planning client outcomes (goal)

[kubebe]

my nursing care plan diagnosis is impaired airway clearance, and one of my goal is: pt will maintain 02 sat at or above 90% on room air at the time of discharge. is this goal ok for my diagnosis? and what is the normal % for O2 sat on room air? :)

[ObtundedRN, BSN, RN]

You could argue that this goal is dependent on the patient. Some might say the O2 sat on RA should be at least 95%. But if the pt has COPD, then 90% is more of a reasonable goal. The goal should be tailored for the patient.

I would probably drop the "at time of discharge" part, just because I would hope they can maintain that sat prior to discharge (unless they expect to be sent home on O2, but that would change the goal). If you really want to add some type of time constraint, you could try setting an actual date. Or just leave no time constraint and the goal would be left as "not met" until met. I personally would do that.

[GreyGull]

The normal SpO2 will depend on the patient and pre-existing disease processes which could include pulmonary, cardiac and neuromuscular.

SpO2 might be one goal for impaired airway clearance but probably not the best. This is where ventilation vs oxygenation may need to be differentiated. A person with secretions may be able to increase their SpO2 by increasing their minute ventilation or work of breathing but still retain secretions.

Discharged home or to another facility?

Is the impaired airway clearance due to a disease process? Acute or chronic or combination? These more factors to determine if your SpO2 goal is appropriate. Examples would be cystic fibrosis, bronchitis, bronchiectasis, COPD, asthma, one of the muscle weakening disorders, CVA, Spinal Cord Injury or PNA. Is the impaired secretion clearance from lack of muscle tone, paralysis, new infection, dehydration, environment, medication or therapies need adjusting? How close is the patient to getting a trach in order for the secretions to be cleared and the SpO2 to rise?

If you go with the SpO2, is it realistic for the medical condition? If the patient is recovering from an acute situation such as PNA, have the SpO2 and overall patient condition been improving to make this a realistic goal for discharge? It is not uncommon for us to discharge someone with a room air SpO2 of 90% if the patient is asymptomatic and the acute problem has improved and is expected to continue to improve.

[kubebe]

the impaired airway clearance is related to anaphylaxis, so i figured that maitaining an 02 sat would be an appropriate goal. is this an appropriate goal for me to set? my other goal is : pt will maintain a patent airway clearance. im just having a hard time with the first goal

[grandmawrinkle]

Well, if a patient with anaphylaxis was not making a sat above 90% at discharge barring any pre-existing pulmonary disease, patient was probably discharged to the morgue. Anaphylaxis is one of those things that if treated quickly, resolves completely. If you don't get to them fast enough, they die.

I would probably focus less on O2 sats and more on airway patency as evidenced by lack of stridor and difficulty breathing, absence of symptoms of angioedema etc. for your care plan.

[kubebe]

so what other goal would be appropriate for me to use for impaired airway clearance r/t anaphylaxis?

[ObtundedRN, BSN, RN]

so what other goal would be appropriate for me to use for impaired airway clearance r/t anaphylaxis?

I think grandmawrinkle just gave you some goals...

[Flying ICU RN]

so what other goal would be appropriate for me to use for impaired airway clearance r/t anaphylaxis?

Post #4 is the end of the story.