COPD, smoking & anxiety

[PeruRN]

I work at a long term care facility. We have a resident in her early 60's with COPD, on 2 l of o2. Which goes outside off o2 to smoke a couple of times an hour. Then is wanting inhalers and nebulizer as soon as she gets back to her room. In addition wants lorazepam every 4 hours then wants midazelam (2,5mg) sc. In addition to all this she has 45ml of vodka tid and a few beers........all to help her cope with anxiety. She is an ex nurse and "knows her rights". I have tried to talk with her about her anxiety and to address the issues rather than demanding meds. I'd appreciate any input as I'm struggling to help the lady in a meaningful way. I do have to say I have observed quietly and she seems not to have real respiratory distress, yet when I knock on her door and approach her she starts gasping. O2 sats 93-94% on 2l o2. Anyone care to share their experience..insight. respiratory care has never been my forte. Thanks. I just requested the respiratory team to come and review her care but that won't happen till midweek and I'm working all weekend with this lady. Thanks

[ChryssyD]

Anxiety is very common in COPD--not being able to breathe can be quite distressing! However, if she's smoking, I'm all out of sympathy. She can smoke or she can breathe a bit easier, but she can't do both. As far as the multiple drugs (including alcohol) being used to manage anxiety, I can't say how necessary any or all of them are, but it sounds like this lady might be enjoying her anxiety a bit too much.

But...you can't change people who don't want to change. If her doc is willing to dope her up while she's drinking, all you can do is voice your concerns and then let it go. She isn't the first person to exaggerate her symptoms to get drugs and/or attention and she won't be the last.

[Silverdragon102, BSN]

Unfortunately, it is a pattern they have gotten into. Best will in the world is for clients to stop smoking especially when they have lung disease, however, form many it is an addiction or habit and one they do not want to break.... many I am sure fell that the damage is done so they may as well enjoy what little time they have left (please note this is my opinion and based on what some have said to me their feelings)