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NURS 3510 - Supportive and Palliative Care > Week 9 > Flashcards

Week 9 Flashcards

1
Q

what is dyspnea

A
  • term used to characterize a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity
  • uncomfortable awareness of breathing
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2
Q

what is imp to note r/t dyspnea

A
  • subjective –> what the pt says it is, not determined by physical exam or test (ex. may look comfortable but feel SOB)
  • NOT the same as tachypnea or increased WOB
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3
Q

what are various categories of causes of dyspnea (5)

A
  • pulmonary causes
  • CVS causes
  • psychological factors
  • chemoreceptors
  • derives from physiological, psychological, emotional, and environmental factors
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4
Q

what are 3 examples of pulmonary causes of dyspnea

A
  • COPD
  • pleural effusion
  • tumour blockage
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5
Q

what are 3 examples of CVS causes of dyspnea

A
  • PE
  • anemia (d/t decreased O2 carrying capacity)
  • heart failure
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6
Q

what impact might chemoreceptors have on dyspnea

A
  • central & peripheral chemoreceptors can sense high CO2 or low PO2 or decreased in pH
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7
Q

what is an important consideration r/t assessment of dyspnea

A
  • ASK the pt if they are SOB (may not be able to see that they are)
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8
Q

if the pt is SOB, describe the assessment of dyspnea (3)

A
  • keep assessment brief (minimal questions)
  • provide prompt intervention = key
  • rate on scale of 0-10
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9
Q

if the pt is not in immediate crisis or discomfort, describe the assessment of dyspneas (6)

A

may do further investigation:

  • more extensive physical assessment (auscultate, OPQRSTU)
  • O2 sats
  • blood work
  • chest x ray
  • ABGs
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10
Q

what are some immediate and simple measures to manage dyspnea (7)

A
  • stay calm
  • provide calming reassurance (not false tho)
  • stay w the pt
  • implement anxiety reducing measured
  • help pt in comfortable position
  • increase air flow
  • breath w pt –> in thru nose, out thru mouth
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11
Q

what position should you put a pt in w dyspnea

A
  • tripod
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12
Q

what is a way to increase air flow for a pt w dyspnea

A
  • apply a fan directed at their face
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13
Q

what are some specific interventions for dyspnea (treat the underlying the cause) (6)

A
  • antibiotics (if infection)
  • bronchodilators (COPD)
  • diuretics (HF)
  • steroids (COPD)
  • anticoag (PE)
  • PRBCs (anemia)
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14
Q

what are nonspecific pharmacological interventions for dyspnea (2)

A
  • opioids

- benzos

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15
Q

what is the gold standard for dyspnea r/t advanced illness

A
  • opioids
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16
Q

how do opioids help manage dyspnea (6)

A
  • decrease metabolic rate
  • decrease O2 consumption
  • alter perception of breathlessness
  • decrease ventilatory response to hypoxia and hypercapnia
  • vasodilate
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17
Q

what are examples of opioids for dyspnea (4)

A
  • morphine
  • hydromorphone
  • fentanyl
  • sufentanil
18
Q

when are benzos used for dyspnea

A
  • not for routine but are an imp adjucant therapy when anxiety is also present w dyspnea
19
Q

what are some side effects of opioids

A
  • resp depression only if used in appropriately
  • sedation & NV –> disapear in couple days

reviewed in pain class

19
Q

what are some side effects of opioids

A
  • resp depression only if used in appropriately
  • sedation & NV –> disapear in couple days

reviewed in pain class

20
Q

describe o2 use for those experiencing dyspnea (2)

A
  • use should be indiivdualized to the pt

- may be used in pts w hypoxemia and are alert

21
Q

describe o2 use for those w dyspnea who are unresponsive and/or not hypoxemic

A
  • not appropriate
22
Q

what is a dyspnea crisis (3)

A
  • palliative emergency
  • sudden onset/rapidly escalating and worsening episode of dyspnea
  • sustained & severe
23
Q

describe assessment of dyspnea crisis

A
  • v hard to miss, will likely see objective signs
24
Q

list nursing interventions for dyspnea crisis (4)

A
  • stay w person til crisis has passed
  • aggressive symptoms mngmt needed
  • use nonpharmacological approaches to managing dyspnea (sit up, reassure, fan, calm)
  • and use meds (opioids, sedatives)
25
Q

what is the preferred route of admin for meds for dyspnea crisis

A
  • IV
26
Q

what is total dyspnea

A

-similar to total pain in which is relates dyspnea to the 4 domains in an effort to describe how profoundly the pt is sufferring

27
Q

describe the relationship between anxiety & dyspnea

A
  • anxiety = signif exacerbator

dyspnea –> anxiety –> worse dyspnea –> worse anxiety

28
Q

define fatigue

A
  • complex, multifactorial syndrome characterized by physical, mental, psychological, and spiritual effects that reduce capacity/functioning and impact QOL
29
Q

what are some causes of fatigue (4)

A
  • disease
  • medical interventions/meds
  • sleep disturbances
  • inadequate symptoms mngmt
30
Q

what are some examples of diseases that can cause fatigue (4)

A
  • COPD
  • cancer
  • anemia
  • hypoxia
31
Q

what are 2 examples of meds/medical interventions that can cause fatigue

A
  • chemo

- diuretics therapy –> voiding at night

32
Q

how can inadequate symptoms mngmt lead to fatigue

A
  • keep pt up at night

- or cause psycholoical fatigue

33
Q

why is it imp to recognize fatigue

A
  • distress d/t fatigue effected 80% of pts receiving formal palliative care
  • can negatively impact QOL if not recognized and treated
34
Q

what is included in assessment of fatigue (7)

A
  • conversations
  • open-ended questions “tell me how things are going for you lately”
  • subjective –> ask pt about it
  • OPQRSTU
  • history (sleep patterns, history)
  • observations
  • physical exams and tests
35
Q

what physical exams and test can be used to assess fatigue (3)

A
  • lvl of alertness
  • strength
  • blood work
36
Q

what are 2 categories of approaches to mngmt of fatigue

A
  • non pharm

- pharm

37
Q

what are non pharmacological interventions for fatigue (4)

A
  • energy conservation
  • sleep hygeine (ex, sleep schedule)
  • delegating tasks to conserve energy
  • consults (OT, PT)
38
Q

what are some pharmacological approaches to mnging fatigue (3)

A
  • manage underlying conditions if possible and appropriate (ex. PRBCs for anemia)
  • decrease likelihood of fatigue r/t meds (ex. give diuretics early in day)
  • manage symptoms (ex. SOB, NV)
39
Q

what is a specific med that can be used to help mng fatigue

A
  • methylphenidate

NURS 3510 - Supportive and Palliative Care (11 decks)

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