At the risk of sounding like a dork, I have a question. I was taking care of an elderly man in a nursing home who recently developed a respiratory infection. He does not have COPD. His lungs sounded crackly, and his sats dropped to 76, so the doctor ordered supplementary oxygen, titrate to keep sats above 88%. At 3.5 liters he did well, satting at about 91-93%. However, he had a dip to 86% for awhile and the nurse during the day upped the oxygen to 4 liters. When I checked his sats that evening, he was at about 95%, more alert, doing well with his breathing treatments, etc, still on the 4 liters.
So this morning, I reported to the oncoming nurse that the patient was on 4 liters and satting at 95%. She asked me why I hadn't dropped the oxygen back down to 3.5 if he was satting at 95%. I sort of stared a her like a deer in headlights (after being up all night, I do that) and I said,"Because I didn't drop the oxygen" I couldn't think of anything else to say. It bugged me all the way home. I know if he had COPD I would need to closely watch to keep from giving too much oxygen, but this guy is having some respiratory troubles due to a respiratory infection brought on by bedrest. It didn't seem to me to be wrong to let him sat between 93-95%.
I know the order said a minimum sat of 88%, but does that mean we have to keep it as near there as possible?
Don't beat me up...no one knows everything. At least I'm smart enough to ask and learn. :)
no harm in keeping him at 4L. You didn't do anything wrong. My guess is the next nurse was going to trial him at 3.5L, if it didn't work, go back up to 4.
No biggie. From what i learned, some nurses are just more passive at some things than others. I'm pretty passive as in "No big deal" attitude. and some are always nagging at you for not doing things THEIR way. The attitude of "Its my way or no way." You didn't do anything wrong :) She just needs to get the stick out of her butt and realize it is OK to keep this patient at 4 if it is needed.
What-ever. Everyone made it through the night. And now that I look closely at the flowmeter it was more like 3.785lpm...perhaps we should develop a new form based on this issue.
We'd give him some time on the 4L and then slowly titrate down. Normally we don't do it overnight due the reasons others have posted. In the AM they'd continue to monitor his sats and if they were in a good range, we'd titrate down slowly and keep his sats within parameters. If the sats dropped significantly we'd go back up again and then try to titrate down again.
Honestly, the oncoming nurse really had no reason to go at you like that.
Next time you're on with a similar situation on nights, and given the opportunity and time, you can titrate down as ordered by the physician and see how your patient tolerates it and you'll have an answer for the smarty pants day nurse. :)
or...you can simply tilt your head, knit your brows and ask "why would i?"
i'm dead serious.
this guy's infection is recent.
and, you leave your pts alone at night, unless something urgent/emergent arises.
you can start weaning him that day or even wait another day.
Next time tell the day nurse that you found the pt to respond favorably to a cyclically varying oxygen rate where the rate at time t equals a sinusoidal function involving the atmospheric pressure.
Nah don't titrate at night unless this is a long term patient and you know how they will react. What if you had titrated and he just stayed down? I also agree with AJPV "If you can't astonish them with your brilliance baffle them with your $%#%."
What-ever. Everyone made it through the night. And now that I look closely at the flowmeter it was more like 3.785lpm...perhaps we should develop a new form based on this issue.
Duck and cover, lol.
Canoehead, are you sure you're not an administrator?
Next time tell the day nurse that you found the pt to respond favorably to a cyclically varying oxygen rate where the rate at time t equals a sinusoidal function involving the atmospheric pressure.
I Esme said it all. We all jump on the clinical bandwagon and discuss the O2 issue, just like they will at work...truth is, doesn't really matter, tempest in a teapot. I've often thought this report/work critiquing behavior comes form someone who needs to demonstrate how smart and on the ball she is. Little things like this can have the unit discussing and discussing, people take sides, it's a nice little bloodless drama. except for the person she goes after who feels upset, ashamed and afraid they missed something important. (this is the match to set off the whole dynamic. I think it's fun to learn from others and discuss things, but I really dislike people who use their clinical knowledge to make people feel bad not good. I promise you, even if you were miles ahead of her, she'd find a way to nitpick your report, the best you can expect from this person is a disapproving silence when you answer with one of the suggestions above. (or they'll say whatever, or well if you want to do it that way, or an eyeroll and pained expression...you get the idea.
Yea, and the minute you put it down you have to put it back up. It's nights and I wouldn't have tried to ween him if he was resting comfortably. Some nurses feel the need to play with the O2 all the time; makes them feel important. You're fine; don't let the small stuff get to you.
Jenni811, RN
1,032 Posts
no harm in keeping him at 4L. You didn't do anything wrong. My guess is the next nurse was going to trial him at 3.5L, if it didn't work, go back up to 4.
No biggie. From what i learned, some nurses are just more passive at some things than others. I'm pretty passive as in "No big deal" attitude. and some are always nagging at you for not doing things THEIR way. The attitude of "Its my way or no way." You didn't do anything wrong :) She just needs to get the stick out of her butt and realize it is OK to keep this patient at 4 if it is needed.