new nurse

[Enurse03]

Hello all I am a new nurse working in ltc. I work third shift and recently had an experience with a patient who had a bilat expiratory wheeze in the upper lobes. Bp 129/62 pulse 102 resp 28 temp 99 sp02 92 on ra. Hyperpnea, no nasal flaring or cyanosis. Protocal says to start o2 only in resp distress or with sp02 less than 88. Dr paged numerous times for prn duoneb and xray but never called the facility. Respirations decreased slightly with hob elevated. Anyway question is should I of started 02? What other interventions could I of used?

[ChristineN, BSN, RN]

I absolutely would have started the pt on O2. You had the right idea about raising the HOB to decreasing the pt's work of breathing. Hopefully you documented this whole exchange with the physician, especially since you did not get a call back

[cardiacfreak, ADN]

It depends on your facilities policy. I work in a hospital and applying o2 is standard policy, however, I once worked at a LTC facility and a nurse applied o2 and was written up for not obtaining an order from the MD even though (just like your scenario) the MD never called back. The MD even refused to DC the o2 since she didn't give the order to place it.

[HouTx, BSN, MSN, EdD]

Is 'pulmonary hygeine' an outdated concept? Since the 'junky stuff' appears to be high in the bronchial tree (upper lobes) & evident upon expiration, it may simply indicate that the patient has some accumulated mucus that could be coughed up. Pulse was not indicated, but BP seems OK... no way to tell if the PulseOx is a significant change from baseline. Does the patient 'feel' SOB?

These hoofbeats don't necessarily mean there's a zebra loose. Start with conservative, common sense nursing interventions. But keep an eye on that temp - first stage of sepsis can be very subtle in the elderly.

[classicdame, MSN, EdD]

I would have called Rapid Response team and/or Repiratory Therapy. Then I would call House Supervisor (chain of command) to complain about MD not returning call. If needed, call the ER doc.

[schnookimz]

LTC has rapid response???

[classicdame, MSN, EdD]

sorry, I missed that part. Surely there is someone else to call, or send to ER.

[nurseprnRN, BSN, RN]

Did you know that coughing and deep breathing is a nursing action? Back in the dark ages when nurses were encouraged to use their critical thinking skills to determine nursing actions, we routinely took people like that and had them do ten deep breaths and ten deep coughs every hour. Cleaned 'em right up and dropped their temps too. I recommend it.

[ChristineN, BSN, RN]

LTC has rapid response???

Assuming you were in the hospital, what about this says rapid response?

[dudette10, MSN, RN]

Did you know that coughing and deep breathing is a nursing action? Back in the dark ages when nurses were encouraged to use their critical thinking skills to determine nursing actions, we routinely took people like that and had them do ten deep breaths and ten deep coughs every hour. Cleaned 'em right up and dropped their temps too. I recommend it.

Thank you for that. I see more and more nurses not doing independent nursing interventions. If I walk into a room of a patient who has been in the hospital for 5 days, and he tells me he hasn't been OOB since he got here, I'm gonna scream. You don't need PT/OT to reverse deconditioning. You need nurses who give a **** from the day of admission!!

[sunshyne17]

Definitely start O2. You can usually give 2L without a doctors order. I would have done some chest percussion to move those secretions around if the patient could tolerate. Deep breathing. Encouraging coughing. The 28 respers is a reason to intervene. You want to do something before it gets worse.