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?

I have no idea if he was a COPD patient or not, as he was not my patient and I didn't even know his name. I really wish we could have gone back the next week so I could have seen how he was doing, but we transitioned to a different floor. I did receive an RN to follow this time, as well as my instructor stuck around instead of leaving the floor, but I am all ready to report every unusual finding immediately from now on, and willing to go find people if they aren't around. Thank you all for your help!

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Anytime you have anything abnormal - If you know who the patient's nurse is, tell the nurse immediately. If you don't, find your instructor and tell him/her immediately.

It worries me that you didn't find someone to tell these results to immediately, especially when you say, "this device has always been reasonable," but felt like you didn't need to share the results with anyone immediately. A result like that, if the patient didn't appear in distress, I would have thought it was the machine. But, if you know the machine has been working well, then you know it's probably not that. So, you need to figure out what else is going on. Fully assess the patient, LOC, BP, respirations, breath sounds, color, capillary refill, etc.

I'm assuming the patient wasn't hooked up to oxygen - if so, that O2 sat worries me WAAAY more! - but was the patient ordered oxygen as needed? If so, I would have put O2 on the patient.

You said the patient wasn't your patient - If you get an abnormal vital sign, like a low O2 sat, after assessing the patient and seeing that the patient appears normal, is breathing well, is not cyanotic, etc., - if another student is assigned that patient, you could go to that student and say hey, the patient's VS were x, y, z, is that normal for the patient? But again, with an O2 sat like that, after taking it again and getting the same result, I would take all the vital signs, assess the patient, and even if everything seemed okay, you need to tell the instructor and the patient's nurse. You are only a student.

One note - Whenever I would be assessing a patient and he/she had a low O2 sat but seemed fine, I would try again on the other hand, then I would ask the patient to sit up and take a few deep breaths for me, after that I would try again.

The other questions you talked about - about the meds - bring it up to your instructor. He/she will be happy to hear that you noticed that and thought about how the med would interact with your patient's diet.

The question regarding Namenda - Have you looked up Namenda in your nursing drug book? Whenever giving patients meds you should always look them up, see their action, their intended use, therapeutic actions, side effects, etc. What web page said that Namenda was not given for dementia? No - it does not slow or stop it. But it does improve symptoms. Namenda is an anti-Alzheimer's agent. Its action is antagonist of CNS NMDA receptors that may contribute to the symptoms of Alzheimer's disease. It is given for moderate to severe dementia in Alzheimer's patients. Therapeutic outcomes of Namenda include improved mood, orientation, and decreasing confusion.

The site's prescribing information pamphlet states, "Namenda is indicated for the treatment of moderate to severe dementia of the Alzheimer's type." "There is no evidence that Namenda prevents or slows neurodegeneration in patients with Alzheimer's disease." "Namenda was shown to improve both cognitive function and day to day function."

Namenda (memantine HCl) – Taking Namenda

http://www.allergan.com/assets/pdf/namenda_pi

In the end, anytime you have a question - ALWAYS ask your instructor. That's what he/she is there for. It's always better to ask then to not ask at all and for something to happen. If it is something about a med (e.g., a med interacts with grapefruit juice, which your patient wants to have), always ask before giving the med. If it is a question about an abnormal vital sign - IMMEDIATELY find the patient's nurse to tell him/her. If you don't know the nurse or can't find the nurse - find your instructor. ALWAYS, ALWAYS, ALWAYS tell someone immediately. Don't worry that there's a party going on or worry about bothering someone. It might end up being nothing, but you definitely don't want it to end up being something and you sat on it until there was a "good time."

Good luck!!

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Specializes in Crit Care; EOL; Pain/Symptom; Gero.

Namenda also is neuro-protective; not strictly for dementia. This individual may have been part of a geropsych registry and was being observed for neurological progress/lack of progress while on Namenda.

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Specializes in Cardicac Neuro Telemetry.

I'm not sure what is so complicated about this situation. You see an abnormal vital sign, you report it to the LVN or RN. Don't tell the CNA or the secretary or the janitor. TELL THE NURSE. He or she will be able to do something about it. Why were you doing this alone? At my hospital, a nursing student must be accompanied by a PCT when taking vital signs.

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I would have felt much more comfortable if I had been accompanied or if someone was near by. I didn't expect to be left alone my second time in a hospital, but my clinical instructor was up a floor grading our care plans, and I have no idea where the rn was. I should have gone to ask the CNAs where to find the rn or LPNs though.

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Thank you for explaining about the Namenda. I can see now why you might want to give it a try even though dementia would still progress. I did talk to my instructor about all the issues after, as well as other various nurses as I kind of like to get different people's takes on subjects. Thank you for your detailed and helpful reply!

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Specializes in SICU,CTICU,PACU.

just my 2 cents. i wouldn't get so caught up with meds like nameda being appropriate for the pt. maybe you could discuss that in post conference as it is not critical info. on the other hand certain meds are serious like beta blockers and you would not give that to this man with a heart rate of 48. also heart rate of 48 may also be ok for some patients (although i would have told someone immediately). the real problem is the o2 sat in the 60s, if true this is an emergency and needs to be addressed immediately. i don't care who is on break/party/etc. you need to get help right away. being new and a student it can be hard to prioritize critical info like an o2 saturation 91% not such a big deal could be the patients norm etc but no one has an o2 sat in the 60s. even if it was your machine and it was an error always better to be safe and let someone know about it.

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