On my rural prac, I came across a few cardio patients, all of whom presented differently with similar pathology (COPD) which allowed me to see the great variation in severity of the disease impacting on the patient’s QOL. They were all generally bright in personality and motivated so compliance was not a problem. What I found interesting was that the readings from oximeters, Ausculations etc does not always correlate with the patient’s presentation.
Patient 1: elderly lady, very keen for exercise however has low exercise tolerance. SOB limits her ambulation distance which was around 10m. SpO2 would below 85% but the patient will need a reminder to take a break and would only report she’s tired once we stop.
Patient 2: relatively younger patient in 50s, on O2 therapy, SpO2 would desat on RA to below 80% dramatically. She could walk a long distance given she had O2 on. TEE and SMI worked very well with getting improved gas exchange with this lady.
Patient 3: this patient was more severe, had a lung reduction surgery on O2 24/7. Only able to ambulate around 10m (housebound) normally. Ambulation limited by severe SOB.
From working with these cardio patients, I found that the oximeter we use to monitor SpO2 was helpful for us to decide when to give pt’s rests or terminate the treatment but most importantly getting subjective feedback and monitoring the pt’s face was very important also. I also found that these patients were very compliant and would keep walking even if their Sats are low, so it is important for us to prompt them when this happens.
I have not yet done my cardio placement but I think the cardio patients I saw on my rural prac will be helpful when I actually see cardio patients for 4 weeks!!
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It would be great to get a variety of cardio patients on ur rural prac.
I am currently on my cardio placement and I have found that in most cases SOB and desaturation often go up and down in unison, however as we learnt at uni, these 2 factors are not predictors of each other. and many patients will desat, to under 88% and still no be SOB. This does not mean though that they do not need to be placed on O2. In fact if the doctor has asked for them to be kept above 88%, then we should do that. However, if the patient is borderline with their O2 and not showing any signs of fatigue or SOB (after being asked) then I would let symptoms decide when to terminate Rx or have a rest. Any other thoughts?
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