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3: Surgery Y3 - Cancer Care [1] (check ILOs) > [18] Breathlessness > Flashcards

[18] Breathlessness Flashcards

1
Q

Why is breathlessness an important symptom to consider in palliative care?

A

The experience of being breathless can be frightening both for patient and family, and it can
affect individuals not only physically but also emotionally and socially.

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2
Q

How common is breathlessness in cancer?

A

50-70% of patients

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3
Q

What does the successful treatment of breathlessness require?

A

A combination of pharmacological and non-pharmacological measures

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4
Q

Why is it necessary to determine the cause of breathlessness?

A

To identify any potentially reversible causes

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5
Q

What can the causes of breathlessness be divided into?

A
  • Cancer-related
  • Treatment-rleated
  • Other cause
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6
Q

What are the cancer related causes of breathlessness?

A
  • Airway obstruction
  • Pleural effusion
  • Anaemia
  • Ascites
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7
Q

What are the treatment related causes of breathlessness?

A
  • Surgery
  • Radiotherapy
  • Drugs causing fluid retention
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8
Q

What are the other causes of breathlessness?

A
  • Infection
  • Cardiac disease
  • Chronic respiratory disease
  • Pulmonary disease
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9
Q

What might be helpful when assessing a patient with breathlessness?

A

The presence of a carer

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10
Q

Why might the presence of a carer be helpful when discussing breathlessness?

A

Assessment requires detailed discussion, which may be difficult for the patient

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11
Q

What needs to be addressed when considering ‘total breathlessness’?

A

The physical, psychological, social, and spiritual domains

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12
Q

Give 2 breathlessness measurement tools?

A
  • MRC dyspnoea scale

- Dyspnoea-12 scale

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13
Q

What does the MRC dyspnoea scale measure?

A

Physical impact of breathlessness

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14
Q

What does the dyspnoea-12 scale include?

A

Emotional factors

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15
Q

What is the limitation of using breathlessness measurement tools?

A

They are not sufficient on their own

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16
Q

What should the assessment of breathlessness include?

A
  • Holistic assessment of physical, psychological, social, and spiritual domains
  • Detailed history including known disease status
  • Identification of any symptoms of depression and anxiety
  • Impact of breathlessness on patients lifestyle
  • Patients coping strategies
  • Meaning and implications of symptom on patient
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17
Q

What it is essential to determine when managing breathlessness?

A

The patients aims for treatment, and the sort of therapies and investigations they are able/prepared to undergo

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18
Q

Give 5 examples of potentially reversible causes of breathlessness?

A
  • Infection
  • Pleural effusion
  • Arrythmias
  • Anaemia
  • Haert failure
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19
Q

What may provide long-term palliation for breathlessness?

A

Anti-cancer treatment, chemotherapy, or radiotherapy

20
Q

What should be done if breathlessness does not have a reversible cause?

A

Combination of pharmacological and non-pharmacological interventions should be discussed and offered to the patient

21
Q

What is the aim of palliation of breathlessness?

A

Change the experience and perception of breathlessness, rather than changing the underlying pathology

22
Q

What pharmacological interventions may be useful in breathlessness?

A
  • Opioids
  • Anxiolytics
  • Nebulised bronchodilators
  • Oxygen
23
Q

How do opioids help in breathlessness?

A

Reduce ventilatory demand

24
Q

Who are opioids most beneficial to in breathlessness?

A

Those who are breathless at rest rather than on exertion

25
Q

How can anxiolytics help in breathlessness?

A

Help patients better cope with breathlessness by reducing anxiety

26
Q

What anxiolytics are recommended for breathlessness?

A
  • Diazepam

- Lorazepam

27
Q

When are anxiolytics recommended for breathlessness?

A

When anxiety is substantially aggravating the breathlessness

28
Q

What bronchodilator may be helpful in breathlessness?

A

Salbutamol

29
Q

How might salbutamol be helpful in breathlessness?

A

By causing bronchoconstriction

30
Q

Describe the role of oxygen in the management of breathlessness

A

It is useful for correcting hypoxia, but breathlessness is not always related to hypoxia

31
Q

Who can introduce non-pharmacological interventions in breathlessness?

A
  • Nurses
  • Doctors
  • Physios
  • OTs
32
Q

In what setting can non-pharmacological interventions for breathlessness be introduced?

A
  • Group sessions, involving carers

- Individual consultations

33
Q

Give some non-pharmacological measures for breathlessness

A
  • Controlled breathlessness techniques
  • Energy conservation
  • Relaxation techniques
  • Handheld fans
34
Q

What do controlled breathlessness techniques involve?

A
  • Positioning
  • Pursed lip breathing
  • Breathing exercises
  • Coordinated breathing training
35
Q

What positions can help with breathlessness?

A
  • Supported high side lying
  • Upright sitting with arms supported on pillows
  • Sitting leaning forwards with arms supported on wall or windowsill
36
Q

What happens to gaseous exchange when hyperventilating?

A

It is reduced

37
Q

What can increase gaseous exchange when hyperventilating?

A

Pursed lip breathing

38
Q

Why does pursed lip breathing help?

A

Because it promotes fully exhaled breath

39
Q

What breathing exercises can be helpful in breathlessness?

A

Diaphragmatic or deep breathing

40
Q

How do breathing exercises help?

A

They help the lungs function optimally and promote feelings of relaxation and stress reduction

41
Q

How can energy conservation be achieved to reduce breathlessness?

A

Through better planning of everyday activities

42
Q

Give an example of how energy conservation in everyday activities can be achieved?

A
  • Some activités can be done sitting down rather than standing, e.g. dishwashing, ironing, and gardening
  • Aids can make activities easier
43
Q

Why are relaxation techniques an essential component of breathlessness management?

A

Breathlessness and anxiety are closely linked

44
Q

What can help with breathlessness exacerbated by anxiety

A
  • CBT
  • Self-hypnosis
  • Progressive muscular relaxation
  • Visualisation
45
Q

How can a handheld fan help with breathlessness?

A

Studies have clearly shown that a handheld fan directed against the cheek improves the sensation of breathlessness

3: Surgery Y3 - Cancer Care [1] (check ILOs) (47 decks)

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