Nursing Reflection

(2012) states that when oxygen is administered in a timely and appropriate manner it is fundamental to quality patient care. Current research states that critically ill patients should receive supplemental oxygen for the prevention or treatment of hypoxaemia, and failure to correctly administer oxygen places a patient at risk of hypoxaemia, respiratory dysfunction and eventual death. Although research has proven that hyperoxia can be detrimental to patients, due to the reduction of tissue oxygen delivery through hypoxic pulmonary vasoconstriction, absorption atelectasis and generation of oxygen free radicals (Eastwood et al.,

The nurse found Mrs Smith to be tachypnoeic, her respirations were recorded as 24 breaths per minute it was observed as being fast and it appeared that her accessory muscles were being used. Mrs Smith’s pallor also appeared flushed and her saturations were documented as 93%. The nurse used the stethoscope to check for wheeze the patient’s lungs were clear and chest rise was symmetrical. Mrs Smith was commenced on 100% oxygen through a non-rebreathe mask, oxygen as an intervention is necessary as Creed & Spiers (2010) highlight ‘metabolic demand for oxygen throughout the body is hugely increased by sepsis and is essential to ensure the supply of oxygen is maximized’ .The nurse monitored the patient closely because in her confused state the patient may try to remove the oxygen mask.

There was additional backup staff present (including a respiratory therapist) that could have been called upon for help, yet they never were. The charge nurse or nurse supervisor could have stepped in at this point to provide additional help. A lack of present nursing staff and support can lead to unfavorable patient outcomes, as is the case with Mr. B. Additionally, the staff on duty could have lacked training regarding protocols or their training could have been out of date.

This week, I was given the opportunity to care for two female patients – 205(1) and (2). The first patient, 205-1, was admitted with respiratory distress and had a past medical history of hypertension, schizophrenia and bipolar disorder. She was initially put on 2 L/min of oxygen and placed on oxygen titration protocol with orders to maintain O2 saturations between 88-92%. The patient was oriented to person and place, but had difficulty with time. She was also obese (BMI 30) and deemed a moderate assist with ambulation. Her care plan included total assistance with ADLs, smoking cessation and oxygen protocols, limited salt intake (3mg), and chronic pain management. The second patient, 205-2, was admitted with a right pelvic fracture and had

Additionally, the care environment developed a hazard when the patient population increased both in number and acuity with the admission of the acute respiratory distress patient and increasing patient load in the lobby without note of available back up staff being called in. Examples of errors from the flow chart comparison might include failure to assess and monitor when Nurse J initiates blood pressure and SpO2 measurements, fails to initiate ECG with respiration monitoring, fails to administer supplemental O2, and leaves the room without apparently noting the baseline of the patient2. Furthermore, there appears to be an error in the lack of communication collaboration between the RN and LPN regarding Mr. B’s post procedure status and monitoring needs, and there is a failure to rescue when the LPN notes the low SpO2 value, fails to respond, and instead re-initiates another blood pressure reading without noting the results. As Mr. B’s condition deteriorates and a code is called, an ACLS error is observed in the timeline when the patient is noted first to have absent pulse and respirations and that a monitor is next applied and the patient and displays ventricular fibrillation. Chest compressions appear to not have been the first action in this scenario, nor is end tidal CO2 monitoring noted as initiated to monitor the quality of compressions. These are examples of hazards and errors in the care of Mr. B and in an actual RCA the level of detail would likely turn up

According to FindLaw (2008), Ellen H. Finnerty, a registered nurse is requesting the Board of Nursing in Texas to set aside the judgment where she was disciplined for gross negligence and incompetence. The board’s decision came after an incident where Finnerty chose not to comply with a physician’s order to intubate a patient before said patient was transferred to the ICU. In August 2002, Finnerty was working at Huntington Memorial Hospital as a charge nurse. A nurse (A. Magi) that was caring for patient(J.C.) begin to display symptoms of respiratory distress, such as rapid and labored respirations of 40 and an oxygen saturation of only 70%. With the assistance of a respiratory therapist, the patient was suctioned and Nurse Magi received orders from the primary care physician for 100% oxygen via a nonrebreather mask with the oxygen saturation to be maintained above 94%, several different blood test, for the administration of a diuretic. After the orders were performed and the patient was continually monitored, there were no changes to the respiratory rate. Another call was placed to the PCP, there was an order given for the patient to be transferred to the ICU and stat intubation. These orders were relayed to Finnerty, who then assessed the patient, but did not disclose her findings with the medical staff. Lab results indicated that insuffient blood oxygenation and acidosis. The

During the pre-briefing, the group collectively discussed the patient’s history, presenting issues and other influences to the patient's care. As well, during this time, the group worked to identify role expectations, protocols, timelines and other presenting issues that would require consideration, including impaired circulation/post-op bleeding, mental status or hypoxemia. Decision-making in this aspect was based on the determined role and intended learning outcomes.

“Put her on 6 liters of oxygen,” I answered more confidently. As I reassessed my patient, I noticed she was breathing easier. Her oxygen saturation was now 98%. I checked her fingernail beds and lips, and the blue tinge I had noticed earlier had disappeared. I lifted her hands slightly to show the medic. He gave me a thumbs up.

I identified priorities in my patient assignments when one of my patients became unstable. I had a patient whose pulse oximetry was reading in the 80% with 6 L of oxygen. At that time, that patient was my main priority. I quickly got my preceptor, and informed her of the situation. She informed the physician and I implemented the order to give the patient IV Lasix to diuresis the fluid out of the patient’s lungs so he could breathe better. We ended up calling a code and we moved him to the ICU where he could be constantly observed.

In April 2012, Mr. Hammett’s death was ruled to be human errors that individually would have been unlikely to harm him but proved collectively to be fatal. Mr. Hammett surgery was at at private hospital that did not have any after hours medical cover. During the procedure his oxygen saturation levels were almost perfect, maintaining it at 99%. Somehow during or after being transferred to Post Anaesthetic Care Unit (PACU) his oxygen saturation levels fell to 64%. The anaesthetist assumed that it was caused by an obstructed airway and discharged the patient to the ward; he did not look for anything further to be wrong with the patient. Mr. Hammett complained continously to the RN of high levels of pain; the RN ignored him and referred to him as a “wimp” when switching shifts. Although Mr. Hammett was on a Gemstar pump, which recorded him pressing

COPD, pneumonia, asthma ,dysplasia or immature lungs in infants,heart disappointment,cystic fibrosis,lung disease, injury to the respiratory framework. To figure out if a patient will profit by oxygen treatment, specialists will test the measure of oxygen in his or her blood. Low levels imply that a man might be a decent contender for supplemental oxygen.

On august 13, 2016 I was assigned to follow one of the ICU Nurse. It was a very calm day. She had two patient one was more critical than the other. Both patients were on the ventilator because they had to be intubated the night before. The lady is obese and had gastric bypass surgery two years ago and suffering from severe sleep apnea, but the patient is non-compliance to the CPAP treatment. That was her second time being intubated. She was admitted for seizure monitoring because she was constantly having seizures the day before while she was at home. Due to the fact that she did not want to wear her CPAP machine while in the hospital, after pain medication was administered she was found unresponsive, that was the reason for her intubation the night before. Patient was on intermittent suctioning, she has sinus tachycardia . I had the opportunity to observe some of her daily care. The patient was on fentanyl but when the Dr. try to wean her out of the ventilator she stop breathing, therefore, the DR. discontinue the fentanyl temporarily in other to retest her later.

The primary nursing diagnosis for this patient is impaired gas exchange, related to abnormal ventilation and perfusion ratio, as evidenced by restlessness, irritability, anxiety, decreased level of consciousness, abnormal arterial blood gases, and abnormal skin color (Gulanick & Myers, 2014, p. 82). A.C. has an endotracheal tube (ETT), and there is a note for the next day to have surgery to put in a tracheostomy. She is currently a smoker, her C02 is 74.6mEq/L which is high, her pH is low at 7.19, and the bicarbonate is 28.6mEq/L which is high. Her oxygen saturation is maintaining at 90%. Her PA02 is 56mm Hg and FI02 is 0.60. The patient is very anxious and restless in the bed, despite sedation and pain medication, and her skin is pale in color and she is diaphoretic.

The record does not document any nurse-initiated interventions or call to the doctor requesting a chest x-ray or recommending a respiratory therapy consult for breathing treatment and incentive spirometer. On post-op day two Ms. C’s respiratory status declined requiring a non-rebreather mask, rapid response team consult, and a transfer to the intensive care unit for a diagnosis of respiratory distress (p. 392).

To prepare for surgery, we first made sure all of the consent forms were signed appropriately and placed in the patient’s chart. My preceptor and I obtained blood work from Mr. R, so the lab work would be as current as possible before the CABG. There were pre-operative medications that had to be given before the patient could be brought to the operating room. The patient had been on a heparin drip based on his weight the past 24 hours, to thin his blood. The morning of the surgery Mr. R was given mopirocin 2% ointment that went in his nostrils, as well as famotidine and vancomycin. He was not given the usual antibiotic, amoxicillin, due to his allergy to penicillin. Oxygen via nasal cannula was applied at 2 L to Mr. R. Right before the patient went down to have the surgery, we bathed him in chlorhexidine gluconate (CHG) to disinfect his skin, to reduce the risk of a surgical site