Collaborating with HCP: Review Orders – COPD Nursing Care in ER

00:01 Okay, cool. You're learning how you're gonna deal with COPD patients which you will see a lot of in your practice no matter what unit you're working in.

00:10 Now, let's take a look at the physician orders, right? We've done the initial stuff, we identified our priorities, now you're constantly keeping an eye on those physician orders and making sure that you're working through them to keep your patient safe.

00:21 The time is -- right, the big hands on the 12, the little hands on the 10. It's 10 o'clock.

00:27 What should you do? Well, based on the orders, this is a key time for you to look at the pulse ox.

00:34 So you check it, you remember you're supposed to do that every 15 minutes, and when you checked it, it's running 88%.

00:41 Now compare this results to your orders.

00:43 Is 88% within the range ordered by the health care provider? No, it's not.

00:52 So now what do you do? Well, looking at the orders, what's the next nursing intervention? Look at the orders every 15 minutes, is it between a pulse ox of 90-93? Nope.

01:05 They're too low so I go up by 1 liter.

01:10 So our nursing intervention is to increase the oxygen from 3 to 4 liters per nasal cannula.

01:16 Remember, we already went up to 3, now we're up to 4 liters nasal cannula.

01:21 So continue to watch those ABCs, make sure she's stable, look at that pulse ox, and remember, note the next time that you need to check the pulse ox and decide if you're gonna titrate up.

01:33 You're always keeping an eye on the pulse ox beside the next time you need to look at it and see since we're going from 3 to 4, you know on this order, our next change is not gonna be to go up on the nasal cannula, it's going to be to change oxygen delivering methods.

01:47 So we've got that laid out, we made that change, we're keeping track of time on our worksheet, so now what are the priorities? What's left to complete? What needs follow up? Well, looking at the orders, whoa, that's a lot.

02:03 We usually like to keep slide with very few words but we left all these words up there on purpose because when you get orders on a patient, it's not often one or two with an admit.

02:16 You have lots of orders so you need to learn your system for working through these orders, making sure you don't miss something because look, lots of them have multiple points, right? The first order, you got stats. How many different blood gases? Stat, 1 hour, and 4 hours. So actually, that first order has 3 parts.

02:37 You haven't completed that order until you have all 3 parts completed.

02:41 And so that's why we wanted you to see the whole kit and caboodle because this is what you'll deal with as a nurse.

02:49 Now, let's get rid of the things.

02:51 Look, I've got arterial blood gases stat. That's already been done.

02:54 I'm already working on the titrating and I know what I got going there.

02:57 I'm gonna get rid of the -- in my mind, mentally, you're on my system, I'm gonna get rid of the oxygen saturation cuz I've got that going.

03:04 Lab work, well, I've got that blood part of it when I drew the ABGs but I still have something remaining.

03:10 Yeah, that sputum culture and sensitivity. Now, it's very, very important.

03:17 And this is the pharmacology professor in me speaking but you get the culture before you give any antibiotic.

03:25 Should the physician order an antibiotic, it's culture and then antibiotic.

03:30 Let me be even more annoying, culture then the antibiotic.

03:35 You're gonna mess up the sensitivity of that culture helping us.

03:39 Make a good decision if they get the antibiotic first.

03:43 So make sure you don't put off getting that sputum culture too long and end up giving an antibiotic before that culture is given.

03:51 So the breathing treatment, you know, we're working on that.

03:53 We facilitated that with the respiratory therapist or we could do it our self.

03:56 We've also got that IV corticosteriod we're gonna wanna give.