What should I have done about super low O2 levels?

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So wondering what I should have done. I was at my 3rd clinical, first semester nursing in a long term care unit. I was told to go practice taking vitals. Not too many nurses or clients were around because they were at a Halloween party. I tried taking radial pulse and O2 levels on a nonverbal man, and they were both very low. Radial pulse of 48, and his finger said it had 69% O2. I couldn't believe it (and this device has always been reasonable) so took it again on another finger and it was similar. No nurse or instructor in sight to tell. His hands were very cold. I wondered if he had peripheral vascular disease and this was normal for him, and not maybe a big deal? When I saw my instructor at post conference I told him, and he seemed to think it was unbelievable, and must be my device. He added that I should take it on an ear lobe next time, and said that pulse can vary and I should have checked what it was normally (but he wasn't my patient and I didn't know his name or room number to check). When I asked my anatomy professor later that day since we were talking about a cadaver who had terrible circulation, she seemed to think I should have immediately notified some one who worked there. What would you have done?

Specializes in SICU, trauma, neuro.

Nope, don't approach anyone in the lunch room. It's not HIPAA compliant, PLUS staff is off the clock during lunch.

I wouldn't notify the CNAs at all though -- assessment findings need to be reported to a licensed nurse. The LPN is fine if s/he's the one taking care of the resident (s/he can then notify the RN if the issue needs to be investigated further), but if you see the charge nurse first that's fine too.

They were probably all tied up at that moment. The floor is NEVER going to be unattended.

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Sorry, I wasn't too clear about it, maybe using the wrong terminology. They weren't all at their lunch breaks, they were throwing a Halloween party for the residents in the resident's dining room. The CNAs were in there (and maybe one of the LPNs? But the charge nurse was not. And the man was still in the hallway by the nurses station with no one around except me and the other student.

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I have questions about reporting other things too, like that my patient was given grapefruit juice for breakfast but that interacts with her buSPIRone she gets daily. She is prescribed Namenda even though it says right on their front web page that it doesn't slow or stop dementia (which is what it was given for). Her aide smelled like alcohol when she came back from break, and not rubbing alcohol. And then the small stage 1 pressure sores (my first time seeing any, so maybe I'm wrong?) Anyway my impression is that I should tell my instructor first and get his input and then he would convey that to the facility if he thought it was worthwhile. We don't have anyone we are working with or under at the facility. I did see an LPN pass needs to my patient, so I guess I could have told her once she was done passing meds? The notes that I write don't get passed on to them.

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Specializes in Neuroscience.

You need to review "normal" VS. What is the normal for respiration, pO2, HR, and temp. As one poster said earlier, if the VS are off, you look at your patient. We might not get excited about a pO2 of 88 in a patient with COPD (think through why or look it up), but the O2 reading you reported might need interventions. It may be a false reading, but I would rather show you how to better get a reading than for you to not inform me. You should have looked at your patient. Was he cold, gray, lips a tinge of blue? Assess his glasgow next. Can he answer questions appropriately, is able to follow commands?

Finally, you are a student. You are not a nurse and you should have notified your nurse immediately. The party would never be a reason you could give to a judge, jury, family member, or loved one. "Sorry the patient decompensated and his brain wasn't being oxygenated. If only that party hadn't been going on, then we could've have intervened."

It's good that you are asking questions to determine what could have been done instead, but if you are the only one who knows something and you are not in a position to do anything about it (and you are not), then you have to let other people know. They can't read your mind, and they expect students to be overly vigilant about perfect VS.

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Heres how I would have handled it, with the vs you reported (did you get a BP?) You find the closest nurse, if you cant find them then use the phone and have the nurse paged to the floor or your clinical instructor (whoever you're more comfortable with so someone with experience can assess the patient) 9 times out of 10, they'll say "Oh, he's always bradycardic and his o2 sat is always out of whack, but they could have explained to you exactly why it was or wasnt something to be concerned about. At this stage, and no iffense intended you don't have enough under time under your belt to say he is or isnt fine. I'll tell you a story about when I was a new grad. I was to discharge a patient who had been hospitalized overnight following a routine test with sedation. I had the discharge orders and as it was vital sign time decided to do her vitals purely for charting, my preceptor had left the floor, when I listened to her heart rate it was 28bpm. Her color was great, aox3, no lightheadness, dizziness, or cardiac symptoms. So what to do. I told her I'd be back in a minute and went for her chart, we didnt have cows, just computers at the nursing station. Anyway, right there bold as brass in medical history: bradycardia, so that got my new grad brain in a conundrum, doc says she's ok to dc, has hx of bradycardia, but 28 is very very low. So without my preceptor I had to make a decision, dc her or what...? I decided to notify the doctor, and be cause she had the brady in her hx and had been deemed ok to go home I fully expected on callback to get told "why are you bothering me with this? we know she has bradycardia", while waiting for doc to callback I trended her vs, her hr had started in low 50's and progressively gotten lower and lower. when doc called back he ordered immediate EKG and cardiac consult. When we got the ekg back she was in a junctional rhythm (basically her heart would have just gotten slower and slower until she dropped dead). After EKG they ordered a zoll at bedsise and she was scheduled for emergency pacemaker. When my preceptor got back she was surprised at all that had happened. I'm not telling this to make myself look great but as an example that a patients condition can change literally in a heartbeat, if that patient had been discharged who knows what would have happened. I struggled with the two "rights" in my head, the patient is fine, looks fine, feels fine, but she has a wildly abnormal VS. So always find someone, if they're in the dining room go in there and whisper in their ear and say this patient doesnt look right or his vs are abnormal, could you please come assess? you dont have to mention a name but at least you have done something... Remember what your training tells you-abnormal vs are abnormal, the worst that can happen is someone says hes always like that, or whatever, but if something is truly going on with the patient, even if he wasnt assigned to you, your notifying means its been caught that much sooner. Honestly, I think you should bring this up in class (not clinicals) and have your professor have a class discussion. I bet some of yoyr classmates have been in the same situation.

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In any instance like that notify your clinical instructor or the Nurse immediately. I mean its okay (for now) now that you know, you wont let that happen again, right? so its a lesson. like the previous person said :

"Often nursing students notice little things that busy nurses miss and can help prevent a bad outcome." tis true :)

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that low of an o2 sat is very serious and next time run to the nearest nurse. o2 sat should be above 92, 90 i would be watching really closely and getting ready to put on oxygen via nc. your pt was o2 was dangerously low. don't wait till you see some one later on, instantly run to someone. its always better to be safe then sorry. you are saving lives don't worry about what someone think of you

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Specializes in OR, Nursing Professional Development.
that low of an o2 sat is very serious and next time run to the nearest nurse. o2 sat should be above 92, 90 i would be watching really closely and getting ready to put on oxygen via nc. your pt was o2 was dangerously low. don't wait till you see some one later on, instantly run to someone. its always better to be safe then sorry. you are saving lives don't worry about what someone think of you

Very much not true for all patients. There are many COPDers who will routinely function at O2 sats as low as 85%. That is their norm and trying to fix it will not work.

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trying to fix it (copd pt) by putting them on O2 is a good way to ensure respiratory arrest.

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trying to fix it (copd pt) by putting them on O2 is a good way to ensure respiratory arrest.

i am pretty sure that's a myth.

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its a good read about the subject and explains why we aim for the 88-92% sats in copd patients

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,,,,,,,,,,,,

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yes you are right about the copds pt. i missed where she had said it was a COPD patient. but as a student in their first semester which she is have some one who's O2 sat is in their 60s I will go get a someone. As an experienced rn like your self you wont have to go get anyone but us students we are still learning and we are told to report any abnormal vitals on the pt. and allow our CI or the patients main nurse decide if the vitals are acceptable or not.

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