dyspnea, or shortness of breath, is one of the most distressing
symptoms for patients and families, particularly when it occurs in
the home setting
defined as the inability to deliver enough oxygen to meet
bodily demands, resulting in an uncomfortable feeling of
it is most often associated with primary or metastatic lung
other causes may include pleural effusion, fibrotic changes in
the lungs due to radiation therapy or chemotherapy, loss of
functional lung tissue after surgical resection, pericardial
effusion, congestive heart failure, pneumonia, and anemia
other symptoms such as pain, anxiety, stress can contribute to
shortness of breath may occur as a result of unrelenting
hiccups, this is usually due to involvement of the diaphragm and
respiratory muscles and usually occurs in terminal patients
aggressiveness of treatment may vary depending upon the stage
of the disease
evaluate the appearance of the patient, including color,
respiratory rate, use of accessory muscles, anxiety level
review past medical history to determine if comorbidities such
as COPD or asthma are contributing to the dyspnea
review the patterns of dyspnea and evaluate for
at rest and/or with exertion
onset and duration
affected by position changes (e.g.. head of bed)
perform pulmonary assessment to evaluate for treatable
conditions e.g.. pneumonia, pleural effusion
psychosocial assessment to evaluate impact of anxiety, stress,
alert the physician when respiratory status changes
if the tumor itself is causing the dyspnea, treatment with
chemotherapy, radiation therapy or surgery may be indicated
recurrent pleural effusions may require drainage of fluid
through thoracentesis, and in some cases, instillation of sclerosing
agents to prevent reaccumulation of fluid
medications used to treat dyspnea may include antibiotics,
diuretics, bronchodilators and steroids
nondrug therapy may include relaxation and breathing exercises,
position changes to facilitate ventilation, psychosocial support,
adequate room ventilation and circulation
Shortness of Breath
when dyspnea is associated with hypoxia, oxygen therapy is
in the terminally ill patient, narcotics and sedatives may be
used to alleviate tachypnea and "air hunger" symptoms
persistent hiccups can be treated with prochlorperazine to
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patient who refuses intubation or ventilation. Dimensions of
Critical Care Nursing, 15, 4-12.
DuPen, AR and Panke, JT (1997) "Common Clinical Problems" in
Varricchio, C. Ed. A Cancer Source Book for Nurses, 7th ed. Atlanta:
American Cancer Society.
Held,JL. (1994). Cancer care: Managing shortness of breath.
Nursing 94, 24, 31.
Kemp, C. (1997). Palliative care for respiratory problems in
terminal illness. American Journal of Hospice and Palliative Care,
Roberts, DK, Thorne, SE and Pearson, C. (1993). The experience of
dyspnea in late-stage caner: Patients' and nurses' perspectives.
Cancer Nursing, 16, 310-320.
Jan 31, 2013 - Early palliative care clinic visits, integrated with standard oncologic care for patients with metastatic lung cancer, emphasize symptom management, coping, and psychosocial aspects of illness, according to research published online Jan. 28 in JAMA Internal Medicine.