I'd like your input on the patient I had yesterday. She was an 82 year old woman with COPD who had been admitted due to increasing SOB. When admitted, she demanded frequent neb treatments as well as an inhaler at her bedside. She was tachycardic (probably from all the meds), and the MD said absolutely not, pick one: bedside inhaler or neb treatments from respiratory.
She chose the neb treatments from respiratory (very reluctantly, with lots of anger, drama, etc.) So, when I had her, she was demanding neb treatments about every hour and a half (treatments were for every 3 to 4 hours). She cried that she couldn't breathe, couldn't breathe, couldn't breathe, and was screaming out to the hall for me to get the respiratory therapist (who, of course, would not come due to MD order).
Meanwhile, her sats are 99% on 2L of O2, and I couldn't see any accessory breathing. When I listened to lungs they were diminished all over, and respiratory said as day went on, they were clear, no wheezing. She was not gasping for breath, and had plenty of energy to yell at us.
Only once did she sit up in tripod position due to her inability to breathe (sats 99% at this point).
So, what do you think? Is she just a PITA patient, or in actual distress? She did not have blood gasses done, so I can't give you that info. She was also very demanding about food, saying the food was always cold, but when we got her a tray, she wouldn't eat it because she said she couldn't breathe.
I just can't imagine she is just making all this up-- can neb treatments have some sort of dependency effect? Even though she was a pretty unpleasant person, it just seemed she put an awful lot of energy into this "can't breathe" thing for it to be made up.
