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What Causes Hostile Behaviour In A COPD Patient?

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Posted on Thu, 20 Nov 2014
Question: Well, I apparently have stumbled upon the reason a elderly woman, diagnosed with end stage COPD, has been so hostile to my once a week visits to her home to do some care giving for her. I am a former nurse (LVN) I thought it was the COPD which was caus
ing all her hostility towards me, as I have seen that before in the hospital . Today she admitted to me she was and has been taking NOCO (dosage unknown) every 3-5 hours. I do not know how long. Also, her physician comes to her home and writes her prescriptions, so he is very aware, Interesting problem. I have retired, but I wonder if I should cross that line to talk to this doctor. Advice? She is end stage with the COPD,02 dependent, low appetite, living alone, and is homebound. I have seen her for close to a year.Excuse me, I misstyped, the medication is NORCO.
doctor
Answered by Dr. Ivo Ditah (43 minutes later)
Brief Answer:
Is she in pain?

Detailed Answer:
Hi and thank you so much for this query.

Before I answer this question in greater details, I will like to know if your client in pains? You said she has end stage COPD, is she on palliative care or hospice? These are vital pieces that have to be put together before asking the doctor what is going on.

When patients have a disease condition that medical science can no longer be of help, we emphasize comfort even if the medications would inadvertently cause death. This is something that has to fall in line with the patient's wishes. I will like to know if this could be the case with your client.

Let me hear from you on the above and how much more information you have and how far you would want to go on with this case. In any case, I recommend caution before confronting the physician on this.

I hope this helps. I wish you well. Than you so much for using our services and feel free to ask for more information and clarifications if need be.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ivo Ditah (13 hours later)
No, no pain reported by patient. She is seen in her home only by a Geriatric doctor, who sees her only once a month. She is completely homebound by her choice. There is no family, and she has never married or had children. She does have a leg wound (Non diabetic) and is seen by a home care nurse twice a week. I have assisted and found the nurses who come to be highly qualified, which is a relief. Labs are done by a lab technician from our local hospital. I am assuming all this is directed and managed by the Geriatric doctor. I have offered my Pulmonologist's name to her, but she is not interested. She has refused to give me her Doctors name, and I do not press it at all. I have seen her 1 day a week for general caregiving for approx. one year now. I am still concerned, but this is by her choice, not any of my business, so I am now "just a caregiver" who does her shopping. She also has Meals On Wheels delivered daily, which mostly she does not eat. She is ambulatory without assistance at this time, but her tolerance for exercise of any type is very limited. She is alert, x 3 at present. O2 at 2 liters by nasal cannula.
doctor
Answered by Dr. Ivo Ditah (46 hours later)
Brief Answer:
I guess it is the patients choice and right!

Detailed Answer:
Hi, considering all the information youhave provided, it is clear that the client fully understands what is going on and prefers it that way. She is exercising her righ and we may disagre with but we cannot do otherwise.

You may wantto talk with her. But, be careful she doesn't she it as being judgemental and ratjer makes it to turn out bad.

I hope this helps. I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ivo Ditah

Internal Medicine Specialist

Practicing since :2002

Answered : 3984 Questions

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What Causes Hostile Behaviour In A COPD Patient?

Brief Answer: Is she in pain? Detailed Answer: Hi and thank you so much for this query. Before I answer this question in greater details, I will like to know if your client in pains? You said she has end stage COPD, is she on palliative care or hospice? These are vital pieces that have to be put together before asking the doctor what is going on. When patients have a disease condition that medical science can no longer be of help, we emphasize comfort even if the medications would inadvertently cause death. This is something that has to fall in line with the patient's wishes. I will like to know if this could be the case with your client. Let me hear from you on the above and how much more information you have and how far you would want to go on with this case. In any case, I recommend caution before confronting the physician on this. I hope this helps. I wish you well. Than you so much for using our services and feel free to ask for more information and clarifications if need be.