't allow this? (ie. you have to get an order from the doctor first no matter what). I understand that O2 is a medication and you need an order for it but If it's an emergency, you have to do what's best for the client?

[ukstudent]

athrun340 - in the real world the rules can be black and white to very very foggy, depending on hospital and which floor/unit within a hospital. However, this question is set in the completely black and white world of nursing school nclex questions. In this world you do not change medications because you feel it will be better for the pt and you do not skip the chain of command by going to the nursing supervisor. You call the doctor again.