Question

Pulse oximetry has been ordered for an elderly client admitted with pneumonia. The best site for placement of the probe is the: A. Toe B. Finger C. Earlobe D. Nose

Short answer

Answer: The best site for pulse oximetry probe placement on an elderly client with pneumonia is the finger.

Step-by-step solution

Understand Pulse Oximetry

Pulse oximetry is a non-invasive method to measure the patient's blood oxygen saturation level (SpO2). It is important to evaluate the respiratory condition of a patient, especially those with respiratory illnesses like pneumonia.

Evaluate Option A - Toe

The toe can be a site for pulse oximetry measurement. However, poor peripheral circulation, cold extremities, and long nail beds can cause false readings. Additionally, in elderly patients, these issues are more likely to occur, making the toe not the optimal site in this context.

Evaluate Option B - Finger

The finger is the most common and accessible site for pulse oximetry. It provides quick and accurate readings in most cases. Unless there are indications like finger injury or severe peripheral circulation issues, the finger is a reliable site for pulse oximetry.

Evaluate Option C - Earlobe

The earlobe provides a good reading, particularly when the peripheral circulation is poor. However, it might cause discomfort and inconvenience to the patient when compared to the finger. Additionally, it may be less suitable for continuous monitoring.

Evaluate Option D - Nose

The nose is not a commonly used site for pulse oximetry and can cause discomfort to the patient. Its accuracy is also questionable, as there is a lack of sufficient reference data for readings from this site.

Determine the Best Site

Based on the analysis of each site's advantages and disadvantages, the finger is the most suitable site for pulse oximetry placement in the context of an elderly patient with pneumonia. Option B, the finger, is the correct answer.

Key concepts

Respiratory Assessment

Respiratory assessment is a critical component of patient care, particularly for individuals with conditions impacting their lung function such as pneumonia. This involves evaluating respiratory rate, depth, pattern, and effort, as well as checking for signs of distress or hypoxia. Key aspects include auscultation of breath sounds, noting any abnormalities like wheezes, crackles, or absence of breath sounds, which may indicate underlying pathologies.

Oxygen saturation levels play a vital part in this assessment, with pulse oximetry serving as a standard tool. Accurate assessment of respiratory status informs clinical decision-making, helping healthcare providers determine the severity of a patient's condition and guide further interventions.

Patient Monitoring Techniques

Patient monitoring techniques encompass various methods and equipment used to observe and measure physiological functions continuously or at intervals. In addition to pulse oximetry, other common techniques include electrocardiography (ECG) for cardiac activity, blood pressure measurement, capnography for expired CO₂ levels, and temperature monitoring.

These techniques are essential in detecting any changes in a patient's condition, allowing for timely interventions. With technological advancements, monitoring devices have become more sophisticated, offering a range of parameters that can be tailored to individual patient needs, thus facilitating comprehensive and dynamic patient care.

Nursing Interventions

Nursing interventions are actions taken by nurses to improve patient outcomes. These can be preventive, therapeutic, or palliative. When dealing with respiratory illnesses, interventions might include administering oxygen therapy, encouraging deep breathing exercises or coughing to clear lung secretions, and positioning the patient to facilitate easier breathing.

Education on smoking cessation, if applicable, and ensuring vaccinations like the pneumococcal vaccine are up to date are also critical. Monitoring with pulse oximetry is amongst these interventions, providing real-time data on the patient's oxygenation status and indicating if additional interventions, such as titrating oxygen flow, are necessary.

Clinical Decision-Making

Clinical decision-making is a complex process that involves gathering data, critical thinking, and applying clinical knowledge to identify and solve patient problems. It includes considering the patient's history, symptoms, and diagnostic test results, such as pulse oximetry readings, to make informed choices about their care plan.

It's essential to incorporate both evidence-based practice and patient preferences when making decisions. For example, in choosing the optimal site for pulse oximetry, factors like the patient's comfort, the condition of potential sites (e.g., poor circulation in extremities), and the necessity for continuous versus spot-check monitoring must all be integrated into clinical judgments to provide the best patient care.