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Discussion

SNF scenario question

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?

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    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?

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    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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