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Dyspnea

Introduction

  • dyspnea, or shortness of breath, is one of the most distressing symptoms for patients and families, particularly when it occurs in the home setting
  • defined as the inability to deliver enough oxygen to meet bodily demands, resulting in an uncomfortable feeling of breathlessness
  • it is most often associated with primary or metastatic lung tumors
  • other causes may include pleural effusion, fibrotic changes in the lungs due to radiation therapy or chemotherapy, loss of functional lung tissue after surgical resection, pericardial effusion, congestive heart failure, pneumonia, and anemia
  • other symptoms such as pain, anxiety, stress can contribute to dyspnea
  • shortness of breath may occur as a result of unrelenting hiccups, this is usually due to involvement of the diaphragm and respiratory muscles and usually occurs in terminal patients
  • aggressiveness of treatment may vary depending upon the stage of the disease

Assessment

  • evaluate the appearance of the patient, including color, respiratory rate, use of accessory muscles, anxiety level
  • review past medical history to determine if comorbidities such as COPD or asthma are contributing to the dyspnea
  • review the patterns of dyspnea and evaluate for contributing/relieving activities
    • at rest and/or with exertion
    • onset and duration
    • affected by position changes (e.g.. head of bed)
  • perform pulmonary assessment to evaluate for treatable conditions e.g.. pneumonia, pleural effusion
  • psychosocial assessment to evaluate impact of anxiety, stress, fear

Intervention

  • alert the physician when respiratory status changes
  • if the tumor itself is causing the dyspnea, treatment with chemotherapy, radiation therapy or surgery may be indicated
  • recurrent pleural effusions may require drainage of fluid through thoracentesis, and in some cases, instillation of sclerosing agents to prevent reaccumulation of fluid
  • medications used to treat dyspnea may include antibiotics, diuretics, bronchodilators and steroids
  • nondrug therapy may include relaxation and breathing exercises, position changes to facilitate ventilation, psychosocial support, adequate room ventilation and circulation

Shortness of Breath

  • when dyspnea is associated with hypoxia, oxygen therapy is helpful
  • in the terminally ill patient, narcotics and sedatives may be used to alleviate tachypnea and "air hunger" symptoms
  • persistent hiccups can be treated with prochlorperazine to suppress them

References

Campbell, ML. (1996). Managing terminal dyspnea: caring for the patient who refuses intubation or ventilation. Dimensions of Critical Care Nursing, 15, 4-12.

DuPen, AR and Panke, JT (1997) "Common Clinical Problems" in Varricchio, C. Ed. A Cancer Source Book for Nurses, 7th ed. Atlanta: American Cancer Society.

Held,JL. (1994). Cancer care: Managing shortness of breath. Nursing 94, 24, 31.

Kemp, C. (1997). Palliative care for respiratory problems in terminal illness. American Journal of Hospice and Palliative Care, 14, 26-30.

Roberts, DK, Thorne, SE and Pearson, C. (1993). The experience of dyspnea in late-stage caner: Patients' and nurses' perspectives. Cancer Nursing, 16, 310-320.





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