Hi all,
I am currently on my Cardiopulmonary placement in which I had an interesting situation occur. I was asked to see a 70 year old male who came in with the following:
PC: 3/7 of palpitations, increased SOB & R neck pain.
PMHx: AF, IHD, MI 84, 95, asthma, COPD, R TIA/CVA, traumatic pneumothorax, (R) lower arm amputee. In addition to this he had pins in his R hip from a previous car accident which prevented him from ambulating very well such that he gets around in the electric wheelchair however he is able to walk short distances.
In doing my subjective Ax on this gentlemen I was getting rather inconsistent information in regards to his smoking history. He said that he had now quit however, he used to smoke 3 packets a day for 15 years and then dropped down to 3 packets a week and then 1 packet a week, and that for the last 6 weeks he had quit. However, he kept on changing how much he had smoked and for how long so I just dealt with the information he gave me. I could also clearly smell that he had a cigarette recently and I had seen him earlier in the morning smoking outside the hospital building. The patient also claimed that he was not on home O2 therapy however since being in hospital he relied on the O2 therapy majority of the time.
The problem arose in that when I confronted my supervisor she told me that this patient already had O2 therapy at home- and smoking whilst on O2 therapy is a big NO NO as the person may start a fire is they happen to leave the O2 on and spark a match.
I was then unsure what to do. I didn’t know whether I should confront the man in regards to his current smoking history again even though he had already denied smoking. For me it became a safety concern in regards to using O2 therapy whilst still smoking. I was thinking I could try calling his next of kin and ask them if they could inform me however, my supervisor said that the best thing to do would be to educate him in regards to smoking and the use of O2 therapy at home.
What would you guys do in this situation?
Thanks,
Debs
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1 comment:
Hi deb,
I agree with your supervisor and think you should discuss the safety issues with your patient. Although he's told you that he has quit smoking, he could just be telling you what he thinks you want to hear. If you can smell the cigarette smoke and you've seen him smoking, he's obvioulsy not telling you the truth. You don't have to confront him in a negative way, but maybe just educate him on oxygen safety and tell him to make sure that noone is smoking in the same room while he's using O2 rather than directly saying that he can't smoke. In regards to the use of O2 at home, you could just say that you read something in his notes about it and just thought you should double check.
If you still have concerns after you talk to him you could try talking to his family when they come in for a visit.
Tara
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