Pulse oximetry in health office?

mustlovepoodles, RN · Dec 14, 2012

I have a small battery operated pulse oximeter in my office. I don't use it on everyone, but if one of my asthma kids comes in c/o coughing, chest pain, SOB, etc, the first thing I do is put the pulse ox on their finger and assess breath sounds. Then I give them a treatment, regardless of whether the pulse ox is low or not. If they say they're having trouble breathing, they get a treatment. If the pulse ox is less than 94% I usually will give a parent a call, just to let them know I gave their kid a treatment. We don't have a specific protocol for the pulse ox, but I hear it's in the works. For now, we use our nursing judgement. Once in a while I've had a kid come in at 90%. If the breathing treatment doens't resolve it, I send them home or to the ER.

Flare, ASN, BSN · Dec 14, 2012

i had one in my last office -just one of the small inexpensive ones you can get from macgill or school health. i would still rely more heavily on student report of SOB and auscultation of lungs, but it was a good tool to be able to see where things stood. Have to get one for this office -will put in for it with new budget.

allnurses Guide · Dec 14, 2012

I have one simply because I'm a hospice nurse as well and carry my nurse bag in my car.

As a nurse, I'm not going to completely rely on the pulse ox number . . . . a kid came in a month ago with exercise-induced asthma attack (he has regular asthma - it just gets worse on really hot or really cold days out on the playground). He was bent over, shaking, and his O2 Sat was 96%. This is the kid whose mom won't get a rescue inhaler - the one I've sent once to the ER via an aunt who showed up when we couldn't find the mom and then this last I drove him there (it's a mile from the school).

An example as a hospice nurse - one of my patients is one of those little old men who have smoked since they were 6 years old who now has COPD and CHF and still smokes like a chimney. He was smoking when I got there on my first visit and I did his vitals when he finished - 02 Sat 96% on room air.

I like having access to my vital sign equipment. The thermometer at the school is worthless.

misty_dawn · Dec 14, 2012

I am having difficulty finding any clinical guidelines on pulse oximetry in schools based on EBP. Any ideas where some can be found? What are your school policies regarding this?

NutmeggeRN, BSN · Dec 15, 2012

Not sure about published EBP in school, maybe check with local hosp to see what their protocols are. I use mine as one tool in the assessment box....a piece of the puzzle. It is quite effective in reassuring a kid who feels they cannot breathe that in fact they ARE getting air (obviously along with observation/auscultation/hx)....AND it shows when a kid who may be exagerating their resp status to be more dire than it really is.....

sfajctxnurse · Dec 19, 2012

I have a small pulse oximeter in my office. I usually only use it on my asthma kids.

mclavers · Dec 28, 2012

Yes I have one and I do use it

pbuttercups · Dec 28, 2012

I do use mine in a school for someone I assess regularly who has a trach. It's just part of my assessment with breath sounds. So I guess it just depends on who your patients are and what their background & medical needs are.

mtgirl81 · Jan 2, 2013

I use a pulse ox in my offices. Typically to gauge where my asthmatic patients are and to ensure that they are safe to be at school. Each time I use it, I check my results against what is "normal" for that kid. I have one asthmatic who has a pretty severe case, and a 95-96% for him is pretty good. That and it's good for this particular kid who "fudges" his incentive spirometer. It all just depends on the kiddos that your working with.

100kids, BSN, RN · Jan 7, 2013

I don't have one in my office but I think I would like to add one next year. This would be helpful for some of my asthmatics. thanks for the responses.

Home Health Columnist / Guide · Jan 10, 2013

Found at NASN School Nurse

September 2012 vol. 27 no. 5 256-258

Implementing Pulse Oximetry in the School Health Office

The Time Is Now

Marie C. DeSisto, RN, MSN, NCSN

Director of Nurses, Waltham Public Schools, Waltham, MA

Abstract
Pulse oximetry can be a useful tool for professional school nurses who daily assess students with a variety of health issues and injuries. Pulse oximeters are now smaller and more affordable and, therefore, an option for school districts to purchase. Before implementing this new tool into their practice, school nurses must have an understanding of how pulse oximeters work and how they measure the oxygen saturation of arterial hemoglobin. A review of the literature will guide a nurse in developing clinical guidelines for practice and facilitating competency in using a pulse oximeter with the ultimate goal of improving student health assessments.