Nurse's Action on Low Oxygen Saturation in Patients - Essay Sample

Introduction

The best and rapid action that the nurse should undertake as the initial act includes increasing the patient's oxygen levels to 2L Nasal Cannula along with continuous monitoring of SP02. Most fundamentally, the patient's SpO2 (oxyhemoglobin saturation) is reported as 94 %. This oxygen saturation level is below the average level required for a patient who is either administered with anesthetic agents during an operation process or a patient who is particularly recovering from an anesthetic medication (Wickerts, Forsberg, Bouvier, & Jakobsson, 2017). Moreover, according to the WHO (2011), every patient ought to have an oxygen saturation level of either 95 % or above that level either during anesthesia or during the recovery period from anesthetic agents. In the case scenario, the patient illustrates signs of hypoxia, which is primarily a shortage of oxygen levels. The WHO's POTM (Pulse Oximetry Training Manual) further emphasizes that a severe fall of the levels of oxygen within just a few minutes is indeed fatal (WHO, 2011).

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In a recent survey conducted by Vold, Aasebo, Wilsgaard, and Melbye (2015), one of the risk factors associated with post-surgery complications involves an oxygen saturation level that either equals to or nearly 95 % (Canet et al., 2010; Vold, Aasebo, Wilsgaard & Melbye, 2015). Furthermore, in emergency medicine, if a patient presents with minimal SpO2 value that is less than 94 %, then the illness associated with that patient is highly associated with elevated morbidity and mortality (Vold et al., 2015).

The Second Nursing Intervention Action

The second best nursing interventional action includes calling the physician to obtain an order for the patient's Nicotine patch and, most essential to report the decreased output of urine with umber urine. According to the case scenario, the patient's urine appears colored inside the Foley Bag amber in addition to the minimum quantity of the urine (40cc) than the required level over the past 2 hours. Reporting of the report, the decreased output of urine with umber urine is vital primarily for postoperative fluid management (Kayilioglu et al., 2015) of the patient in the case scenario. These symptoms imply that the patient is hypovolemic, and as such, the nurse should take prompt action to make a report concerning the findings. Hypovolemia is also associated with hypotension, and as such, both symptoms include the two most fundamental causes of reduced renal perfusion which is principally characterized by the patient's decreased production of urine. Furthermore, the primary causes of absolute or marked hypovolemia include dehydration as well as insufficient replacement of the blood loss during the surgical process (Chenitz, & Lane-Fall, 2012).

Because the patient has a history involving the habit of smoking, it is essential that the nurse orders for a nicotine patch that will be administered to the patient. One of the factors that should be considered for the progression of postoperative AKI (Acute Kidney Injury) includes the smoking habit that has been recognized as a perioperative factor for AKI by Bravi et al. (2019). Therefore, the RN (Registered Nurse) must obtain an order for a nicotine patch to ease the patient's desire to smoke. It is also vital for the nurse practitioner to intervene by providing education concerning the implications of smoking primarily because the patient is recovering from anesthesia.

The Third Best Nursing Action

The second best course of action to perform among the six actions includes the administration of 2mg Morphine injection via the IV (intravenous) route for breakthrough pain that gets reported as eight on the scale of 10. The patient's scale value of 8 denotes severe pain in the case scenario, and as such, after the elimination of hypoxia, the nurse practitioner needs to act to reduce the pain to a moderate level, which is five on the pain scale. According to Meissner et al. (2018), if the patient assessment indicates a rating of between 7 and 10 on the NRS (Nurse Rating Scale) for pain, particularly the post-operative patients, the rating gets considered as the worst intensity pain or severe pain. As such the nurse should administer morphine or a suitable opioid to achieve moderate pain (Shanthanna et al., 2019) and in this case scenario a goal of 5.

The Forth Best Nursing Action

The fourth nursing interventional action involves the use of anti-embolism stockings in a bilateral manner. This approach is vital in the prevention of DVT (Deep Vein Thrombosis) (Lim & Davies, 2014). Considering the case scenario, the patient has anti-embolism stockings applied to the left thigh only. As such, the nurse must use bilateral anti-embolism stockings to avoid the risk of DVT. According to, post-operative patients are often at high risks to DVT that can potentially result in PE (Pulmonary embolism) (Wade et al., 2015). Other long-term difficulties associated with the VTE (Venous thromboembolism) include abnormally increased BP (Blood Pressure) in the pulmonary artery, stroke as well as pulmonary hypertension (Wade et al., 2015). These long-term complications can potentially result in increased hospital care costs ascending from the require treatment along with increased prophylaxis.

The anti-embolic stockings are also referred to as either pressure or GCSs (Graduated Compression Stockings) that assist the patient in the prophylactic management of thrombotic conditions, including PTS (Post Thrombotic Syndrome) and DVT (Wade et al., 2015). The function of GSCs includes exerting pressure between the ankle and thigh at a decreasing gradient, which promotes the velocity of blood flow along with advancing venous return (Wade et al., 2015). Additionally, a previous piece of research led by NICE (National Institute for Clinical Excellence) determined that the untreated patients ailing from VTE are at a high risk of PTS (NICE, 2010). The PTS illness is associated with such symptoms as ulcers, edema, swelling, as well as pain (Farrell, Sutter, Tavri & Patel, 2016). About the findings of Farrell et al. (2016), one may note that the extreme pain rated at eight, as indicated in the NRS in the case scenario, is associated with the patient not utilizing the anti-embolism stockings on his right thigh. Therefore, it could be appropriate for the health practitioners to consider the possibility of PTS associated with VTE during his post-surgical care to improve his QoL (Quality of Life).

The Incorrect Action

The incorrect action in the scenario includes the nurse's action involving the decrease if oxygen saturation levels of the patient. The reported oxygen level includes 94 percent on the 4L Nasal Cannula. As mentioned earlier within this text, a patient who has either undergone a surgical process that involves the administration of anesthesia or a patient in the recovery phase from an anesthesia agent such as the patient evaluated in the case scenario should be maintained on a SpO2 level of not less than 95 %. Any value below 95 percent would indicate hypoxia. However, one of the actions in the nurse's decisions involves a further decrease of the oxyhemoglobin saturation of the patient which can potentially lead to respiratory arrest (Sun et al., 2015).

The research led by Sun et al. (2015) discovered that hypoxemia is prolonged and frequent amongst hospitalized cases recovering from non-cardiac surgical procedures. Sun and colleagues conducted a prospective blinded observational survey to determine the persistence and commonality of postoperative hypoxemia among 594 Cleveland Clinic and Juravinski Hospital (Sun et al., 2015). The authors found that pronged hypoxemia was common, with 37 % of the reported cases having a minimum of one episode involving oxyhemoglobin saturation levels of less than 90 %. The authors found that the working nurses missed approximately 90 % of 'smoothed' episodes of hypoxemia, which included saturation levels of less than 90 % for a minimum of one hour (Sun et al., 2015).

It is imperative to note that any significant oxygen desaturation levels should be corrected to avoid the incident of anaphylaxis or respiratory arrest that may be lethal to the patient. According to O'Driscoll, Howard, Earis, and Mak (2017), any noted prolonged substantial desaturation levels of oxyhemoglobin (SpO2<90%) must be addressed by supplemental to attain target SpO2 of between 94 and 98 percent among post-operative patients. Therefore the nurse in the present case scenario should correct any SpO2 of less than 90 %, maintain the levels at a range of between 94 and 98 % in addition to close and constant monitoring of the patient, preferably after every one-hour intervals.

References

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National Institute for Clinical Excellence [NICE]., (2010). Venous thromboembolism: reducing the risk. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. NICE guideline 92. National Institute for Clinical Excellence, 50.

O'Driscoll, B. R., Howard, L. S., Earis, J., & Mak, V. (2017). British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings. BMJ open respiratory research, 4(1), e000170.

Shanthanna, H., Paul, J., Lovrics, P., Vanniyasingam, T., Devereaux, P. J., Bhandari, M., & Thabane, L. (2019). Satisfactory analgesia with minimal emesis in day surgeries: a randomized controlled trial of morphine versus hydromorphone. British journal of anesthesia, 122(6), e107-e113. DOI: https://doi.org/10.1016/j.bja.2019.03.036

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