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Measuring and monitoring vital signs
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Holmes and Peffers (2013) highlight various conditions that can influence pulse oximetry, such as asthma, peripheral vascular disease in older people, some antiretroviral medication (HIV drugs), anaemia and sickle cell anaemia (a genetic condition causing red blood cells to have a sickle shape affecting oxygen transport). They also identify that nail polish, dirt or artificial nails on the fingertip, movement leading to artefacts and dark or pigmented skin can alter readings. Barnett et al. (2012) and McDermott et al. (2018) describe the choice of sites in pulse oximetry readings and note that ear and finger sites may offer different readings. Therefore, it is important that you identify which site is used routinely in your clinical area, to aim to eliminate errors of reading. If you consider the factors mentioned above, you can try to increase accuracy in measurement of pulse oximetry, and you must report any abnormal findings immediately to a registered nurse or doctor.
Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Pulmonary edema causes signs and symptoms that can mimic an exacerbation of COPD. The edema may be the primary symptom when the patient has no history of cardiac disorders. An immediate chest X-ray is usually sufficient for diagnosis and reveals extreme interstitial edema. If the diagnosis is still not confirmed, the serum brain natriuretic peptide (BNP)/N-terminal (NT)-prohormone BNP levels can be measured. They are elevated if pulmonary edema is present, but are normal if COPD is exacerbated. Other evaluations include blood tests, ECG, and pulse oximetry. The blood tests include cardiac biomarkers, BUN, electrolytes, and creatinine. For extremely ill patients, arterial blood gas measurements are taken. To determine the cause of pulmonary edema and select the best treatment, echocardiography may be done. Other factors to evaluate include severe hypoxemia and carbon dioxide retention, which is a late and severely negative sign of secondary hypoventilation.
Management of the Sick Child
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Pulse oximetry, if available, can be used as an indicator of severity and guide use of oxygen therapy. Chest x-ray may be difficult to access, and is unnecessary unless the child is severely unwell, does not respond to treatment, has HIV-associated pneumonia or the diagnosis is unclear.
Pediatric Bradycardia Is Undertreated in the Prehospital Setting: A Retrospective Multi-Agency Analysis
Published in Prehospital Emergency Care, 2023
Andrew Hanna, Remle P. Crowe, Jennifer N. Fishe
After applying inclusion and exclusion criteria to the 7,422,710 encounters in the 2019 ESO Data Collaborative, we identified 1,209 patients meeting pediatric bradycardia criteria (Figure 1). Patient demographic and EMS encounter characteristics are detailed in Table 1. Of note, most patients were male (58.5%) and the median age was 2 years (interquartile range 0–13 years). The three most common EMS provider primary impression categories were trauma, neurologic, and respiratory. About three-quarters of encounters (n = 952, 78.7%) were with an advanced life support (ALS) EMS units. For included patients, the initial median pulse oximetry reading was 98% (interquartile range 95%–99%). Intravenous access was attempted in 34.0% of patients, and intraosseous access was attempted in 12.1% of patients. One-quarter (24.7%) of patients received fluids, and bag-valve mask ventilation was the most common airway intervention (12.1% of patients).
The effects of music therapy on peripherally inserted central catheter in hospitalized children with leukemia
Published in Journal of Psychosocial Oncology, 2023
Ting-Ting Zhang, Zhong Fan, Shu-Zhen Xu, Zheng-Yao Guo, Min Cai, Qiong Li, Yan-Lai Tang, Li-Wei Wang, Xi Chen, Li-Jun Tang, Zhi-Ying Li, Yun Wen
Before the catheterization, the bedside nurse referred the child to a music therapist. Music therapists and nurses conduct music therapy assessment before the operation, including gathering information of children from the medical staff and their parents; communicating with children to know their music preferences. The emotional state, pain degree, heart rate, respiration and blood oxygen concentration of children were recorded at the same time before the operation. Emotional states were recorded by seven faces depicting expressions varying from very happy to very unhappy, which were assigned a score of 1 to 7. Pain degree was measured by the children’s choice on a scale of 0 to 5 (not painful to very painful). A Pulse oximeter was used to record the heart rate and blood oxygen concentration.
A case of Hb Rothschild (HBB: c.112T>A) with low pulse oximetry: a first familial presentation in China
Published in Hematology, 2022
Diandian Li, Qunfang Wan, Chunyu Li, Hongbing Ma, Gang Wang
Pulse oximetry is a common non-invasive method for measuring oxygen saturation in clinical practice. However, this case highlights the limitations of pulse oximetry. ABG samples using modern blood gas analyzers can overcome these limitations to provide more reliable results. Typically, low oxygen affinity Hb variants have low SpO2 readings accompanied by low SaO2, with no evidence of cardiac or respiratory disease. P50 is one of the common metrics to quantify Hb oxygen affinity. When an altered oxygen affinity variant is suspected, P50 testing should be performed. Nevertheless, in some unusual Hb variants (eg, Hb Titusville and Hb Bonn), altered absorption spectra results in falsely low SpO2 and normal SaO2 [2,3], and P50 should be interpreted carefully since it relies on optical properties of Hb at a 560 nm wavelength.