Week 9 Flashcards
what is dyspnea
- term used to characterize a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity
- uncomfortable awareness of breathing
what is imp to note r/t dyspnea
- 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
what are various categories of causes of dyspnea (5)
- pulmonary causes
- CVS causes
- psychological factors
- chemoreceptors
- derives from physiological, psychological, emotional, and environmental factors
what are 3 examples of pulmonary causes of dyspnea
- COPD
- pleural effusion
- tumour blockage
what are 3 examples of CVS causes of dyspnea
- PE
- anemia (d/t decreased O2 carrying capacity)
- heart failure
what impact might chemoreceptors have on dyspnea
- central & peripheral chemoreceptors can sense high CO2 or low PO2 or decreased in pH
what is an important consideration r/t assessment of dyspnea
- ASK the pt if they are SOB (may not be able to see that they are)
if the pt is SOB, describe the assessment of dyspnea (3)
- keep assessment brief (minimal questions)
- provide prompt intervention = key
- rate on scale of 0-10
if the pt is not in immediate crisis or discomfort, describe the assessment of dyspneas (6)
may do further investigation:
- more extensive physical assessment (auscultate, OPQRSTU)
- O2 sats
- blood work
- chest x ray
- ABGs
what are some immediate and simple measures to manage dyspnea (7)
- 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
what position should you put a pt in w dyspnea
- tripod
what is a way to increase air flow for a pt w dyspnea
- apply a fan directed at their face
what are some specific interventions for dyspnea (treat the underlying the cause) (6)
- antibiotics (if infection)
- bronchodilators (COPD)
- diuretics (HF)
- steroids (COPD)
- anticoag (PE)
- PRBCs (anemia)
what are nonspecific pharmacological interventions for dyspnea (2)
- opioids
- benzos
what is the gold standard for dyspnea r/t advanced illness
- opioids
how do opioids help manage dyspnea (6)
- decrease metabolic rate
- decrease O2 consumption
- alter perception of breathlessness
- decrease ventilatory response to hypoxia and hypercapnia
- vasodilate
what are examples of opioids for dyspnea (4)
- morphine
- hydromorphone
- fentanyl
- sufentanil
when are benzos used for dyspnea
- not for routine but are an imp adjucant therapy when anxiety is also present w dyspnea
what are some side effects of opioids
- resp depression only if used in appropriately
- sedation & NV –> disapear in couple days
reviewed in pain class
what are some side effects of opioids
- resp depression only if used in appropriately
- sedation & NV –> disapear in couple days
reviewed in pain class
describe o2 use for those experiencing dyspnea (2)
- use should be indiivdualized to the pt
- may be used in pts w hypoxemia and are alert
describe o2 use for those w dyspnea who are unresponsive and/or not hypoxemic
- not appropriate
what is a dyspnea crisis (3)
- palliative emergency
- sudden onset/rapidly escalating and worsening episode of dyspnea
- sustained & severe
describe assessment of dyspnea crisis
- v hard to miss, will likely see objective signs
list nursing interventions for dyspnea crisis (4)
- 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)
what is the preferred route of admin for meds for dyspnea crisis
- IV
what is total dyspnea
-similar to total pain in which is relates dyspnea to the 4 domains in an effort to describe how profoundly the pt is sufferring
describe the relationship between anxiety & dyspnea
- anxiety = signif exacerbator
dyspnea –> anxiety –> worse dyspnea –> worse anxiety
define fatigue
- complex, multifactorial syndrome characterized by physical, mental, psychological, and spiritual effects that reduce capacity/functioning and impact QOL
what are some causes of fatigue (4)
- disease
- medical interventions/meds
- sleep disturbances
- inadequate symptoms mngmt
what are some examples of diseases that can cause fatigue (4)
- COPD
- cancer
- anemia
- hypoxia
what are 2 examples of meds/medical interventions that can cause fatigue
- chemo
- diuretics therapy –> voiding at night
how can inadequate symptoms mngmt lead to fatigue
- keep pt up at night
- or cause psycholoical fatigue
why is it imp to recognize fatigue
- distress d/t fatigue effected 80% of pts receiving formal palliative care
- can negatively impact QOL if not recognized and treated
what is included in assessment of fatigue (7)
- 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
what physical exams and test can be used to assess fatigue (3)
- lvl of alertness
- strength
- blood work
what are 2 categories of approaches to mngmt of fatigue
- non pharm
- pharm
what are non pharmacological interventions for fatigue (4)
- energy conservation
- sleep hygeine (ex, sleep schedule)
- delegating tasks to conserve energy
- consults (OT, PT)
what are some pharmacological approaches to mnging fatigue (3)
- 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)
what is a specific med that can be used to help mng fatigue
- methylphenidate
