Week 9

Question 1

what is dyspnea

Answer 1

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

Question 2

what is imp to note r/t dyspnea

Answer 2

• 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

Question 3

what are various categories of causes of dyspnea (5)

Answer 3

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

Question 4

what are 3 examples of pulmonary causes of dyspnea

Answer 4

• COPD
• pleural effusion
• tumour blockage

Question 5

what are 3 examples of CVS causes of dyspnea

Answer 5

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

Question 6

what impact might chemoreceptors have on dyspnea

Answer 6

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

Question 7

what is an important consideration r/t assessment of dyspnea

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

may do further investigation:

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

Question 10

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

Answer 10

• 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

Question 11

what position should you put a pt in w dyspnea

Answer 11

• tripod

Question 12

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

Answer 12

• apply a fan directed at their face

Question 13

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

Answer 13

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

Question 14

what are nonspecific pharmacological interventions for dyspnea (2)

Answer 14

• opioids

- benzos

Question 15

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

Answer 15

• opioids

Question 16

how do opioids help manage dyspnea (6)

Answer 16

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

Question 17

what are examples of opioids for dyspnea (4)

Answer 17

• morphine
• hydromorphone
• fentanyl
• sufentanil

Question 18

when are benzos used for dyspnea

Answer 18

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

Question 19

what are some side effects of opioids

Answer 19

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

reviewed in pain class

Question 19

what are some side effects of opioids

Answer 19

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

reviewed in pain class

Question 20

describe o2 use for those experiencing dyspnea (2)

Answer 20

• use should be indiivdualized to the pt

- may be used in pts w hypoxemia and are alert

Question 21

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

Answer 21

• not appropriate

Question 22

what is a dyspnea crisis (3)

Answer 22

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

Question 23

describe assessment of dyspnea crisis

Answer 23

• v hard to miss, will likely see objective signs

Question 24

list nursing interventions for dyspnea crisis (4)

Answer 24

- 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)

Question 25

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

Answer 25

- IV

Question 26

what is total dyspnea

Answer 26

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

Question 27

describe the relationship between anxiety & dyspnea

Answer 27

- anxiety = signif exacerbator dyspnea --> anxiety --> worse dyspnea --> worse anxiety

Question 28

define fatigue

Answer 28

- complex, multifactorial syndrome characterized by physical, mental, psychological, and spiritual effects that reduce capacity/functioning and impact QOL

Question 29

what are some causes of fatigue (4)

Answer 29

- disease - medical interventions/meds - sleep disturbances - inadequate symptoms mngmt

Question 30

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

Answer 30

- COPD - cancer - anemia - hypoxia

Question 31

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

Answer 31

- chemo | - diuretics therapy --> voiding at night

Question 32

how can inadequate symptoms mngmt lead to fatigue

Answer 32

- keep pt up at night | - or cause psycholoical fatigue

Question 33

why is it imp to recognize fatigue

Answer 33

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

Question 34

what is included in assessment of fatigue (7)

Answer 34

- 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

Question 35

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

Answer 35

- lvl of alertness - strength - blood work

Question 36

what are 2 categories of approaches to mngmt of fatigue

Answer 36

- non pharm | - pharm

Question 37

what are non pharmacological interventions for fatigue (4)

Answer 37

- energy conservation - sleep hygeine (ex, sleep schedule) - delegating tasks to conserve energy - consults (OT, PT)

Question 38

what are some pharmacological approaches to mnging fatigue (3)

Answer 38

- 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)

Question 39

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

Answer 39

- methylphenidate