Here's what the Dr. Ordered: "treatment prn for wheezes." I thought "What if the patient is SOB and is not wheezing? Do we not give a treatment if the patient says he is tight?
When I was a kid a nurse refused to give me a treatment once because, "The wheeze is in your throat."
"But I'm tight," I argued, "I need a treatment."
"The wheeze is in your throat." She made me rest and drink warm water. You don't hear asthma experts recommending warm water anymore, but when I was a kid that was standard. The regime was: rest, drink warm water, and if you don't get better that way use your rescue inhaler.
Years later, as an adult, I went to the hospital and the doctor figured I didn't need a treatment because, "Your peekflow is 700. That's above normal for your age and height."
"Um," I gasped. "I need a treatment."
My point here is that one should not judge whether a bronchodilator breathing treatment is indicated based on a lung sounds or peek flow alone. A thorough assessment and q&a is the best method.
For some asthmatics, myself included, and other chronic lungers too, bronchospasm may be unique to the patient. Sometimes it's noisy, and sometimes bronchospasms don't talk at all. Sometimes they make the peek flow low, and sometimes it may actually get better or stay within personal best range.
For COPD patients, standard therapy recommends not using a peek flow meter at all, considering the PF reading may actually go down after the treatment, giving a false impression that the treatment made the patient worse.
The moral of this post is that the signs of asthma (or COPD) may often vary form person to person, and are not always textbook.
The RT, RN and DR must use common sense in determining the most appropriate means of helping a patient in need, and not simply rely on "is he wheezing? Is his PF low?"
And that, my friends, is the thought of the day.