[saribeth]

Hi all need help with this one...had a 95 y o pt with a FTT dx...she was doing ok, pleasantly confused...facility called yesterday to say she was coughing up a lot of frothy sputum...I made a visit and she was coughing up a lot of sputum, lungs were clear, R were 32, legs were 2+ edema...called MD to order Roxanol and Levsin...helped the pt to the commode at 3:30p, told her I would see her the next day & left...got a message that pt had exp at 5:45p...could have knocked me over with a feather...stunned...possible aspiration????, probably going into heart failure... By the time I could have gotten a suction machine out there I think it may have been too late...should I have had her go to the ER for suctioning? I am sturggling with this one...any info would be appreciated. Thanks so much Janie

[mommazac]

Sounds like she was in flash pulmonary edema, suctioning would not have helped. You did the right thing getting a Roxinal and Levsin order. Seeing to her comfort and providing her with the care you did was all you could do.

[sumrluvr73]

frothy sputum often means pulmonary edema, suctioning probably wouldn't have helped much. Our hospice orders are for scopalomine patches for increase in secretions for comfort.. She was 95 and FTT. You make a visit and got orders........did you report your findings to the doc? If so then it was what you should have done. We never send pt's to ER unless they fall or have some sort of trauma. Just do our best to treat sx at home or in the NH and support the family.

[jessica]

Pulmonary edema was the first think that popped into my mind too. Roxanol to ease respiratory distress and Levsin to dry up secreations.

My only question in regard to the Levsin and secretions would be that the secretions were not oral in nature they were from the lungs. Would someone care to broach the subject on how Levsin would decrease bronchial secretions? Just curious on the rationale and I certainly don't mean to change the subject on Saribeth's post.


Jessica

[sumrluvr73]

doesn't matter where the secretions are, the meds work systemically

[saribeth]

We rarely send pts to the ER unless it is a possible fx or some other situation ie g tube falling out...thanks for your input and yes I did tell the Doc all of her sx...she is resting in peace and I am trying to do the same!

[earle58]

Originally Posted by saribeth

We rarely send pts to the ER unless it is a possible fx or some other situation ie g tube falling out...thanks for your input and yes I did tell the Doc all of her sx...she is resting in peace and I am trying to do the same!

omg, i would be horrified if your pt was transferred to the e.r.
saribeth, i smile at your story, recalling all of the 'lols' i've cared for.
as a doctor once complained to me, "i can't put cardiopulmonary arrest down as a cause of death anymore!".
but that's what it is at 95 yo: cardiopulmonary arrest.
she died quickly.
and pleasantly confused.
to me, it doesn't get any better.

leslie

[EmptytheBoat]

Lungs clear, +2 pitting edema BLE; possible fluid overload from CHF, IM lasix may have helped relieve symptoms; reposition patient on side to allow drainage, possible neb treatment; continue to treat symptoms, oxygen and anti-anxiety medications first for SOB if repositining does not resolve; I'm not one to use antichlorinergic for " a lot of frothy sputum ". Don't beat yourself
up, your learning to ask the right questions, your patient was 95 years old,
she had a full-life. Best wishes on your career!

P.S. Hospice patients are not sent to ED for symptom management

[doodlemom]

Originally Posted by sumrluvr73

doesn't matter where the secretions are, the meds work systemically

It will not work on pulmonary edema.

[earle58]

Originally Posted by doodlemom

It will not work on pulmonary edema.

i had a doctor that ordered lasix iv stat, for flash pulmonary edema.
it did nothing for this pt.
but the crisis passed within 5 minutes and pt eventually stabilized....after more iv lasix and iv k+....