When she came in her sats were in the 70s with a respiratory rate of 28. Even though she had been previously warned against it, she was using her pulse dose portable O2 tank on 5L and it was only pulsing 5 times a minute.
I placed her on O2 continuously at 5L and within minutes her WOB had decreased, her sats had risen to acceptable levels and she looked ten times better. This patient was in the hospital for almost a week for COPD exacerbation, and when she was discharged I made it a point to speak with her, her family and the physician and we all agreed that the pulse dose O2 tank she loved to carry around with her was, in fact, no good for her respiratory health and was not able to meet her O2 needs.
A few days after discharge, I saw her checking in for an appointment ... with the pulse dose O2 tank tucked snugly under her right arm...
This is not a rant against pulse dose O2 tanks, this is a rant against patients who, despite all evidence and experience, continue to indulge in bad habits contrary to professional medical advice.
I understand that non-compliance is a problem as old as the medical profession itself: I am sure the first caveman-RTs were left dumbfounded by their caveman-patients who were passing out from inhaling too much smoke from the first caveman-fires, while continuing to insist that "smoke make Ugg feel good..."
But man! I really thought I got through to her. I thought she understood why it was a bad idea for her to use that tank and why she needed to switch to E tanks exclusively when she is out and about.
Of course I feel like I get through to a lot of patients and then I see them again ... in the ER:
"Spiriva is the one I take when I get short of air, right?"
"What's a spacer? Oh yeah, that thing...I think my kid puts her crayons in it."
"I mean it this time, I am not smoking ever again!"
Maybe I am just not convincing enough. Is there some sensibility I need to appeal to? Does anyone out there have any advice on how to make this stuff stick?