Life Support Issues/COPD


QUESTION: My grandmother has endstage COPD.I talked with her today, she was trying to tell me something, but it was all jiberest. She is fall a lot lately. She is in a wheelchair. ON ox 24-7. Plus she uses a nebulizer, a bunch of other meds for COPD. Does anyone know why she couldn't speak right?

ANSWER: Brandy,
There could be a number of reasons her speech would be affected. Trouble speaking could be caused by medications or another neurological disease like stroke or Alzheimer's disease.  It may be temporary or permanent depending on the cause.

Some medications are very helpful to reduce her sense of breathlessness, like Morphine and Ativan but they also could cause increasing weakness and trouble speaking.

Your grandmother sounds like she requires a lot of nursing care. Have you asked about hospice care for her? If hospice was visiting her, the nurses could answer your questions as you have them and help you to prepare for what is coming and what you need to take care of her.  If she continues to have trouble speaking, they can help you set up a communication board where she can point to the questions she wants to ask.   

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QUESTION: Thanks for responding. I forgot to mention before, that she has been in and out of the hospital for not being able to breath. And with chest pain. She has congestive heart failure, a clystomy bag. Her feet do swell a lot, and turn red or blue. Her nose turns blue also. She said a couple of weeks ago when she could masks sense, that she is not hungry and doesn't care if she eats. She also said that she wanted to sleep a lot. She has almost died 4 times from COPD complications. She wants to be at home and doesn't want hospice at all. Their is people that come in to give her a bath and a nurse comes once a week to check her and do her meds. She is on a lot of stuff for her lungs,bp, ♥. The Dr.told her he has done all he can do form her. She has told me that for about a week she has been very sick, and had to take her nitro glysteron a few times. She does not want to go to the hospital. Do you know if this is part of the disease or could be something else. Also she has become very weak and is confused a lot. She is also crying a lot very sad. She is suffering sooo much and is tired. She has cataracts, which had almost taken her vision. Her arms are covered in bruises. What to do?


It must be so hard to watch her suffer like this. I don't know why she does not want hospice but hospice is the key to keeping her out of the hospital and to improving her suffering. What happens with COPD is that as her lungs fail, it causes her heart to fail also. Hence the chest pain. There is no need for her to suffer. There are medications that will actually improve her shortness of breath and control her chest pain. Its clear that the nurse who is visiting either does not know how to manage her symptoms or your grandmother refuses the interventions the nurse is offering.

So what can you do? Maybe you can start with the current nurse and ask her if there is something that would reduce your grandmother's chest pain and shortness of breath. The correct answer to that question is very small doses of Morphine. It may be that the nurse can talk  her into trying it. If the nurse says she does not know of anything that will help- then your next step is to call the local hospice and ask if they have Palliative Care. Palliative care is not hospice care, but provides a physician who will visit in the home (its covered by Medicare) and he will encourage your grandmother to try comfort medications.  She keeps the same visiting nurse and aide.

 If that fails,  I would tell your grandmother how  hard it is for you to watch her suffer when there are interventions out there that would greatly improve her comfort. Worsening shortness of breath is a terrible way to die.

I hope that one of these ideas will work for her and for you.  

Life Support Issues

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Betsy Murphy


My expertise is in end of life care for adults. Identifying when someone is approaching the end of their life. Benefits and burdens of end of life treatments. Managing pain and other symptoms. Providing care for dying patients at home. Advocating for someone who is dying in a hospital or nursing home.


More than 28 years of experience in hospice care. Currently consulting with hospices to promote access for patients to receive hospice care earlier in the course of their illness. Betsy provides training for hospice marketing staff to effectively work with nursing facilities to help identify eligible patients. She writes Additional Development Request (ADR) letters to Medicare to help hospices get paid for their services and to avoid future claim denials.

Hospice and Palliative Nurses Association

Articles: Clinical Reviews, Advance for Nurses, Nursing Spectrum, Washington Business Woman,; Understanding Medical-Surgical Nursing (FA Davis and Company), Guide to Caregiving in the Final Months of Life (TM Brown publishers).

Bachelors of Science in Nursing, additionally trained as a Family Nurse Practitioner and certified as a hospice and palliative care nurse.

Awards and Honors
Outstanding Woman in Loudoun County (VA) by Loudoun County Commission on Women 1997 and 2002.

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