One aspect I have found extremely frustrating and have had difficulty in getting answers about is oxygen therapy during ambulation. Despite us being taught to check the charts and that O2 is a drug and will (I don't think so!!) be charted it rarely is. Not only is is not charted, the patients status can change quite rapidly post surgery and the nursing notes do not often reveal the level of O2 therapy the patient is on during any particular shift. So I can have a client who yesterday was 98% on 2L O2 via NP during ambulation and when I next see him he is SOOB and hasn't had O2 on all morning and is 98% on room air. Do I walk him on O2 or not?
Take for example two of my current patients - at rest both have SpO2 98% on room air and both desaturate with ambulation however
Patient A drops to about 92% and then stabilises no further intervention/O2 therapy required but
Patient B drops to about 92 %, but if he stops walking rises to 94% if he sits he immediately returns to 98% but if I allow him to continue walking he continues to desaturate (we have reached 77%) and I have had to bump up the O2 to 6L via Hudson mask for him to stabilise at 92%.
When I have asked for help in trying to decide if/when I need to use O2 during ambulation and more importantly when it is safe to try without O2 the only answers I get seem to imply that it is all about clinical judgement- something that comes with experience. Lets hope this develops quickly in these situation which seem a little too much like trial and error!
What I have learnt or had reinforced during these 4 weeks
that I am quite conservative in nature (and I don't always trust oximeters)
to be prepared to back my own clinical judgement ( I think I might be developing some!)
and to keep asking for advice again and again and again until you get what you need.
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Hi snaggers, I have had similar experience and what I learnt from my cardio placement was that patient's safety always comes first and different supervisors have different approaches. I had 3 supervisors during my cardio placement, and I was always told by one of them to always aim to wean patients from O2, therefore always check O2 level on room air if they are on O2 therapy, and if their O2 level is stable, then try ambulating on room air first with stand-by O2. If the patient desaturates to 85% (80% for COPD), we would then ask the patient to stop and have a rest to see if their O2 level comes up, if desaturation persists, we would then give the patient O2. I would do this every time I see my patients hoping to wean them off O2 before they get discharged, otherwise it might indicate that they need long-term O2 at home. However, my other supervisors would not think of weaning O2 during first few treatments and would always have O2 on patients who were already on O2 therapy to keep their saturations at optimum level throughout ambulation. I would prefer the first approach, and it really depends on your own clinical judgement, whatever you think is best for your patient. Hope this helps, good luck :)
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