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. :)
Specializes in telemetry, cardiopulmonary stepdown, LTC. Hospice.
I want to thank all of you for your help! I didn't feel comfortable messing with his oxygen at night, either. It seemed unwise, based on his recent need for upping the oxygen in the first place, and because he was resting. I don't think that day nurses, very often, think about how necessary good rest is for health. We already have to wake these poor people up every two hours to bed check them, and the patient in question has extensive coccyx wounds that require redressing at night due to intractable diarrhea. In short, he is an elderly man who is not going to be with us much longer, and in the grand scheme of things 0.5 liters just seems like, well, nothing to be worried about. But at times, with nurses who have been in the biz for a lot longer than I have, I do let them intimidate me more than I should, and make me worry. Next time I will ask the nurse for an explanation for her concern. It's a great comfort to come on this forum and receive so much support and help! Thanks!
I probably would have dropped the oxygen down just a touch but I wouldn't have worried too much if I hadn't, either. It's not like he was on 10 liters and was being blasted away with oxygen. Generally if he's not a chronic oxygen user they do like to titrate them down a little. Was he comfortable at the 4 liters or a little SOB? And 95% might seem more than adequate to people that are used to taking care of patients who runs in the low 90's... but 95% could be better? If it was say 99% or 100% sure I would decrease it but he was still only at 95% even with 4 liters. And you know, at night time you don't really breathe as deeply when your asleep and I bet you anything his sats probably dropped a little bit through the night. Just my input and judgement.
Specializes in telemetry, cardiopulmonary stepdown, LTC. Hospice.
His resp were at 18, HR at 73 and he had a really restful night. I hated to wake him up for bed checks. Breathing even and unlabored. He still had some coughing at times, but mostly when I was turning him and I was glad he was getting some of that gunk out of there. Naw, turning down the O2 was just never anything I saw as pressing. That's why after my second 12 hour night I was bleary-eyed and surprised when the nurse made a big thing out of it to me.
If there is one thing about nursing I've grown tired of in the past three years, it's the one-upmanship that goes on. As soon as a nurse walks off the floor, the new nurse on the floor is telling all the CNA's how rotten she was and how much better she's going to handle things all day. I think it was worse when I was in a big-city hospital than it is in LTC, but it still goes on. I have a thicker skin than I did when I started, that's for sure, but this time I was worried that maybe I fell asleep in a nursing class where they told me something about oxygen titration that I should have known. I want to do the best for my patients that I can, and I'm sure glad I have Allnurses to come to for help!
As a day shift myself I think questioning a 0.5L of o2, how stupid. I would not question you on it unless they were on a 100% NRB with a sat of 98-100. Next time enlighten her on how pt's desat at night due to mouth breathing. And that 3.5-4 is nothing
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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.
:hhmth: I like that......I'm going to steal it for my repertoire. I'll quote you though....
Specializes in telemetry, cardiopulmonary stepdown, LTC. Hospice.
As a day shift myself I think questioning a 0.5L of o2, how stupid. I would not question you on it unless they were on a 100% NRB with a sat of 98-100. Next time enlighten her on how pt's desat at night due to mouth breathing. And that 3.5-4 is nothing
I worked day shift when I did cardiopulmonary stepdown, and if someone had said they bumped them up the day before, I wouldn't even think much about them dropping it at night. I'd make a mental note to try and drop it during my shift. Come to think of it, I'm sure respiratory therapy would come by during the day and attempt that themselves. Note: respiratory therapy never came during the night in the hospital and tried to titrate down.
Hoosiernurse, ADN, RN
160 Posts
I want to thank all of you for your help! I didn't feel comfortable messing with his oxygen at night, either. It seemed unwise, based on his recent need for upping the oxygen in the first place, and because he was resting. I don't think that day nurses, very often, think about how necessary good rest is for health. We already have to wake these poor people up every two hours to bed check them, and the patient in question has extensive coccyx wounds that require redressing at night due to intractable diarrhea. In short, he is an elderly man who is not going to be with us much longer, and in the grand scheme of things 0.5 liters just seems like, well, nothing to be worried about. But at times, with nurses who have been in the biz for a lot longer than I have, I do let them intimidate me more than I should, and make me worry. Next time I will ask the nurse for an explanation for her concern. It's a great comfort to come on this forum and receive so much support and help! Thanks!