Pre judging

  1. My mom had COPD, and occasionally was hospitalized for pneumonia. I always knew the COPD would catch up with her. She was discharged from the hospital with oxygen and a home respiratory therapist. She was constantly SOB and it was getting worse, although she was satting around 95 on oxygen and 92 on room air. But despite the numbers she was still symptomatic and weak. Hmmm, what's going on here? Her doctor attributed it to COPD. Her RT attributed it COPD. Hell, I attributed it to COPD and was preparing myself for the worst. But why were her sats normal? I must admit I suspected she was malingering.........until she had a routine CBC. She has a history of angiodysplasia, and somewhere between her hospitalization and the CBC, she started bleeding internally. Her crit was 4. That's right, 4. Her doc immediately hospitalized her for blood transfusions, while I just sat there and ate crow. Holy Jesus no wonder she was SOB and weak.
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  2. 16 Comments

  3. by   soltera
    Quote from mwcia12
    My mom had COPD, and occasionally was hospitalized for pneumonia. I always knew the COPD would catch up with her. She was discharged from the hospital with oxygen and a home respiratory therapist. She was constantly SOB and it was getting worse, although she was satting around 95 on oxygen and 92 on room air. But despite the numbers she was still symptomatic and weak. Hmmm, what's going on here? Her doctor attributed it to COPD. Her RT attributed it COPD. Hell, I attributed it to COPD and was preparing myself for the worst. But why were her sats normal? I must admit I suspected she was malingering.........until she had a routine CBC. She has a history of angiodysplasia, and somewhere between her hospitalization and the CBC, she started bleeding internally. Her crit was 4. That's right, 4. Her doc immediately hospitalized her for blood transfusions, while I just sat there and ate crow. Holy Jesus no wonder she was SOB and weak.

    OH MY GOODNESS!!! how is she doing now?
  4. by   nursemary9
    Hi

    Holy Moly!! Hope Mom is better!! That sure is good reason for her symptoms!!

    We do get a fair number of patients, tho, with COPD who sat. just fine but are still symptomatic.

    Let us know hows she is doing!!
    Don't be too hard on yourself either!!
  5. by   suzanne4
    This just gives more fuel to my theory, you have to treat the patient and not go just by the numbers that you see. She was "satting" okay, but symptomatic...................

    Glad to hear that they found out the cause.............I give my students case studies like this all of the time to show them what can happen...............

    Please keep us posted on how she is doing....
  6. by   flowerchild
    Even if you had identified the problem for what it was. Would anyone had listened to you? Don't be so hard on yourself. The s/s, the doc statements, etc led you to believe it was just the COPD. Anyone would have done the same. Everytime I try to tell the docs what I think it is, I have been discounted to nothing, it's like they think they are the only ones who know, they don't listen and try to disprove me which only lengthens the time that my family gets help. I have been correct in my assumptions EVERY time but it has been only a hindrence to their care. So perhaps it was best you didn't ID it and push the issue. It's never worked for me. Again, don't be so hard on yourself. I hope your Mom recovers quickly.
  7. by   SmilingBluEyes
    a really good reminder not to be so quick to judge quickly indeed.

    4

    wow! never seen a 4 in any patient of mine, ever ...eek!

    hope she came thru ok?
  8. by   leslie :-D
    one time i had a pt. who was sob, diaphoretic, pale and diminished lung sounds. he was a brittle diabetic w/crf. he was satting at 96% on ra but i sent him out and the emt's gave me such a hard time yelling "HIS 02 SAT IS 96%!!!" I told them to look at him and not the oximeter. they sent him out and he was in acute heart failure. the advice re: looking at the patient and not the numbers is so true. oximeters don't always tell the whole picture.
  9. by   jemb
    Yikes! I thought I'd seen low crits with oncology pts!

    I once had a patient walk in with c/o SOB. Her Hgb was 3 and the crit was 15. I think that's the lowest I've come across in a living, breathing human being.
  10. by   VivaLasViejas
    Quote from earle58
    one time i had a pt. who was sob, diaphoretic, pale and diminished lung sounds. he was a brittle diabetic w/crf. he was satting at 96% on ra but i sent him out and the emt's gave me such a hard time yelling "HIS 02 SAT IS 96%!!!" I told them to look at him and not the oximeter. they sent him out and he was in acute heart failure. the advice re: looking at the patient and not the numbers is so true. oximeters don't always tell the whole picture.
    I recently had to "educate" one of our physicians about that........the other night we had a fresh post-op (liver biopsy) whose Sp02 was 97% on 5 liters, but whose respiratory rate was 40, lungs were coarse & wheezy, and his skin color was gray. He was clearly in distress, yet his BP remained stable and the SP02 never dropped below 95%. I called the MD twice to report his worsening resp. status, and all he wanted to know was "what're his sats?"
    Finally, he decided to come in and see what I was nagging about, and suddenly we're pushing Lasix and getting a NRB mask and doing nebulizer treatments. We ended up moving the pt. to ICU after all this......and do you know, the man's sats never did go down during this whole ordeal. But he looked, and was, critically ill.

    I was glad we had some students there that evening, as well as a couple of newer nurses who still rely on pulse oximetry to tell them how a patient is doing. They got to see firsthand an example of how you need to look at the PATIENT and not just the monitor!!
  11. by   BadBird
    We must remember to always check the patient and not believe the numbers if the symptoms don't correlate. Good lesson learned here. I hope your mother is better.
  12. by   Havin' A Party!
    Quote from SmilingBluEyes
    a really good reminder not to be so quick to judge quickly indeed...
    Absolutey right!
  13. by   suzanne4
    Quote from flowerchild
    Even if you had identified the problem for what it was. Would anyone had listened to you? Don't be so hard on yourself. The s/s, the doc statements, etc led you to believe it was just the COPD. Anyone would have done the same. Everytime I try to tell the docs what I think it is, I have been discounted to nothing, it's like they think they are the only ones who know, they don't listen and try to disprove me which only lengthens the time that my family gets help. I have been correct in my assumptions EVERY time but it has been only a hindrence to their care. So perhaps it was best you didn't ID it and push the issue. It's never worked for me. Again, don't be so hard on yourself. I hope your Mom recovers quickly.
    I don't agree with you that you are just supposed to sit back and possibly let someone die because the physician was relying on numbers only. A COPDer is normally not going to have a sat of 95%, something else was going on and not with the respiratory system. You have to go by your gut feeling. I have always stood up for what I believed in and as an advocate for my patients.
    Until the physician can prove that I am wrong ............... I do not take no for an answer. The nurse is the one who is with the patient all day, and especially if it is a family member..................remember, you have to definitely stand up for what you believe in, someone's life depends on it.
  14. by   sharann
    What is angiodysplasia? Wishing your mom well.

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