Shortness of Breath

[SilleLu]

If a patient c/o shortness of breath but SPO2 99%, RR 18, color pink/normal, brisk cap refill, no nasal flaring, no retractions, chest movement bilateral and equal and of normal depth, lung sounds clear, patient talking normal voice and no coughing, gasping or absolutely no other indication other than patient statement....would you call doctor because patient states last time was here the breathing treatments helped? Oh, and no history of lung issues of any kind and pt admission has nothing to do with anything respiratory.

I guess what I'm asking is, is shortness of breath as objective as pain - do we just take the patient's word for it?

[SilleLu]

Did you mean subjective?

Symptoms are subjective. They are what the patient feels. The patient feels short of breath.

Signs are objective. They are what we observe.

You painted a pretty good picture of someone with a subjective symptom of shortness of breath, but no outward objective signs of hypoxia.

A good CYA move would be to report it to the physician, and document appropriately. Let the physician decide what to do with the information.

Having said this, you've painted a pretty clear picture of someone with anxiety. Me, personally, I would explore that with the patient, taking care not to give the message that I think it's "all in their head". See how open they are to nonpharmacologic, independent nursing interventions such as taking slow, deep breaths, visualizing a place/situation where they feel calm and happy, distractions such as books, games, movies, or even simply folding some washcloths.

Sometimes people who are having a health crisis seemingly out of the blue, can be hypervigilant about different sensations in their body that they may not have paid much attention to before their current health crisis, and it can be helpful to explore that with them.

Yes, sorry. I started to word my question in a different way, then when I reworded it didn't change it....thanks for catching that!

[SilleLu]

Thanks for all the replies!

Overall picture is a patient that constantly c/o pain and nausea. But always happily chatting, laughing on phone. Only eats the dessert on her tray, says she is too nauseous to eat, but I find wrappers of more junk food around the room. Says she throws up but no one ever sees or hears it.

I've noticed if she feel she is not getting enough sympathy, she'll add new complaints, hence the SOB. She specifically stated the SOB was when she was walking, so I said we should check her SPO2 with activity - she said maybe later then refused again when I came back.

There are many more examples of her 'crying wolf' of various complaints, has had workups for all sorts of things on this and prior admissions. Nothing ever comes of anything, all tests come back normal. I'm very suspicious this is more of a psych/attention seeking issue.

[Pangea Reunited, ASN, RN]

Thanks for all the replies!

Overall picture is a patient that constantly c/o pain and nausea. But always happily chatting, laughing on phone. Only eats the dessert on her tray, says she is too nauseous to eat, but I find wrappers of more junk food around the room. Says she throws up but no one ever sees or hears it.

I've noticed if she feel she is not getting enough sympathy, she'll add new complaints, hence the SOB. She specifically stated the SOB was when she was walking, so I said we should check her SPO2 with activity - she said maybe later then refused again when I came back.

There are many more examples of her 'crying wolf' of various complaints, has had workups for all sorts of things on this and prior admissions. Nothing ever comes of anything, all tests come back normal. I'm very suspicious this is more of a psych/attention seeking issue.

That's exactly how my acute MI patient acted and that's why I didn't take her seriously ...cautionary tale.

[Anna Flaxis, BSN, RN]

^^^ That. Even attention seekers can have something going on. Believe me, in the ER, when treating that frequent flyer coming in for the fifth time this month for the same dang thing, the one time you discount them is the one time they really have something going on. Don't let yourself get complacent.

Odds are, your instincts are probably correct and she's just milking all the attention she can get. But what if you're missing something? Do you want to be that nurse?

Report her complaints to the physician and let the physician make the call.

[thmpr]

Also AAA

[cayenne06, MSN, CNM]

I also feel SOB when I get an anxiety attack. And I agree with the previous posts- when you've got a complainer/frequent flier/attention seeker, it is easy to start dismissing their nebulous complaints. It's tiresome, but you gotta take people at their word no matter how much you want to roll your eyes and ignore them. I agree that a complaint of SOB, even without objective signs of a problem, merits a call to the provider.

[akulahawkRN, ADN, RN, EMT-P]

Thanks for all the replies!

Overall picture is a patient that constantly c/o pain and nausea. But always happily chatting, laughing on phone. Only eats the dessert on her tray, says she is too nauseous to eat, but I find wrappers of more junk food around the room. Says she throws up but no one ever sees or hears it.

I've noticed if she feel she is not getting enough sympathy, she'll add new complaints, hence the SOB. She specifically stated the SOB was when she was walking, so I said we should check her SPO2 with activity - she said maybe later then refused again when I came back.

There are many more examples of her 'crying wolf' of various complaints, has had workups for all sorts of things on this and prior admissions. Nothing ever comes of anything, all tests come back normal. I'm very suspicious this is more of a psych/attention seeking issue.

I think many of us have seen patients like this. We do have go be careful, but we should be mindful of the onset of symptoms, such as a new complaint that may keep someone in hour ER that magically happens right before the patient being taken to jail, and not a moment sooner than that, often accompanied by a sudden onset of remorse and concern for "the kids." I'm not suggesting that we blow-off the complaints, but just evaluate the situation as a whole. The symptom could be real or it could be invented in an attempt to delay going to jail.