dolphinmonkey

The high flow O2 was administered for no more than 2 minutes.

I was caring for a patient with COPD, who was normally on long term oxygen therapy (low flow) at home. I was on the night shift and during the day she had become unwell, increased respiratory rate, increased O2 requirement. She had been settled but then began to c/o breathlessness, her oxygen sats were 65%. I have been trained that when a patient's O2 saturations are that low, you should administer 15L 02 via a non rebreathe mask until sats within target range. I have been told during training sessions that this also applies to COPD patients. Normally I hesitate in giving O2 to these patients and will try different positions/deep breathing/nebuliser if say, their sats are 80-84% (most COPD patients have target range 88-92%). However as this patient was unwell and sats so low, I applied non rebreathe mask 15L-sats quickly increased and I titrated O2 down however patient clearly became increasingly unwell. Blood gas showed increased c02 - patient had type 2 respiratory failure caused by high flow oxygen. Do you think this was a poor judgement and I should have slowly increased O2 with venturi? Would you ever apply high flow O2 to a COPD patient?

The thing is I did check the stopcock during my shift and it was in the correct position, it was during the day shift morning that they found it knocked BUT as you say it should be checked at the end of the shift and I didn't check at handover to next shift. My issue as well is that they stated that was the reason it hadn't drained but that was incorrect because it wasn't draining at any time after the first few hours post procedure. But I'm just rambling on, you are right I should have checked it at regular intervals with the other observations and documented, thank you for your reply.

I work on an acute medical elderly care ward, several weeks ago I came onto a night shift and one of my patients, who had been with us for several weeks, had had a chest drain inserted that day due to a pleural effusion. At handover there was 400ml in the canister, it was not swinging or bubbling. I checked the drain with the day nurse; the 3 way tap was open, there was fluid in the tubing and we went over the care plan. By 11pm, the drain had not drained any further fluid and was still not swinging/bubbling. I informed the nurse in charge who advised me to finish the routine work and then deal with issue (patient was saturating on room air, no breathlessness). I discussed with a nurse on a respiratory ward (we do not normally care for surgical patients or chest drains) they advised it can be normal for the chest drain to stop swinging/draining and that action may be to flush the drain. I discussed with FY1 on call (junior doctor), they advised that they would not take action overnight and to continue to monitor. Also discussed with the critical response nurse who advised the same. I continued the obs on the drain (not swinging/bubbling or draining) and the patient stayed saturating on room air/no breathlessness throughout night. Handed over to day team. When I came back the next night, the day team stated at the board handover that the chest drain had not drained anything overnight as it had been CLAMPED closed. The other nurses at the board were saying how terrible and dangerous that was. When i took the bedside handover, tbe nurse informed me that the matron had come to check the drain during the day shift and the 3 way tap was at a 30 degree tilt from the open position, as though it had been knocked. However, with tap in position, there had been no further fluid drained from the original 400ml and the drain was still not swinging/bubbling. I had not checked the 3 way tap that morning before handing over however I feel it is very unfair for the nurse to have stated that it had been closed and that's why it wasn't draining. The repeat xray showed that the effusion had been drained and then the drain was removed. I know the most important thing is that no harm came to the patient, however I feel very anxious at work yhat my colleagues see me as someone dangerous and incompetent that would not pick up on something like that. Would you feel this way about a colleague in this situation? The senior nurse approached me to ask what I had done about the drain not draining the previous night, I told him and he advised I should have escalated to the registrar (senior doctor) to review. He stated I had not done anything wrong but I feel he said this because he could see I was worried as I later heard him talking to the ward sister about it being 'clamped' overnight and them both shaking their heads/shocked at how terrible that was.

I am concerned about my abilities as a nurse due to an incident at my former work place over a year ago and was hoping for your opinions. I came on shift and noted a patient I had cared for 2 days before (I had been off for 2 days), who at that time had been independent with a frame and talkative was lying in bed with her mouth wide open and looked terrible. During handover I discussed with the other nurse how poorly she looked. The nurse stated that the night before last (over 24hours ago) she had vomited twice and since then had been unable to walk or eat/drink. She had been reviewed by a doctor since that time and it seemed no clear cause had been noted. That morning we were short staffed and I had several other patients with issues that I prioritised. The ward round was also late that morning, meaning the patient was not reviewed until nearly 11am. At this time the registrar approached me and said how long has the patient been with left sided weakness, he stated the patient had had a stroke. I informed of what the overnight/weekend nurses had informed me. I informed the ward sister that the patient had had a stroke. However this patient did not go down for an urgent CT scan. She was not scanned until later in the shift. She was also not transferred to a stroke unit until that evening. Looking back I cannot understand why it was not made more urgent immediately the time. I am concerned that the reg would have taken my repeat of the weekend staff's account as well it will be too late to treat. But surely the doctors who reviewed on the weekend would have picked up on a stroke? The stroke reg who reviewed in the evening was angry that the dayteam had not made the scan more urgent. Of course looking back I would have highlighted I was concerned about my patient at the beginning of the shift and bleeped the reg. However at the time I told myself well this is ongoing since over the weekend and I waited for the ward round, and prioritised other patients. Do you think this shows a basic lack of judgement as a nurse? At the time I had been qualified for 1 year.