A client arrives in the emergency department on a cold winter day. The client is calm, alert, and oriented with a respiratory rate of 20/min and a pulse oximeter reading of 78%. The nurse suspects that the client's pulse oximeter reading is inaccurate. Which factors could be contributing to this reading? Select all that apply. A)Black fingernail polish B)Cold extremities C)Elevated WBC count D)Hypotension E)Peripheral arterial disease

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11ecbb05_cb82_2fbb_b433_7b50f75ed746_MD0009_00 A pulse oximeter is a noninvasive device that estimates arterial blood oxygen saturation by using a sensor attached to the client's finger, toe, earlobe, nose, or forehead. The sensor (reusable clip or disposable adhesive) contains light-emitting and light-sensing components that measure the amount of light absorbed by oxygenated hemoglobin. Because the sensor estimates the value at a peripheral site, the pulse oximeter measurement is reported as blood oxygen saturation (SpO₂). Normal SpO₂ for a healthy client is 95%-100%. Any factor that affects light transmission or peripheral blood flow can result in a false reading. Common causative factors of falsely low SpO₂ include: Dark fingernail polish or artificial acrylic nails (Option A) Hypotension and low cardiac output (eg, heart failure) (Option D) Vasoconstriction (eg, hypothermia, vasopressor medications) (Option B) Peripheral arterial disease (Option E) (Option C) Abnormal WBC count has no direct influence on light transmission or peripheral blood flow. Educational objective: Any factor that affects light transmission or peripheral blood flow can cause a falsely low reading for oxygen saturation on pulse oximeter. Common causes include dark nail polish, hypotension, low cardiac output, vasoconstriction (eg, hypothermia, vasopressor medications), and peripheral arterial disease.

A Client Arrives in the Emergency Department on a Cold