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    9 views3 pages

    Assessing Oxygen Saturation

    Uploaded by

    PANGPANGDEO Shanne Delle B.

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    Home Care Considerations Blood Pressure + the cont taxes blood pressure readings at home, the nurse ‘should use the same equipment or calibrate it aganst a systom known to be acouate, ‘Observe the clent or family member taking the blood pressure ‘and provide feedback i futhor instruction is needed. Home blood pressure measurement done by the client or family ‘can confim pressures identified when the olen is soen in a lni¢ or ace setting. This may be significant because so-called “white coat” hyoortarsion can occur, whichis an elevation in OXYGEN SATURATION A pulse oximeter is a noninvasive device that estimates a clients arterial blood oxygen saturation (Sa0,) by means of a sensor attached to the clients finger (Figure 29-25 Mtoe, nose. earlobe or forehead (or around the hand or foot of a neonate) The oxygen saturation value is the percent ofall hemoglobin binding sites that are occupied by oxygen. The pulse oximeter can detect hypoxemia (ow oxygen saturation) before clinical signs and symptoms, such asa dusky color to skin and nail beds, develop, ‘The pulse oximeter sensor has two parts (a) two light emitting diodes (LEDs)—one red, the other infrared—that transmit light, through nails, tissue, venous blood, and arterial blood: and (b) 2 photodetector placed directly opposite the LEDs (eg. the other side ‘ofthe finger. toe, or nose), Because the photodetector measures the amount of red and infrared light absorbed by oxygenated and de- ‘oxygenated hemoglobin in peripheral arterial blood itis reported as, pO, Normal oxygen saturation is 95% to 100%, and below 70% is, Iie threatening alse oximeters with various types of sensors are available from several manufacturers. The oximeter unit consists of an inlet connec tion forthe sensor cable, anda faceplate that indicates (a) the oxygen saturation measurement and (b) the pulse rate, Cordless units are also available (Figure 29-26 MD. A preset alarm system signals high and ~ Figure 29-25 Bl Fingers ox'metorsansor [ad Chapter 29 © Vital Signs 507 PATIENT-GENTERED CARE blood pressure du to mill anxiety associated withthe health core provider's presance—who historically wore a whe lapors- tory coat. An elevated blood pressure may be dismissed as the white coat phanomenca when, fact, the blood pressure is truly elevates. + Ifthe chants ina chair or low bed, postion yourself so that you maintain the olent’s arm at heart leveland you can read the sphygmomanomete at eye level, low $pO, measurements and a high and low pulse rate. The high and low SpO, levels ae generally preset at 100% and 85%, respectively for adults, The high and low pulse rate alarms are usually preset at 140 and 50 beats/min for adulls. These alarm limits can, however, be changed using the manufacturers directions. Factors Affecting Oxygen Saturation Readings “Among the factors influencing orgen stration readings are hemo ‘globin levels, circulation, activity and exposure to c2zbon monoxide + Hemoglobin. the hemoglobin is fully saturated with oxygen, the pO, will appear normal even ifthe total hemoglobin level is low ‘Thus, the cient could be severely anemic and have inadequate ‘oxygen to supply the tissues but the pulse oximeter would return anormal value + Circulation, The oximeter will not return an accurate reading if the area under the sensor has impaired circulation + Activity. Shivering or exeessive movement ofthe sensor site ma interfere with accurate readings + Carbon monoxide poisoning. Pulse oximeters cannot discrimi natebetween hemoglobin saturated with carbon monoxide versus ‘oxygen In this case, other measures of oxygenation are needed. Skill 29-7 outlines the stepsin measuring oxygen saturation. Figure 29-26 ml Fngortp oximeter sensor (cores Arencirasasb Ary, Bees 508 Unit7 © Assessing Health Evidence-Based Practice Are Pulse Oximeter Readings Accurate if Measured on a Restrained Arm? The aim of this study by Korhan, Yent, and Khorshid (201 1} was to compare the pulse oximety values cbtanad from a finger on 1a svanod or unrestrained sides of the body. In clncal setings such fas intensive care, physical restraints may be incicated to lessen the chances that clonts wil displace tubes and monitors. However, the ‘most important compication in using physical restraints is impaired Circulation. Thus. oxygen saturation ftom body parts in which = culation is mpared can be accurate, The research sample con- sisted of 30 hospitalzed clients. A significant difrence was found bbatwaan the axygan eaturation valies obtainaa ‘rom a finger of an fm that had can prysicaly resivanod and a tngor of an arm that had not been physcaly restrained, The mean axygen saturation EVIDENCE-BASED PRACTICE ‘value measures trom a finger of an arm that had baen physicaly restrained was found to be 93.40 and tre mean oxygen saturation vvalie measured from a finger of an arm that had not boon physicaly restrained was found to be 96.53, IMPLICATIONS “Tho results ofthis study indicate that nurses should uso afingor of an arm that is rot physicaly restrained when evaluating oxygen sat tration vakies. The use of physical restarts is caratlly evaluated because chore are many possible adverse etfects of ther use. This study provides ona addonal physiologial consideration: that as- sossront data gathores fom a ast-ained Ima may nat eo accurate, euro ered PURPOSES * To estimate tho artoral blood oxygen saturation *+ To detect the presence of hypoxemia before visible signs develop ‘ASSESSMENT Assess *+ The best location fora pulse oximeter sensor basad on tha clant’s age and physical condition. Unless contraindicated. the finger is usualy selected for acuits. + The client's overal condition ncluing tsk factors for dovelooment of hypoxemia (og. raspeatory or cardiac disease) ‘and hemoglobin level * Vital signs, skin color and temperatura, nail bod color anc tissue perusion of extremities as baseline data + Adhesive allergy PLANNING Many hospitals and eles havo pulso oxtaters roadly avalable for use with other vital signs equioment (or even as an integrated part ‘ofthe electronic blood pressure device}. Other facies may have a Innited supply of eximetars, and the nurse may need to raquest it from the contal supply departmort. DELEGATION ‘eplzation ofthe pulse oximeter sersor and recocing ofthe Sp0, valuo may be debagetod to UAP. The ierreiaton of tre oxygen ‘sRuration valle and determination of aporoprate responses. @e done by the rus, Equipment + Nall posh remover as nooded + Alechel wip + Shoet or towel + Pulse oxmater INTERPROFESSIONAL PRACTICE Measuring oxygen saturation may be within the scove of practice ‘or many heat care providers, For exemple, in addition to nurses, respratory therapists may check the clen's oxygen saturation before, dung, and after treatment. Atijough thes therapists may \vatoally communicate thei ndings and plan tothe healt care team mambo, the nurse must alse know whore to locate their docuen- tation nthe clent’s mocical cord IMPLEMENTATION Preparation ‘Check that the oxmster equipment is functioning normally Performance 1. Prior to performing the procedire, ntroduce salt and varity the alent’ identty using agancy protocol. Explan to the client ‘what you are going to do, wiy its necessary, and how he ar she can partciale. Discuss how the resulls willbe used planning futher care or treatments. 2. Perform hand hygiene and observe appropriate infection prevention procedures. 3, Provide fr cent privacy, 4. Choose a sensor appropriate forthe clion's weight, size, and sired location. Bacause weight Imis of sonsors over, a pediatric sensor could ao used for a smal ad. Ifthe clentisalorgic to adhesive, use @ cp o sensor without adhesive. + fusing an extremity, poly the sensor ony ifthe proximal pulse and capilary rfl atthe pont closest tothe site are present the clent has low issue perfusion due to periph sal vascular disease o” theraoy using vasoconstetive medications, use a nasal eonsor or a reiactance sensor on the forehead. Avoid using lower extremities that have a compromised culation and extremities that are used for infusions or other invasive monitoring, 5, Propare the ste. + Clean the ste wih an aloohol wipe before apoling the sensor + Iimay be necessary to remove a female clan's dark nail polsh Rationale: Nailpolsh may intorfra with accurate measure- ments although the data about this ae nconsistent * Alternatively, postion the sensor onthe side ofthe fnger rather than perpendicular to the nallbed, eau stra neal Chapter 29 © Vital Signs 509 6. Apply the sansor, and connect itto the pulse oxreter ‘+ Make sure the LED and photodetector are accurately aligned, that i, opposite each otner on either sie of ‘the ng, too, nose, or earlobe. Many sensors have ‘markings to facta correct algnmant of the LEDs and ‘photodetector. + Astach the sensor cable to the connection outlet on the oximeter. Tum on the machine according to the manufac- ‘wor’ directions. Appropiate connection will bs confemodt ‘ey an audible beap ncscating each arterial pulsation ‘Some devices have a wheel nat can be turned clockwise to increase the pulse volume and counterclockwise to sectoase ft *+ Ensure that the bar of fght or wavatorm on the face ofthe ‘oxmeter fuctuats with eacn pulsation, 7. Sel and tun on tne alarm when using continuous monitoring. + Check the peeset alarm mits for high and low oxygen

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