Oxygen Saturation – Vital Signs (Nursing)

by Samantha Rhea, MSN, RN

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    00:04 Welcome to the portion of vital signs where we talk about oxygen saturation.

    00:09 So when we're talking about normal vital sign ranges.

    00:12 On oxygen saturation, we're really going for a goal at least above 92%.

    00:19 So this can vary from patient to patient but this is a general goal.

    00:23 So let's just talk about oxygen saturation.

    00:26 So we measure the arterial oxygen saturation and you may see this as SaO2.

    00:32 Now, this is the amount of oxygen that's in the blood carried to the extremities of the body.

    00:37 So think about all the way out to our fingers, to our ears, to our nose, all the way down our feet into our toes.

    00:45 Now, this ideally is usually between 95% to 100.

    00:49 And again, remember I said greater than 92%, that is ideal, we really, really love 95 to 100%.

    00:58 But of course, if a patient has lung disease, or some other conditions, this varies a bit.

    01:04 So let's take a look at this image here.

    01:06 Let's take a start on the blue side of this image.

    01:10 So if you think about when you pump blood all the way through your body, eventually, we need some more oxygen.

    01:16 So let's start on the blue side of this image, we got to go back to the heart to get some more oxygen in our blood.

    01:22 So this blue side represents a level of blood that's low in oxygen.

    01:27 So we go and dump right back into our heart to pick up more, we go into that right side of the heart, we push this through our pulmonary artery, go all the way back to those lungs.

    01:37 And that's where we're going to pick up more oxygen.

    01:40 So if you take a look at the start or the top of this image, it kind of looks like a web and a little popcorn, if you will.

    01:46 This is where the alveoli are.

    01:47 And there are tons of these in the lungs.

    01:50 This is really important, because we're going to pick up more oxygen here.

    01:53 Now, oxygen diffuses through the alveoli of the lungs.

    01:57 It attaches to the hemoglobin molecules in those red blood cells.

    02:02 So now we're going back on the image on the red side, because we picked up more oxygen, and we're oxygen rich here.

    02:08 So we've got oxygenated red blood cells and they're carried through the left side of the heart.

    02:14 And this is where we push that from the left ventricle, through the aorta, and all the way out to our peripheral capillaries to reach of course, our nose, our ears, our toes, our hands, or legs.

    02:26 So oxygen detaches that the capillaries and diffuses into the tissue.

    02:30 And once it reaches those tissues, like as you can imagine, this is where we're gonna get that reading.

    02:37 So let's see how the oxygen saturation is measured.

    02:41 This is what we call a pulse oximeter.

    02:44 So you can just see on this device, it kind of clamps down on the finger.

    02:47 And don't worry, this is very non-invasive.

    02:50 There's a little lighter, LED light that shines through.

    02:53 It's able to pick up with that photo detector.

    02:55 And this detects the amount of oxygen bound to the red blood cells and calculates our oxygen saturation.

    03:03 Now, if you see SpO2, this is where we get that measurement.

    03:08 Now let's talk about the different types of oxygen saturation probes.

    03:13 As you can see here, like that photo detector.

    03:15 The finger is a very common one.

    03:18 Now this is usually used intermittently, just to get a one time reading and move on.

    03:22 This is typically used for maybe our more stable patients.

    03:26 Now, sometimes we need a little bit more continual monitoring, or for whatever reason, maybe the patient moves around a lot.

    03:33 So we'll have to use a different methods to get the oxygen saturation.

    03:38 We may even use the ear for example, as you see in the image.

    03:42 We could use the nose, or we could even use the forehead.

    03:46 And again, depending on if the patient's got a nasal gastric tube, maybe they move around a lot, we're going to use various methods to pick up the oxygen saturation.

    03:57 Let's take a look at what levels that we need to know as a nurse.

    04:01 What's important.

    04:02 Now if you recall, normal blood oxygen levels are great, right? It's in the green at 95 to 100%.

    04:09 That, of course is ideal.

    04:11 Now when we go below that near yellow zone.

    04:13 This is a little bit more concerning.

    04:15 So we're about 91 to about 95%.

    04:19 This is concerning, but this is not scary yet.

    04:23 Now keep in mind as a nurse, there's various lung disease and things such as like COPD, where maybe our patients safely won't meet 95%.

    04:32 So again, you're going to have to use your patient assessment in your judgment.

    04:36 Now once we reach below 90%, we consider this low blood oxygen levels and we may need to intervene fairly quickly.

    04:45 Now moving on down this ladder, you see at 80-85%.

    04:49 Now this is pretty low oxygen saturation and this is where affects that we're not getting good oxygen to our brain.

    04:55 So of course this is very concerning at this level.

    04:58 Now let's hope we don't reach here.

    05:00 As you can imagine, we've talked about some concerning levels that we would want to intervene before this red zone happens.

    05:07 The red zone is 67%, even lower.

    05:10 This is what we call cyanosis.

    05:13 We're not getting oxygen to our tissues.

    05:15 You may see cyanosis and maybe blue in their lips.

    05:19 We're not getting any perfusion to those tissues.

    05:22 And this is really dangerous.

    05:23 And this is typically a medical emergency.

    05:26 So this is a good chart for you to remember that these are good guidelines.

    05:30 But of course, it's independent and individual to your patient.

    05:35 Now let's talk about the things in regards to your patient that can actually affect the oxygen saturation.

    05:41 Now one of those is infection.

    05:43 As you can imagine, when you're talking about infection, your body's under a lot of stress.

    05:49 You're fighting off infection or something really ugly.

    05:52 So here we're increasing our metabolic demand.

    05:56 So this could, of course affect your oxygen saturation.

    05:59 Now, we've talked about this a little bit, but disease is also a thing that can affect oxygen saturation.

    06:05 Remember, those alveoli we talked about.

    06:07 Now, if those are damaged in a lung disease, such as COPD, this can also affect our oxygen saturation, where maybe it's not normal that we meet that 95-100% goal.

    06:19 And don't forget about peripheral perfusion.

    06:22 We talked about that we hope that all that perfusion goes out to our periphery, like our fingers, our nose, our toes.

    06:29 Sometimes things can inhibit this from happening.

    06:32 And lastly, of course activity.

    06:34 The more activity, if you're doing a strenuous exercise, this is going to increase that metabolic demand.

    06:39 And of course, affect our oxygen saturation.

    06:44 Now, let's talk how we actually apply that pulse oximeter.

    06:47 We're going to take our device and put this on the client, where, of course, turn that on, and ensure the light illuminates.

    06:55 Now here, we're going to check to see if the pulse ox tracing or the pleth is working and matching the heartbeat.

    07:01 So if you take a look at this image, see how that heartbeat kind of goes up and down.

    07:05 You see on the blue side here, this is where we measure what we call the pleth of the tracing.

    07:10 And this is typically on a typical monitor where you're going to see the oxygen saturation.

    07:16 Now just know that we may need to check the limit settings to make sure they're appropriate for the patient.

    07:21 And each condition warrants this and you'll go by your physician's orders.

    07:25 And we've talked about this briefly.

    07:27 But no, sometimes we may just have a one single reading to where we use our pulse oximeter with our finger probe, take it once.

    07:36 Or you may see a graph like this if the patient has to be continually monitored, because we're worried about their oxygen status.

    07:43 Now make sure of course, you continually monitor and document the clients SpO2 per the orders.

    07:53 Now let's take a look on how we apply a pulse oximeter with our patient.

    07:57 So before we get started, let's get familiar with our equipment.

    08:00 So you may see a machine much like this in the hospital or clinic that you use.

    08:05 So this is great, because with this particular one machine, you can take the patient's temperature, their blood pressure, and even their pulse oximeter, usually just about the same time.

    08:15 So this is very common that you may see.

    08:17 Or you may see an independent pulse oximetry, and I can show you that in a bit too.

    08:22 So let's go ahead and make sure your machine is on.

    08:25 And then I'm going to turn on the device and ensure that when I open up my probe that the light is on here, that way we know it's functioning.

    08:32 So I can apply this to my patient.

    08:36 And as I hold up there, you're gonna see that the pulse oximeter is starting to read.

    08:44 And we see we have a 98% reading on oxygen saturation, which is fantastic.

    08:49 So as you recall, 95-100% is really goal for patients.

    08:54 Now when you're applying this device to the patient's fingers, make sure you check the nail for example.

    08:59 Make sure you're not doing it to an injury or damage nail, maybe even if the client has nail polish or artificial nails, for example.

    09:07 So don't forget, anytime that you are using, maybe a continuous pulse ox, you may need to make sure that the pulse oximetry tracing is working and matching the patient's heartbeat.

    09:17 And don't forget to check your limits.

    09:20 And of course, we will monitor and document the clients SpO2 or saturation oxygen per the orders.

    09:27 Now let me show you one more.

    09:29 You may see a device much like this and this is just an independent pulse oximetry.

    09:34 So when I open this, you're gonna just open up the claws, much like we were going the other one.

    09:38 I'm gonna push the button up top and place this on Brandon's finger.

    09:43 The nice thing about these independent pulse ox is you can usually obtain a heart rate and the SpO2 at the same time.

    09:49 Now again, same thing is you're going to check the patient's nails for example and make sure that there's no damage fingernail polish to impede the reading.

    09:56 So here we see the patient's heart rate is 61 and a 98%.

    10:04 Let's talk about some special considerations in regards to pulse oximetry.

    10:10 Now, as you can imagine, if we use a finger probe that false fingernails or maybe nail polish, these may have to be removed because we're not going to get a good reading.

    10:19 Now, avoid a site that either edematous or sweaty or maybe has skin breakdown.

    10:24 And you might have to change locations of the sensor to prevent injury and skin breakdown.

    10:30 So just going back to those image, if you recall, sometimes we use those finger probe but sometimes we have to use more of a sticker like method that has a probe in it that goes on the ear, the nose, the forehead, because we're usually doing continuous monitoring with that.

    10:46 Now, as you can imagine, if that probe stays on the forehead for a long time, or maybe the nose, we can definitely break down the skin.

    10:53 And of course, be sure the pleth corresponds to the patient's heartbeat to get an accurate reading for a patient in our measurement.

    11:01 Thanks so much for watching.

    About the Lecture

    The lecture Oxygen Saturation – Vital Signs (Nursing) by Samantha Rhea, MSN, RN is from the course Vital Signs (Nursing).

    Included Quiz Questions

    1. > 92%
    2. > 98%
    3. > 90%
    4. > 96%
    1. Forehead
    2. Finger
    3. Nose
    4. Ear
    5. Arm
    1. 67%
    2. 92%
    3. 90%
    4. 87%
    1. Infection
    2. Disease
    3. Peripheral perfusion
    4. Activity
    5. Diet
    1. Nail polish may need to be removed.
    2. Sites that are sweaty should be avoided.
    3. Locations should be changed to avoid skin breakdown.
    4. Nail polish does not need to be removed.
    5. The location should not be altered.

    Author of lecture Oxygen Saturation – Vital Signs (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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