Blessed RN

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.

All pharmacologic treatments that can be administered have been administered. He refuses any more anxiolytics and he is on continuous nebs to q2hrs. We already have an oscillating fan in the room, and I have the temp turned down as low as it will go but he still states that it feels too hot for him.

Hi Everyone, I used to be thankfulnurse2b here on allnurses and haven't posted in a while. I finally finished nursing school in December and passed my boards this week!! So, I am working now as an RN on a Med/Surg floor. My question is, what kind of advice can you all offer in how to provide comfort and to help decrease anxiety in a patient with severe end-stage COPD? I took care of this poor fellow last night, and all pharmacological remedies have been exhausted for him. We are basically offering palliative care, though he is still a full code. The story is quite sad; he is determined to stay alive to care for his sick wife at home. I taught him breathing techniques and tried to provide distraction. What else can you all think of to make him more comfortable?