Dyspnea,Edema

Question 1

Dyspnea

“a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.”

Question 2

Neural pathways involved in the generation of dyspnea

Question 3

What is Dyspnea

Answer 3

Dyspnea happened if the sensory cortex perceives a mismatch between ventilatory demand and the body’s ability to respond to that demand

Question 4

Mechanisms by Which Opioids May Reduce Dyspnea

Answer 4

• Decreased metabolic rate and ventilatory requirements

• Reduced medullary sensitivity to hypercarbia or hypoxia

• Blunted medullary response to hypercarbia or hypoxia

• Alteration of neurotransmission within medullary respiratory center

• Cortical sedation (i.e., suppression of respiratory awareness)

• Analgesia reduction of pain-induced respiratory drive

• Vasodilation (i.e., improved cardiac function) • Anxiolytic effects

Question 5

DVT in hospice patient

Answer 5

• The prevalence of deep venous thrombosis (DVT) in advanced cancer patients in hospice is 50% if routine screening is done.
• Only 5%-15% of these individuals become symptomatic.
• Risk factor: A low albumin and low fibrinogen and circulating activated coagulation parameter
• A normal D-dimer has a 97% negative predictive value in excluding a DVT in advanced cancer.
• Guidelines for the use of anticoagulants and prophylactic heparin in advance cancer patients in hospice are not well established.