I recently had a patient who was nasotracheally intubated and on a
ventilator who would drop his SPO2 down into the 70s without explanation. No
ventilator alarms sounded and his pulse oximeter probe was functioning
properly.
The respiratory therapist was called to assess and could not find an
immediately recognizable problem. She put her ear down close to his mouth
and could hear a small air leak around the cuff. The leak was not
significant to trigger a low exhaled volume alarm on the ventilator, but it
was significant enough to drop his SPO2. It was also not audible without
putting her ear down close to the patient's mouth.
From that time on I would frequently listen down close to his mouth in an
attempt to detect any leak.
In your professional experience and opinion, would it be considered
acceptable and necessary practice for me as his nurse to frequently assess
his airway for this leak as I have described to you above? Do you consider
it violating this patient's boundaries by putting my ear down close to his
mouth to assess his airway for a leak? I have been accused of a boundary
violation for this reason and I can't see where I have violated any
boundaries here. I need a professional opinion from a neutral, objective
professional and would appreciate your input.

Thanks,
Bryan Mildenhall
Salt Lake City, UT