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- Nov 23, '11 by CreamsodaFrom what i could infer from you post, they made her hospice. Im assuming she was a DNR/DNI. Bipap might help with the co2 in the short-term if she can tolerate it, but if she's retaining co2 that bad, next step is intubation and mechanical ventilation. Very hard with end stage COPD'ers to get them off that vent, hospice is often the best thing when its end stage.
- Nov 23, '11 by diva rnGreentea....your grid brought back memories of a similar one a R/T in PICU drew for me many, many years ago....I had forgotten about it...
You are AWESOME!!!!
- Nov 23, '11 by GrnTea::[color=pink]blushing:: aw shucks.
seriously, though, thanks for the kind words.
i remember so vividly what it was like to be totally clueless and have somebody tell me something in the same language that confused me in the first place, over and over. then i was blessed with some really good clinical teachers in my first critical care job, and once the light came on, it stayed on. i learned to explain things in plain english and to keep trying other ways if i wasn't getting those "aha!" looks from my students. but i stand on the shoulders of giants.
i knew i was getting ok at some of this when driving home one night with my kids, aged 5 and 8, from a class i taught on f&e that i had to take them to, having no babysitter that evening.
my 8-yr-old said, "mom, what's kay?" "oh," said i, "that's k, the abbreviation nurses use for potassium." "ok," she said. "now i get it."
(now she's a college physics professor, but still.:d)
- Feb 27 by srichardsonI just saw your post. I'm on 2 liters myself for COPD. My mother just went on Hospice for a severe heart condition. They have her on 15 liters of oxygen. I did learn in Pulmonary Rehab that you have to be careful when you increase the oxygen as the brain does tend to tell the body that it's getting enough. I know some have to be on more, but then you need to watch the extremities of the body as they may not really be getting the proper oxygen reguired. She has 3 arteries in her heart totally blocked and one that they could only get a balloon in so the blood is only dripping slowly to the two lower chambers in her heart.
- Feb 27 by TiffyRNTo the OP,
I'm so sorry your family is going through this tough time. We have no way to determine all that has gone into the decision to place your grandmother on hospice care. Even if we did, it is not within the scope of this board to advise you on that.
As for the hypoxic drive theory and COPD patients, I have learned recently that this is more a theory but not so much based on science. I found a great blog site from an RT that provides multiple scholarly references explaining how the hypoxic drive theory has fallen out of favor as it does not hold up to rigorously controlled trials (but continues to be taught to students).
Regardless of the current science, if your grandmother is on hospice care, the focus there is comfort and oxygen is very comforting to a hypoxic patient regardless of their CO2 retaining status. I don't know how aware your grandmother is, but even minimally aware people can be comforted by the presence of their loved ones and that would be my advice to you.
Respiratory Therapy Cave: Hypoxic Drive Theory: A history of the myth
- Feb 27 by PoochiewoochieQuote from TiffyRNThe OP posted this in 2011-I'm sure her grandmother is no longer on hospice.To the OP,
I'm so sorry your family is going through this tough time. We have no way to determine all that has gone into the decision to place your grandmother on hospice care.
- Feb 27 by TiffyRNQuote from PoochiewoochieWhoops, I'm usually check that stuff better. So I guess she's not a new grad either now.The OP posted this in 2011-I'm sure her grandmother is no longer on hospice.
- Feb 28 by uRNmywayI know this thread is old, but Grntea, I want to give you a standing ovation on that metabolic/respiratory acidosis vs alkalosis post. Even while lying in bed fighting my melatonin, I understood what you were explaining, and I'm one of those who has a difficult time with the blood gas stuff most of the time. Thank you SO much, I will definitely be carrying that around on some kind of cheat sheet!