Resident with End-Stage COPD

Specialties Geriatric

Updated:   Published

Horribly anxious. Increasingly dependent with ADLs and losing continence, which is new. Obsessed with her bowel movements - it's hard for her to defecate 2o exhaustion. Very frail, arthritis, already on axiolytics and we started her on Vicodin yesterday for severe back pain. She has been in bed moaning, "Oh, dear, oh dear" and, while I feel great sympathy, she is driving me nuts while breaking my heart.

Any suggestions? We have speech working with her on eating because she gobbles from fear of getting too tired to finish which, of courses, exhausts her.... it's a vicous circle.

1 Votes
Specializes in Hospice, LTC, Rehab, Home Health.

COPDers are always a challenge. No big ideas but maybe several small meals instead three big ones and nutrient dense snacks/ house shakes for in between meals.

1 Votes
Specializes in cardiac, oncology.

Try a small dose ativan for the anxiety or maybe morphine nebulizers? Also be sure she is on Miralax daily to help with her bowels, esp now on Vicoden.

These patients are sure hard to take care of due to multiple problems caused by copd.

1 Votes
Specializes in Infusion, Med/Surg/Tele, Outpatient.

Get with the dietitian and do a 3 day calorie count. This might seem crass, but is she OOH DNR - is she at a point where y'all can make her comfortable - Ativan q 1-2 hrs, Roxanol q 1-2 hours, Miralax, Dulcolax? Or does she need a higher level of care?

1 Votes
Specializes in Geriatrics, Transplant, Education.

Would definitely get some Roxanol on board--maybe scheduled, and then a prn dose for breakthrough pain or resp distress. Definitely some Ativan too...what is she already on for anxiolytics?

I'd definitely get a bowel program going as well. I had an end stage COPDer on Miralax BID and Amitiza which seemed to work well for her.

Is she being seen by hospice?

1 Votes
Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.

We did scheduled lorazepam, roxanol, miralax, senna. MD added theophylline. Tried Medrol dose pack during flare ups. Made sure o2 was humidified. Scheduled duonebs. Grouped together cares & room order to ensure more rest time. Private room. Commode and urinal at bedside. Teaching staff to use a calm approach and establish a routine. Finally the pt agreed to hospice, but hospice just really continued with the med regiman we got him on. The pt really enjoyed the hospice reflexologist that visited. I'm sure this all helped improve the quality of his life some but the end was still a battle. This guy was the first pt that died while I was holding his hand and he struggled so much, all I wanted to do was make him comfortable.

1 Votes

Duoneb, xanax (added PRNs to scheduled) today, prednisone, tessalon perles, Spiriva, Miralax, Ceftin, Colace, Vicodin, and 11 other meds, including cardiac and HTN. The doc looked at her today and she's going to tweak what we're doing for her.

Thanks, all. She is not quite at the roxanol stage. We don't accept hospice patients but we are good at comfort care.

We'll see how the extra Xanax goes.

1 Votes
Specializes in Gerontology, Med surg, Home Health.

Sounds like she might have terminal agitation....see if you can get an ABHR suppository or gel. Ativan, Benedryl, Haldol, and Reglan. I've seen it work wonders.

1 Votes
Specializes in LTC, Hospice, Case Management.
CapeCodMermaid said:
Sounds like she might have terminal agitation....see if you can get an ABHR suppository or gel. Ativan, Benedryl, Haldol, and Reglan. I've seen it work wonders.

I have never heard of this, but without ever hearing the formal term "terminal agitation" I know I have seen it. So this is one suppository containing all 4 of those meds? Interesting. Gonna go Google this and keep this in the back of my head.

1 Votes
Specializes in Gerontology, Med surg, Home Health.

Yes..it's one suppository with all those meds in it. Not that I would think a suppository is a comfort measure, but the proof is there. The combination of medications make a huge difference. Try calling your Hospice provider.

1 Votes

CCM, she had a very good day. I told the floor nurses to hold the RS Tylenol and use the Vicodin along with the PRN Xanax and have requested that the doc d/c it and make the Vicodin RS. She was comfortable today for the first time in a long time. Slept most of the day and that's fine. I've spoken with the daughter and all she wants is for her mom to be comfortable. She's already on Reglan, BTW.

Thanks.

1 Votes
Specializes in LTC.
CapeCodMermaid said:
Yes..it's one suppository with all those meds in it. Not that I would think a suppository is a comfort measure, but the proof is there. The combination of medications make a huge difference. Try calling your Hospice provider.

Ah, we have a cocktail likes that but ours is BARD gel - Benadryl, Ativan, Reglan, decadron. It comes in a syringe and you put like 0.25 mL on the inner aspects of their wrists and they rub it in. It's fabulous!

1 Votes
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