Audible Wheezing Question

RedhairedNurse, BSN, RN · Oct 10, 2008

I had a pt that was wheezing, he had COPD. I had him to take a couple of deep breaths and then cough. The wheezing went away after he did that. So I guess it just depends. I don't have a lot of experience to answer this question.

NewWayofLife · Oct 10, 2008

Many wheezes are cleared by a good cough. Not at all impossible.

primalhowl · Oct 10, 2008

So how can I instruct/teach the person and guards that PRN WHEEZING MEANS..

(only wheezing after you cough ?)

Yes, I do have them cough also before I listen, but I guess I call that a "tickle" or ?? something,

but would that actually be a wheeze in (?) what sense.

There has to be a way to explain rationale what we do so that it makes sense to anyone. When I tried to explain 2 different times apparently I used words that were Greek because I only got weird looks....

(dang,I sure miss NICU where mostly "mommie" was spoken.) LOL.:heartbeat

vampiregirl, BSN, RN · Oct 10, 2008

Did this by chance occur after eating a high-acid meal, particularly if the person lay down. Where I'm going with this is GERD and the sometimes very audible ephogeal reflux "wheezing". Could this be a possibility - lungs clear but most of the airway "sounds" over the neck/ esophogeal area? This is another situation where a good cough or throat clearing could lead to a sudden stop in audible wheezing.

Thornbird · Oct 10, 2008

Possibility #1 As above, if he coughed he may have cleared it.

Possibility #2 Not all asthmatics wheeze throughout an attack. Some don't wheeze at all. Sometimes lack of wheezing means they are no longer compensating so the lungs are hyper-inflated to the max and wheezing can't happen. Neither lung sounds nor O2 sats are good indicators for asthmatics. Peak- Flow meters are the best way to determine the status. All asthmatic patients should have baseline peak-flow recorded. Then you can easily determine if there is an airflow exchange problem. It is never contra-indicated to give an asthmatic their prescribed rescue inhaler, usually albuterol, when not sure. When it comes to respiratory and cardiac complaints you still have to give the patient some benefit of the doubt even when they are known to be unreliable, such as addicts and inmates, just because of the very bad consequences of not treating.

I speak not only from professional experience, but personal experience. I have nearly died twice in the ED waiting room because triage nurses heard no wheezes and my sats were fine. Just meant that I was near the end of compensation and pre- respiratory arrest.

here's an adage : "All that wheezes is not asthma and all that is asthma does not wheeze." from paramedic school. That's who I call now when I'm having an attack. Unlike the ED they treat me immediately. Apparently they think preventing avoidable intubation is a good thing.

dusky1228 · Oct 11, 2008

I speak not only from professional experience, but personal experience. I have nearly died twice in the ED waiting room because triage nurses heard no wheezes and my sats were fine. Just meant that I was near the end of compensation and pre- respiratory arrest.

I am one of those "non-wheezers", and it almost got me in a lot of trouble a few times, for the same reason you mention. I then found a good pulmonologist who explained it very simply "You have to be able to get air *into* your lungs before you can wheeze". I now get treated based on my peak-flow results, *not* on whether I am wheezing or not. It's kept me out of the ER, and away from being hospitalized.

RedhairedNurse, BSN, RN · Oct 11, 2008

Possibility #1 As above, if he coughed he may have cleared it.
Possibility #2 Not all asthmatics wheeze throughout an attack. Some don't wheeze at all. Sometimes lack of wheezing means they are no longer compensating so the lungs are hyper-inflated to the max and wheezing can't happen. Neither lung sounds nor O2 sats are good indicators for asthmatics. Peak- Flow meters are the best way to determine the status. All asthmatic patients should have baseline peak-flow recorded. Then you can easily determine if there is an airflow exchange problem. It is never contra-indicated to give an asthmatic their prescribed rescue inhaler, usually albuterol, when not sure. When it comes to respiratory and cardiac complaints you still have to give the patient some benefit of the doubt even when they are known to be unreliable, such as addicts and inmates, just because of the very bad consequences of not treating.
I speak not only from professional experience, but personal experience. I have nearly died twice in the ED waiting room because triage nurses heard no wheezes and my sats were fine. Just meant that I was near the end of compensation and pre- respiratory arrest.
here's an adage : "All that wheezes is not asthma and all that is asthma does not wheeze." from paramedic school. That's who I call now when I'm having an attack. Unlike the ED they treat me immediately. Apparently they think preventing avoidable intubation is a good thing.

Thank you. Very good lesson for us all. And this is a prime example (IMO) of how and why this board of allnurses is here. I remember reading about this in books, but how soon we can forget if we're not exposed.

primalhowl · Oct 12, 2008

This occurred an hour after supper, and he could have laid down in that hour before he went outside for his group meeting. I never thought of GERD! (will watch for that)

This person is the most somatic complainer I think I have ever had, and most of the time he has nothing wrong with him. Needless to say we check him anytime he complains, AND he goes ballistic if he doesn't get whatever he is requesting done! We can't trust his word, so we have to end up assessing everything.

ALSO, this was NOT a case of asthmatic who had the NO wheezing, and no diminished breath sounds. HE was EXtremely clear, and took big ole' breaths when I asked him too (I am asthmatic also, so I know what you mean)

Actually this person was a abuser of his rescuer inhaler till 3 months ago, which is another reason we watch him so closely.

I wanted a way to teach non-medical staff HOW to check if no nurse there, and also way of explaining to them what they heard, but still think it was the noise in the throat and when I told him to cough first before I listened, that's why I heard such clear sounds.