Comfort measures for an end stage COPD pt

Blessed RN · Jan 25, 2009

OK...just got off work..whew!

My poor fellow was transferred to the unit before my shift began last night. I think he's in denial about his prognosis.

While he was on the floor, I had fans going, temp down as far as it would go. I'm not sure why exactly he refused anxiety meds, but I did encourage him to take them and explained why these would help. Talking is extremely taxing for him, so he wouldn't go into details, only quick bursts of "no, no."

O2 was at three liters. He was acidotic. No surprises here. pCO2 on the high side. PO2 in 50s. Normal for COPD. O2sat between 88 and 93 all night.

He was on all meds mentioned for COPD; Solumedrol and as many neb tx as is allowed. Sometimes refused continuous neb tx because it made him feel smothered. Only thing he wouldn't have was the Morphine, even after encouragement. I think maybe the MD will have to convince him on the anxiolytics and morphine. He refuses to listen to us.

I was in his room every 20 minutes to give him bites of jello or pudding; he couldn't take more than one bite every few minutes or so because chewing causes him to be SOA. Pitiful. He previously had a corpac but was removed...pt felt smothered by it.

He's probably on the vent now.

I wish I could have eased his suffering somehow. I guess it's the reality of the disease.

nerdtonurse?, BSN, RN · Jan 25, 2009

The worst part of the end stage COPDers (to me, anyway) is when they are terrified to be left alone, grabbing at your hands, begging you to stay, and because you've got 5 other folks, you can't stay. The ones with no family, no sitters, nobody that can stay with them thru the night, it breaks my heart.

Unfortunately, the ones that are like the OP's pt, sometimes they are in such denial, nobody can even start to bring up end of life issues without making things worse -- panic, anger, which leads to more breathlessness and anxiety.

Sometimes, I've given them ice packs to put on their forehead, or throat, or wrists, and that may help a little (big bag, not a lot of ice, just so they can feel the cold, more than anything else). Sometimes Lasix, sometimes solumedrol help, but generally, the one's I've had that remain a full code end up on a vent in the unit, and stay there until they finally die.

Daytonite, BSN, RN · Jan 25, 2009

I worked on a stepdown unit where we had a lot of end stage COPDers who were frequent flyers. We got to know them pretty well. What I used to do was spend as much time with them as I could. I seldom sat at the nurses station except when I had to do my time at the telemetry monitors. I would park my medication cart outside the room of this type of patient and let them know I was always nearby. I would poke my head in their room and inquire on how they were and if they needed anything all the time. I would let them see me as much as possible so I would keep the door to their room open and the curtains pulled back so they had a clear view of the hallway unless they objected. We also got them moved to a room as close to the nurses station as possible. When I did sit down to chart I would often sit at their bedside if they wanted someone near them. The biggest fear of COPDers is that they will suffocate and be alone. Because of their anxieties, the constant coughing and sputum production there aren't many people that want to be around them. Isolation isn't fun. Many of these people were once outgoing, happy smokers who are now depressed. I tried to remember that and not increase their isolation. Always remain calm around them even when they are having a breathing crisis.

leslie :-D · Jan 25, 2009

morte said:
This man intends to go home and care for his wife, therefore he cant, in his mind, be overly sedated.....many things need to be done, not much can be until he acknowledges he is dying.......he needs to make provisions for his wife's care, or delegate such, and prob. is not going to do this, because it would be admission of his on inability.....and mortality.......

Bingo...when I reread this thread, I noticed about his sick wife...

And am certain he needs to finish some business before dying.

I'm pretty sure he's not afraid of dying, but afraid of no one being there for his wife.

Time to get ss involved??

Daytonite said:
I worked on a stepdown unit where we had a lot of end stage COPDers who were frequent flyers. We got to know them pretty well. What I used to do was spend as much time with them as I could. I seldom sat at the nurses station except when I had to do my time at the telemetry monitors. I would park my medication cart outside the room of this type of patient and let them know I was always nearby. I would poke my head in their room and inquire on how they were and if they needed anything all the time. I would let them see me as much as possible so I would keep the door to their room open and the curtains pulled back so they had a clear view of the hallway unless they objected. We also got them moved to a room as close to the nurses station as possible. When I did sit down to chart I would often sit at their bedside if they wanted someone near them. The biggest fear of COPDers is that they will suffocate and be alone. Because of their anxieties, the constant coughing and sputum production there aren't many people that want to be around them. Isolation isn't fun. Many of these people were once outgoing, happy smokers who are now depressed. I tried to remember that and not increase their isolation. Always remain calm around them even when they are having a breathing crisis.

Bravo, joyce!!

Quiet, calm, reassuring environment.

Good for you!!

litbitblack, ASN, RN · Jan 25, 2009

Yes it sounds like ss needs to be involved whole heartedly.