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supplemental O2???

sweetieann sweetieann (Member)

I have a patient who has an order to "titrate O2 to keep sats >92%." She is NOT on continuous pulse ox (this is a psych setting). We are ordered to check her pulse Ox 2 times/shift or if she c/o of SOB. She tends to sat 96-98% during the day on RA and drop off a bit at night (from what I've seen). So, as of 11 pm yeserday eve, she was 98% RA. I came on during night shift. I checked her at 2am and she was 88%, so I applied 2L NC and she came up to 98%. My question is--since she isn't on continous Pox monitoring and since we are checking 2x/shift, isn't there a possibility (probably illustrated by what I said above) where she is below 92% for a few hours before we go back and check her and realize this and THEN apply the O2? She was ok at 11pm, then dropped at 2am--so that's 4 hours she might have been below 92, but what can you do, go in and wake her and check every other minute so see when exactly she drops off? A big piece of this, I guess, is that she isn't SOB or symptomatic. Does this all sound ok? Obviously, if she woke up complaining of SOB, I'd check and apply O2, so I guess that's the point of their order.

Thanks for any thoughts!

czyja, MSN, RN

Specializes in Critical Care, Progressive Care.

If you know she de-sats when she sleeps why not just start the O2 2L NC before she sleeps?

this is the first day I noticed this (thefirst day she was ordered this) so maybe now they will just put it on her at night. It would make sense =)

sharlynn

Specializes in ICU, CCU,Wound Care,LTC, Hospice, MDS. Has 43 years experience.

Does she have sleep apnea? Just went thru this with my husband. When he finally decided to believe me and got tested, he was dropping to 64%!

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

Document your findings and leave a note for the doctor. Maybe she needs a sleep study.

Babs0512

Specializes in Med surg, Critical Care, LTC. Has 20 years experience.

I agree with the other posters, place patient on o2 for sleep, all of us desaturated to some degree while sleeping, 88% is usually quite acceptable while sleeping - however, if no history of lung problems - may have sleep apnea, and a sleep study is a good idea. Pulmonary function tests might be suggested as well.

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

It's likely that she's been doing this for a while. While I would certainly not be doing backflips over this, I would definitely communicate your observations to the doctor, since sleep apnea increases the risk of heart disease.

DDRN4me

Specializes in pedi, pedi psych,dd, school ,home health.

can you do prn spot checks say 1 hr past when she falls asleep to see if it is positional or every night? maybe something as simple as raising the HOB...jmho

S1XGUNS

Specializes in MS, ER.

88% probably easily fixed by simply raising HOB or sleeping with 2 pillows.

that's what I suggested...she is on 2 pillows right now but she also has some positional pain in her legs from edema (alot of eating disorder patients get refeeding edema) and she wears SCDs and everything is positioned just so for her comfort, so hard to elevate her anymore. Thanks for the reply!

88% isn't really all that bad for sleeping. For asthma kids in the hospital, we actually allow for transient episodes in the high 80s. And we keep them off continuous pulse ox because otherwise people panic about transient minor desats. And 88% is very minor. Just putting the nasal cannula on was probably enough to wake her enough to bring up her sats, even without turning on the O2 through it.

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