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Use the high-Fowler position only if the patient is responsive, hemodynamically stable, and has an unobstructed airway.
Opioids may cause depressed respiratory rate and depth. Because opioids are metabolized in the liver, with any impaired liver function, the amount of opioid—particularly morphine—that is released into the bloodstream may be lacking or may vary.undefined#ref4">4
Dyspnea, characterized by subjective breathlessness,3 is a common symptom in patients with terminal cancer, and in many cases, it is not managed well. Dyspnea is a complex symptom involving physiologic and psychologic factors that can occur in conjunction with many disease processes, especially in patients who have a life-limiting illness.2 Dyspnea may also be associated with respiratory and cardiac conditions (e.g., airway obstruction, chronic heart failure, chronic obstructive pulmonary disease [COPD], and respiratory infection). With progression of the underlying disease processes, dyspnea worsens and usually peaks in the last week of life (requiring additional home visits to better manage symptoms).5 As life expectancy decreases, the need for opioids and benzodiazepines likely will increase. Examination may reveal tachypnea, inspiratory retractions, accessory muscle use, nasal flaring, and cyanosis. Auscultation may reveal normal or diminished breath sounds, inspiratory stridor, expiratory wheezing, and crackles.
Common causes of dyspnea include:
Differential diagnoses include:
Pharmacologic interventions include those that may relieve contributing factors, such as bronchodilators, benzodiazepines, and diuretics, as well as those that may provide direct symptom relief, such as opioids (particularly morphine), steroids, and oxygen.4 Nonpharmacologic interventions include use of a fan or ambient air, decreased room temperature, sitting upright, breathing exercises, proper positioning, and relaxation techniques.
Rationale: Dyspnea is multidimensional and multifactorial.3
Rationale: Providing nonpharmacologic interventions in conjunction with pharmacologic interventions may improve dyspnea management.
Rationale: Increasing airflow to the patient’s face stimulates the trigeminal nerve and inhibits dyspnea.
Rationale: Oral hygiene enhances olfactory sensations.
Notify the practitioner if dyspnea does not improve with oxygen use. If oxygen is ineffective, obtain a practitioner’s order to discontinue it because of the potential for adverse reactions from continued therapy.
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