SNF scenario question

Nurses General Nursing


Hello all, just wanted opinions from experienced nurses. I've been an RN for about two years and have only worked in SNF so I don't have a lot to draw on. A scenario I've faced several times..COPD pt on 02 3 L NC who was calling for help had 02 sat of 79. I have been taught I can increase 02 place non rebreather to get 02 up while I call dr to wait orders/send pt out to hospital..among other standard interventions (elevate hob, tripod position etc). I also bumped him up then reduced 02 again did not leave him on high. I got into kind of an argument with another nurse who doesn't work in my facility over what I did. Like I'm going to kill him..I understand how copd works with the respiratory drive and all that but I don't have rapid response to use or to get help for them it's just me. Am I wrong?

Specializes in Critical Care.

The carbon dioxide vs oxygen driven in COPD patients is a bit understood, but in general you aren't going to harm a patient by giving them more supplemental oxygen because their oxygen saturation is 79%.

However the next step is not to send them to the ER, the next step is to address the symptoms of COPD that are likely resulting in a sat of 79%, namely bronchoconstriction, what would be your first assessment and based on that, intervention in this scenario?

Prn duoneb treatment was also give, in addition to repositioning, instructing pt on breathing, then switching to non rebreather. Sats would come up (88/89%) then tank again after I turned him back down. I sent him out per dr orders. I guess I'm just questioning myself if I have been doing the right thing as this is my usual course of action for my copd patients

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