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.