O2 is 81, what shoud you do?

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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.

Specializes in CTICU.

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!

I would be careful how you answer this question. If the pt has increased ICP or a dissection you don't want them to cough. You want to carefully assess them and find out the cause of the hypoxia. You definitely want to get the O2 back on a neuro pt. If they have decreased O2 and have a head injury their ICP will rise until the CO2 is decreased.

Specializes in NICU.

Firstly LOOK and ASSESS your patient.

If your patient is sat there, talking to you or happily reading a book - don't panic!

Check all your settings/equipment etc.

If your patient is laid there, going blue, then SHOUT for help!

Specializes in CVICU, ICU, RRT, CVPACU.
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'! ;)

Just becasue someone doest jump at a problem doesnt make the problem not exist. 81% sustained for anyone is too low. I personally am very interested to hear your rationale behind why an Sp02 of 81@ on a Neonate, let alone an adult isnt a concern to you? Ive worked in critical care, Respiratory Therapy and with neonates and this is the first time Ive ever heard this one?

Specializes in NICU, Med/Surg.
Just becasue someone doest jump at a problem doesnt make the problem not exist. 81% sustained for anyone is too low. I personally am very interested to hear your rationale behind why an Sp02 of 81@ on a Neonate, let alone an adult isnt a concern to you? Ive worked in critical care, Respiratory Therapy and with neonates and this is the first time Ive ever heard this one?

Neonates are an entirely different patient group and the same rules don´t apply....

Some of my patients make regular desats down to 10 (sats) and we watch and just stand back and wait for them to recover again. Doing somehing, anything, even just opening the incubator doors only means that the baby will take longer to recover.

To stand back even if the patient is doing poorly is one of the hardest lessons one needs to learn doing neonate care. It doesn´t mean that I don´t care about it, I still do an assesment and try to decide the moment when this isn´t ok anymore.

Some babies go from 97 to 15 to 96 in just a few minutes, disturbing them just means they will stay longer in the lower range.

Sorry, didn´t mean to hijack the thread..

Anna

Specializes in CVICU, ICU, RRT, CVPACU.
Neonates are an entirely different patient group and the same rules don´t apply....

Some of my patients make regular desats down to 10 (sats) and we watch and just stand back and wait for them to recover again. Doing somehing, anything, even just opening the incubator doors only means that the baby will take longer to recover.

To stand back even if the patient is doing poorly is one of the hardest lessons one needs to learn doing neonate care. It doesn´t mean that I don´t care about it, I still do an assesment and try to decide the moment when this isn´t ok anymore.

Some babies go from 97 to 15 to 96 in just a few minutes, disturbing them just means they will stay longer in the lower range.

Sorry, didn´t mean to hijack the thread..

Anna

I would be very interested in reading any literature or studies that you have that suggest a sustained Sp02 of 80% for a neonate is an acceptable practice.

Specializes in NICU.
I would be very interested in reading any literature or studies that you have that suggest a sustained Sp02 of 80% for a neonate is an acceptable practice.

There was no mention of "sustaining" sats of 80%. It's not uncommon for chronic babies with BPD to drop their sats down to 80. Typically they go right back up with no intervention.

As far as sustaining sats at 80% .... that's actually where we want our cardiac babies to be (i.e. doctors will write orders to keep sats 75-90).

It's all about knowing your patient population.

Specializes in CVICU, ICU, RRT, CVPACU.
There was no mention of "sustaining" sats of 80%. It's not uncommon for chronic babies with BPD to drop their sats down to 80. Typically they go right back up with no intervention.

As far as sustaining sats at 80% .... that's actually where we want our cardiac babies to be (i.e. doctors will write orders to keep sats 75-90).

It's all about knowing your patient population.

You yourself just mentioned in the above post that you keeps sats 75-90%. If you "keep" something in that range that says to me its sustained. I am asked to do things everyday by physicians.........some are very intelligent and some are completely insane. My point is, show me some literature, studies, books,...........essentially anything that states that allowing a neonate to maintain sats of 80% is an acceptable practice (Evidence based practice). I understand that neonates have frequent desaturations and understand very well the processes behind BPD, however I am (In all seriousness) very interested to read any solid research or studies that show this is acceptable, not someone just telling me "the doctor tells me to do it so I do". How about some physiology behind why this is acceptable? The orginal question in the post was about a Neruo ICU patient and its developed into a thread thats made me curious about this practice in your NICU. In all sincerity, I am very interested to learn about the logic behind this.

Specializes in Advanced Practice, surgery.
You yourself just mentioned in the above post that you keeps sats 75-90%. If you "keep" something in that range that says to me its sustained. I am asked to do things everyday by physicians.........some are very intelligent and some are completely insane. My point is, show me some literature, studies, books,...........essentially anything that states that allowing a neonate to maintain sats of 80% is an acceptable practice (Evidence based practice). I understand that neonates have frequent desaturations and understand very well the processes behind BPD, however I am (In all seriousness) very interested to read any solid research or studies that show this is acceptable, not someone just telling me "the doctor tells me to do it so I do". How about some physiology behind why this is acceptable? The orginal question in the post was about a Neruo ICU patient and its developed into a thread thats made me curious about this practice in your NICU. In all sincerity, I am very interested to learn about the logic behind this.

I worked on a cardiac PICU and the rationale we were given for keeping sats 75 - 90 was that if they have an abnormality within the circulation around the heart it was often the Patent Ductus Ateriosus that kept the baby oxygenated until surgical repair is possible. Now if you increase oxygenation this is one of the signals for the PDA to close, by keeping sats lower the PDA does not close.

The babes compensate by having a polycythemia.

You yourself just mentioned in the above post that you keeps sats 75-90%. If you "keep" something in that range that says to me its sustained. I am asked to do things everyday by physicians.........some are very intelligent and some are completely insane. My point is, show me some literature, studies, books,...........essentially anything that states that allowing a neonate to maintain sats of 80% is an acceptable practice (Evidence based practice). I understand that neonates have frequent desaturations and understand very well the processes behind BPD, however I am (In all seriousness) very interested to read any solid research or studies that show this is acceptable, not someone just telling me "the doctor tells me to do it so I do". How about some physiology behind why this is acceptable? The orginal question in the post was about a Neruo ICU patient and its developed into a thread thats made me curious about this practice in your NICU. In all sincerity, I am very interested to learn about the logic behind this.

There are several studies and journal articles out there on the results of hyperoxia in the premature neonate. Set aside a couple of hours and Google it.

Specializes in NICU.
You yourself just mentioned in the above post that you keeps sats 75-90%. If you "keep" something in that range that says to me its sustained.

Yeah, in that post (not in previous posts) I said to "keep", to give an example of a situation, since you asked. In your previous post you said there was mention of "sustaining" and there was no such mention of that in the previous posts.

however I am (In all seriousness) very interested to read any solid research or studies that show this is acceptable, not someone just telling me "the doctor tells me to do it so I do".

Do a search on neonatal cardiac anomalies. There are way too many situations to mention here. I don't do it just because "the doctor told me to do it", I do it because the last thing I want is for a PDA-dependent baby's PDA to close before they can get to surgery.

Specializes in Cardiac.
Just becasue someone doest jump at a problem doesnt make the problem not exist. 81% sustained for anyone is too low.

Sometimes my pts desat down into the 80s and all it takes is me shaking their shoulder and telling them to breathe.

Calm, intelligent, and common sense decisions are always better for pts than someone who 'jumps' at a number on a monitor.

Most critical care nurses know how to assess. Sometimes that means sitting back and watching your pt. Sometimes it means getting the intubation equipment ready.

To the OP. You should be able to answer both of your scenerios. I don't think the interviewer will expect you to know intubation meds or which pressor to use. They want to see your critical thinking, how you would respond, what you would anticipate...

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