Oxygen masks? What?

[emt_cookies]

So something I've seen is the improper usage of oxygen masks by nurses. I'm sure they have their reasons, but it's frustrating.

First case is when we're picking up a patient from the hospital and we find out that the nurse didn't both to hook up the patient up to oxygen even though she's normally on oxygen. Maybe the patient doesn't actually need oxygen, but her family doctor wrote orders for her to be on it.

Second case I haven't seen yet but I've heard about it. It's using a non-rebreather mask. In my state, nurses can give up to a low number without a doctor's order. I think it's 6 lpm but I'm not in the patient care part of nursing school yet and I don't see oxygen in my pharm book. I think this is true of the state where I am taking my medic school too. The numbers for NRBs is usually 12-15 or 10-15 or just 15 lpm depending on what book you read. What I guess is happening is the nurse forgot to ask for oxygen orders when they requested permission to send the patient to the hospital.

Another case is when a nurse was sitting next to a patient and she looked white as a ghost. The portable pulse ox was reporting an oxygen sat of 54%. Pretty sure the pulse ox wasn't reporting properly or he was cold or he had poor circulation in those fingers. Something like that other than his saturation level was 54%.

[Sapphire Silk]

Most hospitals have standing orders for oxygen by nasal cannula up to 4 liters can be administered by a nurse prior to getting an order, but she must then call and get the order.

Critical care units are different; there are standing orders for NRBs for patients in respiratory difficulty. I've heard respiratory therapists give two parameters for NRBs--some say 10 liters will do the job, others insist on 15 liters. Either way, you won't get more than about 50% oxygen (2 liters by nasal cannula is about 24%).

Nurses who work med surg or outside of hospital settings tend to be the least familiar with the different oxygen devices and how they are used. I'm not sure why this is because it IS covered in nursing school, and it's something I focus on in Simulation and in test questions.

And yeah, some nurses will panic when they see a low sat and not account for poor circulation which throws it way off. I look at the overall picture; if the patient is in no distress and I can't get a reliable reading, and central signs are OK, then I don't panic.