COPD'ers and anxiety

GregRN · Mar 31, 2007

It's very common for COPD'ers to have anxiety. Improper ventilation and lack of oxygen will do that to someone.

In the face of anti anxiety meds that appear to not be particularly effective, be proactive with the patient in letting them know you'll be there for them when they are on their call light a ton due to anxiety. Let them know that you will be in their room every hour on the hour and you will tend to their needs at that time. In the meantime, for the sake of the other patients you have, their call light should only be used in an emergency. This is classic behavior modification. Here's the kicker: you MUST be there every hour on the hour (or whatever timeframe you set) or the program will fail. Also, if the patient uses the call light at an inappropriate time and it is NOT an emergency, you CANNOT tend to their need at that time, otherwise you're right back in the same trap as before. It take some time but it does work and is much better than neglecting other patients due to someone being on the call light constantly.

Here's another odd suggestion: try a fan. Even on a low setting, COPD'ers find comfort in a fan being blown gently on their face. Sounds crazy but it really does work.

stressgal, RN · Apr 3, 2007

Having a fan makes sense to me.

I cannot imagine a more stressful event than not being able to breath. My experience is that these folks are pretty "educated" on their disease. Early dx they know at some point they will be on a vent, if they so chose. Life on a vent offers many challenges. If I were on a vent AND the power went out you can guarantee that I am going to be anxious. You better be at my bedside with an ambu bag ready to go. You may have other patients, but I could care less if I cannot breathe. Remember ABC. My airway and breathing comes before the pressor patient's circulation.

Just trying to look at it from the other side of the coin.

Creamsoda, ASN, RN · Apr 4, 2007

Thanks for the replies.

I do understand the anxiety and fear of not being able to breathe. But I did imediately go to this patients room, told her that her ventilator was fine from the back up power, and that she was doing ok and I would continue to check on her frequently. Her ABC's were all good, and she knew it, and I could see her from where I was helping out. But to call me in 5 min later when we were still dealing with the whole situation, and she continued to do fine, to tell me she wanted to go to bed because she was tired of sitting up?? Thats what I dont get.

Indy, LPN, LVN · Apr 5, 2007

I haven't been in your situation with the power outage, and hope I don't see that anytime soon. With the COPD'ers I have, I look at positioning, sats, (that's sometimes as much for their comfort as for mine), ask them what relaxes them, (NOT smoking) and generally they can be 5-10 minutes of nitpicky TLC per hour. I suspect that if your gal was sitting up and got tired, maybe she was hunched over and that isn't the position I like mine in, I'd rather have 'em in better posture to maximize their breathing.

I agree with you though, they do get anxious an awful lot.

NurseMeg · Jul 19, 2007

I agree with the other posters. I'm sure that if I wasn't able to breathe well, I'd be anxious too. These people also do not have a whole lot of control in their lives. Especially in a hospital setting.. and COPD'ers are often in and out of the hospital frequently. The call bell = bossing the nurse around = control for MANY patients. Annoying, I know. These are the patients that burn you out. At least, at the end of the day you get to go home!

smileyRn96 · Jul 20, 2007

My philosophy, If you can ring a call bell you are not ICU material. :nono:

Several years ago when I worked cardiac step-down we always had one of those chronic vents on the floor. We would send them back to the unit when they were really ready to wean. I would set strict limits about how often they would see me, do not forget I had 5-6 other patients. I would also break up my visits between RT and CNA visits. I would also recommend antidepressants like Paxil or others used for OCD and panic attack type disorders. Try not to get to upset with the patient it is all part of the disease process and COPD personality. It is like getting upset with a cardiac pt because their bp is high.

-Smiley

Long Term Care Columnist / Guide · Jul 20, 2007

I know COPD patients are difficult to cope with. It helps if you try to understand a little of what makes them that way.

First of all, air hunger---the sensation of being unable to get sufficient air in OR out---can be overwhelming. I'm an asthmatic who knows exactly what that feels like, and it's TERRIFYING. Try holding your nose and then breathing through a straw for a few minutes; it's the closest thing I can think of to an episode of air hunger. Your lungs burn, and you feel like you're suffocating. If nothing happens to relieve that sensation, the panic sets in, and until your inhaler or your nebulizer treatment kicks in, everything inside of you is focused solely on drawing that next breath.

Now imagine living with that feeling every single day of your life. It's nothing short of exhausting, and to be honest, not much else matters when you are literally fighting for each and every breath..........not food (too much work to chew!), not cleanliness (a shower wipes you out for two days), and certainly not the priorities of other patients. When you're working your accessory muscles and hanging onto a table or chair just to breathe, you are NOT thinking about other people.......in fact, you're hardly even aware they exist. All that matters is getting that next breath of life-giving oxygen.

I hope this helps.

UM Review RN, ASN, RN · Jul 20, 2007

In my experience with the COPD'ers we get who are typically long weans off the vent, ive noticed that a majority of the pt's who have COPD are always anxious, all the time, always on the call bell ect, always tapping the side rail to get attention, press the call bell 2 seconds after you leave the room. I find that even though I try an explain to these patients that I have one other pt and can not always be in the room immediately, they still do it.
For example yesterday...we had a power outage in our ICU, and get this...it was the emergency power that went out, so our monitors shut off, prisma machines shut off, only some vents had back up power, so the ones that didnt, the pt's had to be bagged untill the power went back on. It was proably off for 15-20 min. I had one pt who had COPD, long wean ect. Her vent had back up power, but she was pretty basic, she was up in the chair, breathing fine, reading a book. I told her that the power went out, and that she was doing ok, and her vent was fine, leave the room to help out with the more complex patients where we had to switch to transport monitors, because they were maxed on pressors, and the bedside monitors were off from the power shortage, and just making sure everyone else was ok eg checking ABC's. Well not 3 minutes later in the middle of the power shortage, she presses her call bell for the 1000'th time that day because she wanted to get back to bed. Her GCS is a 15/15, totally with it. She was fine, breathing fine, so obviously I told her no and left to room. She had already had her anxitey medication. I was already extremely frustrated with her to begin with because she was so needy, so demanding, especially in inappropriate times.
My point is, that pretty much every patient who has COPD in my experience has these anxiety issues, or think they are the only patient on the unit despite educating them about it all, and I cant always be running into their room when they press the call bell every 5 min because the pillow needed to be moved just a little bit, or the head down just a little bit...(they can often do this stuff themselves).
Have any of you guys noticed this? I wonder if it had anything to do with the fact that most were heavy smokers throughout their lives and that was how they coped with stress. It drives me nuts, and the other nurses nuts as well and eventually no one wants to take them as patients because they are so frustrating.
Cher

Yes, I've noted this also. COPD'ers are typically pretty claustrophobic too. One patient was so claustrophobic that he absolutely refused to allow the staff to draw the curtain for assessments.

I think part of it is lack of O2. Some of that can be attributed to the steroids (ever have a Neb treatment? You'll shake like a leaf afterwards).

They're only frustrating to me because we're only able to provide palliative care at best. They're dying and they know it.

I do the "breathing is mechanical" and adjust their position and "breathing is very psychological" teachings as I explain that if they control their fear, they'll breathe more effectively. Sometimes I'm successful.

But if pain is what a patient says it is, I've learned that so is breathing. I never attempt to tell a patient how well or how poorly they're breathing and as many times as I get called in there, I try to recall how frightening it is when you just cannot get enough air.