Coughing/Choking Patients

[jetstream13]

I was taking care of a patient the other day and giving them their pills. They swallowed too many at once and began coughing. I've dealt with this situation several times before and my first approach is to simply allow the patient to continue coughing to see if they can clear the blockage on their own. However, my patient's family immediately became panicked and yelled that the patient was choking. As I was assessing their coughing, the family grabbed water and started trying to get the patient to drink some, since I (the nurse) "wasn't doing anything to help them." The patient cleared their throat within a couple minutes and was just fine. They afterwards angrily told the doctor that I "just stood there and watched their mom choke," when in fact I was actually trying to assess the situation to see if the patient could cough the blockage out on their own without help. It may have looked like I wasn't doing anything, but I was. They were alert and breathing, so I didn't need to do the Heimlich Maneuver. If a patient is actively coughing they have a partially open airway, so isn't the best thing to let them continue coughing? Or was there something else I should have done in this situation?

[brownbook]

What a mess.

Of course with an actively coughing patient, good forceful coughing, maybe even some wheezing, good air exchange, you stand and by do nothing. But what a mess with the family right there.

I think I would have done the same as you, I think most nurses would. Obviously your assessment was right on. They cleared their airway fine. But I guess if it ever happens again I would put on the call light, probably just because the family was there, and ask a co-worker to stand by to help just in case they became obstructed. Or ask the co-worker to remove the family from the room! (Kink of joking.)

I can never get my husband to not pound me on the back whenever I start coughing.....he even does this to our pets when they occasionally start coughing something up!

[loriangel14, RN]

If they are coughing then air is getting through. This is not choking. You did fine.

[kiszi, RN]

Your actions were fine, but remember many family members are, ehm, not exactly health literate. Nothing wrong with speaking up, both to explain that she wasn't choking, and to let them know that you are in charge of the situation and have it under control. I would have probably said calmly, "she's not choking, she's coughing. That means she can still breathe. Let's just give her a minute." And some type of action, even a reassuring back back rub and a "that's right, cough it out" might help the family feel like you're "doing" something.

[jdub6]

I agree, you did the right thing. People freak when they see someone "choking." In hospice families would panic all the time about terminal congestion because they thought the pt was choking when in reality their breathing was unaffected, it was just noisy.

Sometimes you can educate these people in the moment or like a pp said talk to the pt for the benefit of the family also: I have often said something along the lines of "that's great, mrs, x, you've got a strong cough, keep doing that and you'll get it all up and then we'll let you have a rest. " I have also reminded families that sound is caused by air movement, thus a choking pt will not make any sound. And, as you said, evidence based recommendations including cpr and bls state that the pts own effective cough is the best intervention and they should be encouraged to do it unless they are no longer able. But sometimes they are too panicked and too convinced they are right and you are evil for you to really be able to do anything. (And sometimes it's all you can do to keep them from smacking their back until they really DO choke,which is why I love the prior suggestion of lightly rubbing the pts back: so the back- pounders will think you are doing it and they don't have to! )

I hope the MD tried to educate them and didn't encourage their belief that you were negligent.

[Jensmom7, BSN, RN]

I agree, you did the right thing. People freak when they see someone "choking." In hospice families would panic all the time about terminal congestion because they thought the pt was choking when in reality their breathing was unaffected, it was just noisy.

And thank Jebus for Atropine drops and Scop patches, right?

On topic; remember, as nurses we are always assessing our patients, many times without them (or their families) even being aware of it.

So, while you were busy assessing how strong her cough was, and whether she was effectively clearing her airway, all the family saw you doing was standing there.

As PP have said, talking calmly to the patient, and the family, and even just putting your hand on her shoulder or back may have helped their anxiety.

Or not. Some families are just bat guano crazy.