How can I explain to a LOL

Nurses General Nursing

Published

Specializes in Med-Surg/Tele, ER.

Ok everybody, I am at my wits end with this pt of mine :banghead:and could use some ideas. This LOL is a classic pink puffer, came in to the E.R. with COPD exacerbation and was admitted to the floor. At home the pt was using her O2 at 3-4 LPM continuously. The problem is her ABG's showed a high critical CO2 level (78) meaning she is retaining CO2. We turned down her O2, explained to the pt why, explained to the family why increased O2 causes increased CO2 retention and all that. Ever since, this LOL has been on the call light every 30 min. minimum begging me to turn up her O2. I keep explaining, but I'm not getting through to her that IT WILL KILL HER! Any ideas of how to get through to her? Her Co2 retention is causing her to be SOB and all that is what I need to explain. I have tried explaining that she needs more effective breaths, not more O2, but no go. Thanks!

Up Vote Up Vote ×
Specializes in ED/trauma.

Try having an RT (or even the doc, esp a pulmonologist!) explain it to her. Although, all the explaining in the world may not help simply because the average Joe/Jane doesn't understand physiology like we do. Neither does his/her family. Their understanding is simple: More oxygen = more "air" = better breathing. They don't understand that COPD doesn't follow the same rules of oxygentation as it does for the "normal" person.

If all else fails, document your butt off! I've given tons of education to patients, yet they still refuse treatment. If the patient continues to demand more O2 throughout your shift, which prevents you from providing safe and effective care to your other patients, then you can't stop this particular patient. Just remind them that they are jeopardizing their health by not following their plan of care. And then document some more!

Good luck!

Up Vote Up Vote ×
Specializes in IMC, ICU, Telemetry.

Perhaps a bipap might help in this case - the pt will feel like she's getting the amt of air she's been begging for and it will help her blow off all that extra co2.

Some ativan and or morphine might be of benefit as well.

Up Vote Up Vote ×

Tell her the excess O2 will make air bubbles in her blood that could cause her to have an blood clot or worse. Tell her she will eventually start fizzing like a bottle of soda if she doesn't heed your warning.

Up Vote Up Vote ×
Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
Tell her the excess O2 will make air bubbles in her blood that could cause her to have an blood clot or worse. Tell her she will eventually start fizzing like a bottle of soda if she doesn't heed your warning.

:chuckle

Up Vote Up Vote ×
Perhaps a bipap might help in this case - the pt will feel like she's getting the amt of air she's been begging for and it will help her blow off all that extra co2.

Some ativan and or morphine might be of benefit as well.

Good thinking.

Up Vote Up Vote ×

i agree w/maolin.

nothing worse than air hunger.

if she's not getting her o2, it's causing her unneeded anxiety.

get her some mso4 and ativan.

and yes about the bipap.

ftr, docs are consistently split re administering o2.

some will crank it up on a short term basis:

others give it minimally.

what does this pt's doctor say?

he should be involved to give her the add'l meds she needs.

she's not hearing what you say because all she knows is that o2 makes her breathe easier.

keep in mind, co2 retainers have compensatory mechanisms that enable them to function.

if she is alert, i wouldn't be as focused on the numbers.

pt presentation is half the assessment.

leslie

Up Vote Up Vote ×
Specializes in Med-Surg/Tele, ER.

Hi all and thanks for the replies. The LOL IS on ativan q4-6 as well as buspar (sp?) We also keep getting conflicting orders on her (she's been here a couple of weeks) One day it's DON"T LET HER SATS GET ABOVE 91%, The next day is 93%. Today she is at 98% and the doc says leave her at 2 LPM to keep her happy. The doc tells me to turn her up to 2 and if she seems comfortable, gradually turn it down. Then she (the doc) tells the pt that her o2 can be at 2LPM all the time! So, the pt freaks when she looks up at her oxygen and sees it lower than 2 (causing SOB and the whole 9 yards). That's why I wanted to try and get through to her the reason why we turn it down. The bipap is a great idea, but the only ones in the hospital belong to sleep study (and we can't raid them lol)

Up Vote Up Vote ×
Specializes in ICU, telemetry, LTAC.

This is not related to your original problem, but WHAT THE HECK KIND OF HOSPITAL does not have Bipap available to floor patients if the doctor orders it? What do you do if a patient on home bipap is admitted emergently and needs it, due to some circumstance didn't bring their own? You need to raise holy heck over that issue alone; respiratory should have them available for the patients. Our facility went through a little bit of that issue last year when we had two patients who needed it, and one bipap in the facility. Lemme tell ya there was enough said, and enough paperwork put forth on it, that there is bipap, cpap, and vents enough to go around now. Just imagine trying to tell a physician their patient can't physically have what they need, can we please use something else? It wasn't pretty.

Up Vote Up Vote ×

What the others said. She needs and anxiolytic. I'd be terrified if it felt like I coulnd't breathe.

Up Vote Up Vote ×
Specializes in Assisted Living, Med-Surg/CVA specialty.

What's an LOL? I see LOL and think of laugh out loud.

Up Vote Up Vote ×
Specializes in ICU, telemetry, LTAC.

Little Ole Lady

Up Vote Up Vote ×
+ Add a Comment