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Discussion

O2 is 81, what shoud you do?

If a patient's O2 sat 81, what should a Neuro ICU nurse do? If a patient is low blood pressure, what should you do also?

Please help with these two scenario questions, I am preparing for a Neuro ICU interview next week.

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I'd like to hear what your first interventions would be :smokin:

start bagging,ABG's, intubate. lower HOB for low BP and get a pressor. all done with orders of course

I would say "I have no idea ...... teach me" :D

Because honestly I have no idea, in our unit sats of 81 are no biggie, and definitely don't require bagging. But each speciality is different and if they have a good orientation program, then they should go into thorough detail about all kinds of stuff that you would encounter on that unit.

First of all...what else is going on with this patient? Always check the ABC's first...and is that a real SPO2? BP? Begin with the basics...put on nasal cannula...how low is low? Is it sudden? What meds are they on?

Right, I wouldn't start bagging this patient...

Number one ASSESS your patient. Does he look like he has an oxygen sat of 81% is his lips blue, how is his LOC (generally there will be a decline). Check your waveform on the pulse ox if the pulse ox is not on correctly or needs to be readjusted. Listen to your patients lungs.

Then if all that was correct and the patients pulse ox was that low bag and think. What would cause this persons pulse ox to go so low. Which is the fun investigative game.

Low blood pressure usually notify MD and they will give a fluid bolus of 500ml. but find out the underlying cause. Maybe if it is declining fast give a vasopresser.

Good luck on your interview

kent

sorry i was assuming the worse and assuming that the pt would be in distress and if that is the case then act accordingly. and if the sats are a true 81 then YES it is a big deal or should be on any unit you work on especially if their in AD.

Check pt and equipment first. Low O2: suction, turn-cough-deep breathe, raise HOB, increase o2 flow. Low BP: reposition cuff and recheck, lower HOB, think about meds you've given recently (pain meds, sedation, etc), fluid bolus, stimulation. The most important thing is to assess the situation and not have too-quick reactions because you can make things worse or have rebound consquences (like a sky-rocketing BP). It's really important in neuro pts to not have sudden or drastic changes in BP.

and if the sats are a true 81 then YES it is a big deal or should be on any unit you work on

If you worked in the neonatal ICU and jumped everytime a chronic RDS kiddo hit 81, you'd be doing a whole lot of jumpin'! ;)

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With any of these questions you can't go far wrong if you answer ABC assessment.

I would start with has there been a deterioration in LOC, what is the AVPU score as a rapid assessment.

Airway, is it compromised, if so you need to take action, if it because of a deteriorating GCS then basic airway manouvers, head tilt chin lift, jaw thrust that kind of stuff to improve patency.

Breathing, look listen and feel, are there any changes to previous assessments, if your talking about an acute deterioration then high flow O2 in line with resuscitation guidence. Are they ventilated, is there any problems with the ventilation and do you need to take action.

Circulation, are there any changes to previous assessments, are they tachy, brady, what is the BP and perfusion like

Disability - glasgow coma score assessment and pupil reactions, again is there any changes to previous assessments.

Think about what may have caused such a deterioration and if this could be related to the neuro status.

If you worked in the neonatal ICU and jumped everytime a chronic RDS kiddo hit 81, you'd be doing a whole lot of jumpin'! ;)

i didnt know we was talkin neonates here...:yeah:

i didnt know we was talkin neonates here...:yeah:

We weren't. But you said "any unit" :)

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I would want more information - and before instituting any treatment, I would keep in mind it's a neuro patient and want to know what their problem/injury is. For example, you would not necessarily want to turn a neuro patient if they have associated cervical injuries etc. Are they already ventilated? Can you run a blood gas and check what their pO2 is before you bag etc.? Always assess before treating.

BP - it's super important in neuro patients to keep an adequate cerebral perfusion pressure. So if you have a hypotensive patient, you need to add pressors to keep the BP high enough to overcome any raised ICP and maintain cerebral blood flow.

Just keep in mind whatever you're doing, that it's a neuro pt.

Good luck!

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