Reflective Journaling, Clinical Journal 4

Name: Kara Saba

NUR 4948L
3/11/2016
Noticing
Subjective and objective data

As I was walking out of one of my patients rooms having just checking in on

them, I heard a bed alarm going off in the patients room next me. This was not
one of my patients, but since the alarm was going off and I was right next to the
room I ran in to see what had happened. There was a mid 40 year old, obese
female patient attempting to sit up and get out of bed. At first I thought she was
just trying to stand up, so I attempted to help her and told her to please not get
up without my help or help from other staff. I then realized she was sitting up to
try and breath more easily, she then started gasping for air and I looked over at
her oxygen saturation, which was 75%. The alarm had been silenced so I did not
notice it was out of range at first. The patients patient care technician walked in
behind me and at that point I told her to call the nurse we might need to call a
rapid response on this patient.

Subjective data: The patient didnt state it all came on so quickly she did not
ask for help but it was clear she needed it after assessing the situation.

Objective data: The patient was attempting to sit up and struggling to get out of
bed. She then started gasping for air, and as I looked over at her 02 sats they
were 75%. She was clearly in distress, and her breathing was labored.

How did you know there was a problem?

o

After hearing the bed alarm go off I knew the patient was in some kind of trouble,
but then I realized the situation was much more serious then just trying to get out
of bed after recognizing the patients presentation. The patient was on 3 L
oxygen via nasal cannula already, but after attempting to get out of bed her nasal
cannula had slipped off her nose and she was no longer receiving the oxygen
she needed to keep her oxygen level at or above 95%.

Interpreting
What other information do I need to make a decision?
o

I needed to know how much oxygen she was receiving, so I looked at her oxygen
saturation, which was extremely low at 75%. I then looked at how many liters of
oxygen she was on and if I could possible raise it. However since she was

already at 3 liters and I did not know the patients background or history I did not
raise the level of oxygen myself.

Is there anyone else I need to involve or notify?

o

The assigned patient care technician to that patient followed in right behind me
and I did not want to leave the patient alone so I asked her to go notify the nurse
of this patient. The nurse ran into the room minutes later and decided we needed
to call a rapid response. The nurse manager, coordinator, other nurse and my
preceptor all entered the room as well to assess the situation while waiting for
rapid.

What could be happening and how critical is this situation?

o

Based on the patients presentation it became obvious to me that she was unable
to take full breaths on her own and was not getting in the oxygen she needed.
This situation is very critical, if the cells and vital organs in the body are not
getting the oxygen they need they can start to die putting the patient at risk of
death.

Responding
Should I do something now or wait and watch?
o

How will I know if I am making the best decision?

o

Something needed to be done immediately, I first fixed the patients nasal cannula
for her and raised the head of the bed up and told her to take slow deep breaths
in through her nose once I fixed the nasal cannula properly. The oxygen
saturation was slowly starting to rise and she was able to catch her breath. By
the time the nurse manager and other staff got there her oxygen had raised to
94%.

I knew I had made the right decision by staying with the distressed patient and
telling her to take slow deep breaths, until her oxygen saturation has risen above
at least 92% and she was no longer gasping for air.

What interventions can I delegate to other members of the healthcare team?

o

The patients technician was able to go delegate to the nurse of the patient the
current situation and then the nurse got the nurse manager and rapid response
involved. I told them what had happened and thankfully by the time they got there
the patients oxygen had stabilized. Its important for the others to know that the
patients oxygen alarm level on the vitals machine was turned off by someone
and it is very important that it is turned back on to notify people that she is in
trouble.

Can include evidence-based practice here to justify why you might make one decision
over another.
o

This was not my patient, but being on the orthopedic unit we get many
postoperative patients and I later found out that this particular patient was
postoperative knee replacement. These patients are supposed to be watched
carefully for the first 24 hours after surgery, having the pulse oximetry alarm off
was not appropriate for this patient or any patient. An evidence based article I
found reinforces the importance of monitoring oxygen status post operatively.
The patient most likely received anesthesia, and is also on pain medication,
causing the patient to become very sleepy and puts them at even higher risk for
respiratory distress.

Retrieved from: http://europepmc.org/abstract/med/4014768

Reflecting
Did I make the right decision?
o

Did I achieve the desired outcome?

o

I believe I did make the right decision first in responding to the bed alarm in the
room next to one of my patients, then by staying with the patient and fixing her
nasal cannula and talking her through her breathing while the PCT went for help.

The desired outcome was definitely achieved when her oxygen level increased
after taking a few deep breaths in through her nose. Also having others come to
reinforce and assess the situation was an outcome that was required for this
situation.

What did I do really well? What could I have done better?

o

I was the first person to walk into the room and hear the alarm, and I responded
quickly. However it took me a minute to realize the patients oxygen saturation
was so very low since someone had turned off the alarm.

Even though my response was fast, it took me a minute to realize the patients
oxygen saturation was so very low since someone had turned off the alarm. Next
time in a situation like this I will be sure to look at that right away, even if it is not
alarming.