O2 checks

[Working4Lord, BSN]

Guys, I just made a dumb dumb mistake. Had a patient, COPD and other issues. On 10 L and refusing things at times. Checked vitals at beginning of shift and O2 was 91%. Had scheduled nebs and RT checked O2. Throughout the day, checking BP because of meds and baseline low BP. Yet, I failed to check on his O2 and was so focused on his temp and BP and later in the evening, he had to be placed on Bipap. Why, I ask myself, did I dismiss his lethargy and only attribute it to some known confusion and infection? I feel like the dumbest nurse for this most basic of vitals!! I’m going to write a report on myself when I go back to work. But I can’t get over my stupidity. Anybody else just want to kick yourself for these things??

[buckchaser10]

I know it has been a month and a half now but just thought I'd write back to you. We are constantly learning. Every mistake you make makes you that much better. Going forward, never forget to fully think about what you should look at for focused assessments.

As far as the patient in question, if he was that bad off RT should (and may have been) more involved. It's very possible that they had been monitoring the patient all day without you realizing. BiPAP is not that big of a deal (it is but it's not a ventilator for cripes sake.) It is very possible your patient would have ended up on BiPAP regardless. O2 sats alone won't show you the need for BiPAP because CO2 can cause high pulse ox levels but actually is an indication for BiPAP use. ABGs would be your friend here.

[Okey Foley, BSN, RN]

Sometimes it's easy to get caught up in something happening and hard to back up, see a bigger picture and remember fundamentals. Things like this really reinforce the importance of fundamentals.

Like buck said, this patient maybe would have needed bipap no matter what. Good reminder for me too that retaining CO2 could cause the high pulse ox and ABG would be a better tool.

[amoLucia]

On ‎4‎/‎4‎/‎2020 at 12:18 AM, buckchaser10 said:

... O2 sats alone won't show you the need for BiPAP because CO2 can cause high pulse ox levels but actually is an indication for BiPAP use. ABGs would be your friend here.

I wish this could be posted in super big bold letters in every nsg station wherever! VERRRRRY few people understand the O2/CO2 relationship in hypercapnia/sleep apnea.

"Well, your pulse OX is 95%!", they'll spiel off. They just don't understand that I'm becoming increasingly exhausted & fatigued, my thoughts are becoming fuzzy, and it's just sooo hard to follow along. But my pOx is 95%! NO, I need to blow off the CO2. I DO NOT need your putting a nasal canula @2L on me! Get me Resp Therapy - I need ABGs and a machine!! I WAS trying to tell them & explain.

NOTE: This was my very real, actual experience during my May 2020 hospitalization. And the nurse was verbally snippy (smart-mouthed) with me. Fortunately with RT, things were addressed.

To OP - be wary of too much reliance on diagnostic tools like the pulse Ox. They are useful under the right situations and within 'the BIG picture'. Skills will fine-tune with time & experience.

[Kebner]

A tip...something that has saved several patient lives.

Always communicate with any person that provides treatment to your patient.

Basically, anyone that touches that patient has information you need.

This patient belongs to everyone that provides care to them.

Other disciplines will have a point if view that may enhance that patient's care.

I've followed nurses that have a vent patient on trials, didn't even know the patient was breathing on their own...

It's crucial, would you administer 1 gram IVP Diladid to a patient weaning from a ventilator?

ABGs!

I live at 5280 ft..88-89 % saturation for COPD..OK!

Sea level...different story. Context goes along way.

I don't really have enough information to judge you. But, communicate, talk to anyone that touches that patient, and talk to the patient.