Respiratory Arrest Protocol?

Live and learn, right?

You need to follow (in order of priority) physician orders --> approved medical protocols/standing orders --> organizational policy & procedures. Based on the information provided, the patient's condition should have triggered a Rapid Response Team at the very least. If your patient's condition is changing, you have a duty to notify the physician. If you do not get an appropriate response, you need to go up the chain of command. Although RTs may be highly expert, do not ever assume that they have the authority to direct your actions.

From a physiological standpoint, the amount of time it takes for oxygen to decrease resp drive on a COPD patient is much longer than you think... it is not a consideration when the patient is in a crisis situation. You may want to take some time to review the multi-system impact of DM crises, systemic response to pH changes, etc. The value of ABGs in this situation? They would have provided insight into pH status. Also, FWIW, it is always a good idea to check BS on a DM patient who is experiencing any type of major change.

You'll do much better next time.

Agree with the above, but wanted to note that many, many, many, MANY hospitals do NOT have rapid response teams. The primary nurse is it. RR is often taken for granted on this forum, but it simply doesn't apply in many institutions.

As always, thank you HouTx, and yes VANurse we do not have a RR team.

The physician's comments do make me wonder if the protocol / standing orders include an ABG (which they should) so he didn't feel he had to additionally order it. You need to know this -- ask a charge nurse, unit educator, or a nurse who precepted you ASAP.

And as an acute care nurse, please, PLEASE forget whatever bunk you may have learned in school about "too much O2" for COPDers. If a patient is in distress -- they need O2. Nothing good comes from hypoxia. And the SpO2 does not tell the whole story -- even without an ABG, what did the patient look like? Respiratory rate/effort, color, etc. These things can indicate the need for further respiratory interventions just as much as/more than an SpO2 number.

It also sounds like the hyperglycemia was not being treated aggressively enough. If the "initial" blood sugar had been 900, is there a reason an insulin gtt was not started?

When you have some free time -- do a simple search for "nursing myths" or "nursing sacred cows". The COPD/O2 myth will come up and you can get some direction for some further reading on the topic.

Even if you don't have a RRT or a standing order for ABGs, you can be the one to initiate the order for ABGs. Especially if your pt is having continuing respiratory issues, you would want to know if it's an acid/base problem. And if you find your COPD patient to have a decreased level of consciousness, your first thought should always be respiratory acidosis and you'd need to check an ABG to confirm.

Sometimes you have to drive the boat, you know?

Altra, yes the patient was a an insulin gtt when she was first diagnosed at the hospital, by the time she was admitted to the specialty hospital where I work she was no longer on the gtt. Thank you for the topic suggestions, I will look them up. :)

thank you GoBlueGirl15 :)