What to Do When Endotracheal Tube Insertion Goes Wrong

What finding after endotracheal tube insertion would require immediate action by the nurse?

• A. Breath sounds can be heard bilaterally
• B. Pulse oximetry of 88
• C. Client is unable to speak
• D. Mist is visible in the T-Piece

Answer: (B)

After endotracheal tube insertion, a pulse oximetry reading of 88% indicates that the patient's oxygen saturation level is significantly below the normal range of 95-100%. This low reading suggests that the patient may be experiencing hypoxemia, which can quickly lead to tissue hypoxia and other serious complications if not addressed immediately. In the context of airway management, hypoxemia can occur for several reasons, including improper placement of the endotracheal tube (e.g., in the esophagus instead of the trachea), inadequate ventilation, or a significant respiratory issue. Therefore, a pulse oximetry reading of 88% is a critical finding that necessitates urgent intervention, which may include confirming correct tube placement, providing additional oxygen, or initiating manual ventilation. Breath sounds being present bilaterally is a reassuring sign and indicates that air is reaching both lungs. While the client being unable to speak is typical after intubation and therefore not an immediate concern, it does not imply a pathology requiring immediate action. Likewise, mist in the T-Piece is often a normal finding indicating humidity and moisture, suggesting appropriate humidification in the airway management process, and does not require urgent intervention.

Every RN knows the stakes are high when it comes to airway management, especially after inserting an endotracheal tube. It’s a procedure that’s as vital as it is delicate. Now, let’s talk about one crucial scenario when you might need to spring into action: a pulse oximetry reading of 88% following intubation. Yikes, right?

Why does this matter so much? A reading of 88% isn’t just a bad hair day; it’s a glaring red flag in the nursing world. Normal oxygen saturation levels range between 95-100%. So when your patient dips below that, you're looking at hypoxemia—a serious condition that can spiral downward fast.

Think about it: if the oxygen level is low, that could signal a possible disaster. Maybe the endotracheal tube is misplaced (it’s happened before), or there's a bigger respiratory problem bubbling under the surface. Whatever the reason, nursing intervention must be swift and decisive. Immediate actions might include checking tube placement, providing supplemental oxygen, or initiating manual ventilation.

But let’s compare this with other scenarios you could see after intubation. If breath sounds are audible bilaterally, you might breathe a sigh of relief. It means air is making its way to both lungs—phew! Then again, when patients are intubated, they naturally can’t speak—no need to panic there. It’s just part of the intubation process. And mist in the T-Piece? That’s usually a good sign too, indicating humidity—nothing to stress over.

So, next time you’re faced with nursing assessments after endotracheal tube placement, keep your eyes peeled for those pulse oximetry readings. They’re more than just numbers; they’re potential warning signs. If that reading drops, remember—the quicker you act, the better the chances for your patient.

It’s this blend of vigilance and knowledge that truly defines effective nursing. If you're preparing for the HESI Registered Nurse EXIT Exam, keeping these key points in mind will surely give you an edge. Studying beyond textbook definitions and embracing real-world scenarios like this one can make a world of difference come exam day. Take a deep breath—you’ve got this!