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Posted: 16 Jul 2010 04:42 AM PDT

Dyspnea is the technical word for difficulty breathing. It’s a common symptom in people who have lung cancer or have cancer that has spread to the lungs. People who experience dyspnea describe it as difficulty in breathing or shortness of breath. They often compare it to feeling like they are suffocating or being smothered. In many cases, patients may develop anxiety or panic if they feel they cannot breathe. Often their anxiety and fears can make the dyspnea worse. By panicking, patients can become more breathless and begin a cycle that is hard to stop.

Dyspnea occurs when patients have trouble moving air in and out of their lungs. Patients can also experience dyspnea if their lungs are not getting enough oxygen.

Here’s some advice from Teresa Knoop, RN, MSN, AOCN, Cancer Information Nurse Specialist, Vanderbilt-Ingram Cancer Center, about how patients can work with their healthcare team to treat their dyspnea and control the anxiety it can cause.
Who Gets Dyspnea?

“Patients with primary lung cancers commonly complain of dyspnea. So do patients who have another type of cancer, such as breast cancer, that has spread to the lungs” says Knoop. But, she explains, people can also have dyspnea if they have any of these health issues.

*A fever, anemia, or infection
*Emphysema
*Heart disease
*Overweight
*Allergies

Some cancer treatments, such as lung surgery, radiation to the lungs, and certain chemotherapy, may damage the lungs and cause dyspnea. Other treatments such as draining the lungs or placing a catheter into the veins of the chest can also cause patients to experience dyspnea.
How Is Dyspnea Evaluated?

Dyspnea is subjective, explains Knoop. “As nurses, we are dependent on the patient to describe and rate the sensation. Generally, we ask patients to explain their breathlessness in terms of 'mild,’ 'moderate,’ or 'severe.’”

“Dyspnea may prevent people from doing something they normally do with ease,” says Knoop, That’s why we often ask patients to describe how their dyspnea affects their daily life and their quality of life.

To help you talk with your doctor or nurse about dyspnea, it may help to keep track of how it affects you. Keep a journal of when you have it, what makes it better, and what makes it worse.
How Can Dyspnea Be Treated?

Treatment of dyspnea is usually directed toward the treatment of the underlying disease. “For example, if fluid is collecting in the lung, the fluid may need to be drained to lessen the dyspnea. Chemotherapy or radiation therapy may shrink a tumor to lessen the dyspnea. If dyspnea is being caused by an infection, antibiotics may be required,” says Knoop.

Your doctor may treat dyspnea with medication. Here are some options for that.

*Bronchodilators open a patient’s airways and decrease their dyspnea.
*Steroids help reduce any swelling in the lungs that may be causing the shortness of breath.
*Anti-anxiety drugs can help the cycle of panic leading to more breathing difficulties.
*Pain medications can make breathing easier.

Your doctor might also prescribe oxygen. Ask your healthcare team about breathing and relaxation techniques you can try on your own.
What Can a Patient Do to Manage Dyspnea?

“Relaxation exercises, meditation, breathing techniques, conservation of energy, and limitations of activity may be helpful in dealing with dyspnea,” says Knoop. These techniques may also control your anxiety level, an important part of treating dyspnea.

It might also be helpful to change the way you sit or sleep. Patients with dyspnea may find it helpful to try sitting upright in a chair, leaning forward slightly, and resting their forearms on the arms of the chair or their knees to help their lungs to expand. Sleeping with several pillows or in a recliner can also help.

Here are two types of breathing exercises to manage dyspnea. Always talk with your doctor or nurse before trying these techniques. It can also be helpful to talk to a respiratory or physical therapist for hints on how to manage dyspnea.

*Diaphragmatic breathing. This is also called abdominal breathing. To do this type of breathing, you must first find your diaphragm. Here’s how: Place your fingers just below your breastbone and breathe in. The muscle that moves is the diaphragm. You may find it useful to lie flat on your back and place a book on your abdomen so you can watch your breathing pattern as the book rises and falls. Your goal is to make the book rise and fall with each breath.

*Pursed-lip breathing. To do this type of breathing, keep the lips pressed together tightly, except for the very center. Take normal breaths. Breathe in through the nose. Then take twice as long to breathe through the center of your mouth.
source : http://www.healthline.com/sw/cs-struggling-to-breathe-a-nurses-tips-for-managing-dyspnea

Please read this important information

Nursing care plan congestive heart failure (CHF)

Posted: 16 Jul 2010 04:34 AM PDT

NCP for Congestive Heart Failure (CHF) with a nursing diagnosis of decreased cardiac output related to mechanical alteration in preload resulting in ventricular hypertrophy causing a decreased in contractility; mechanical alteration in afterload resulting in vasoconstriction causing increased work for the heart; electrical changes in rhythm, rate, conduction caused myocardial ischemia, electrolyte imbalance resulting in decreased contractility, stroke volume and arrhythmia’s. The second diagnosis would be an altered cardiopulmonary, peripheral tissue perfusion related to myocardial ischemia resulting in reduced blood supply, cardiac output, fluid in the alveoli resulting in ventilation perfusion imbalance; systemic venous congestion caused vasoconstriction.

What is Congestive Heart Failure (CHF)?
CHF is a group of manifestations caused by a chronic or acute abnormal state of cardiac pump performance that results in a heart rate and volume that are insufficient to meet metabolic requirements to the tissues. The result is a retention of fluid leading to systemic or pulmonary circulation congestion.

Nursing care plan Congestive Heart Failure

Nursing Intervention and Rationale

Assess for blood pressure, increased pulse and respiration and central venous pressure. Signs of reduced cardiac output as heart attempts to compensate for decreased contractility.
Assess for presence of extra S3 and S4 over apical area on auscultation. Indication of mechanical failure.
Assess for dyspnea, air hunger, tachypnea, shallow respirations, crackles and wheezes on auscultation. Indication of pulmonary congestion with fluid in alveoli.
Assess for dependent edema in extremities, sacral area, weak peripheral pulses. Systemic venous congestion with reduced cardiac output affecting perfusion caused by vasoconstriction.
Monitor vital signs every two to four hours including apical pulse, peripheral pulses, capillary refill, CVP and PAP if appropriate. Indicates change in cardiac status and potential for arrhythmias, compromised systemic venous flow.
Monitor for heart sounds and breath sounds. Indications of recuced cardiac output caused by mechanical failure, pulmonary edema.
Monitor electrolyte level of sodium increases and potassium decreases. Diuretic therapy may induce hypokalemia; decreased glomerular filtration rate (GFR) may cause hypernatremia; arrhythmias may be induced by potassium imbalances.
Administer Vasodilator e.g. nitroglycerin, hydralazine, while monitoring hemodynamics status. Decreases afterload by increasing blood flow to myocardium.
Administer inotropic agents (digoxin, dopamine) while monitoring hemodynamic status. Increases cardiac output by increasing cardiac contractility.
Administer diuretic (hydrochlorothiazide, furosemide) while monitoring for electrolyte imbalances. Acts on distal tubule to increase water and potassium excretion or loop of Henle to promote excretion of sodium and chloride.
Administer bronchodilator (theophylline). Dilates airways to facilitate breathing if dyspneic.
Administer oxygen therapy by cannula. Provides oxygen if hypoxic from decreased cardiac output or with ventilation perfusion imbalance from fluid in alveoli.
Administer potassium for replacement.
Provide bed rest with head of bed elevated 30 to 60 degrees. Promotes lung expansion and decreases venous return.
Perform deep breathing exercises, incentive spirometry ever two hours. Improves breathing and oxygen intake.
Perform cautious administration of IV solution avoiding sodium if retained. Improves preload.
Provide quite environment limiting stimuli. Stimuli and stress stimulate catecholamines and cardiac workload.
Provide small meals six times per day. Reduces pressure on diaphragm and enhances chest expansion.

Educate the patient to report palpitations, dizziness, weakness, fatigue, leg cramps, excesive thirst, loss of five pounds per week, heart rate of less than 60 per minute and to hold dose, blurred vision, nausea, vomiting, mental confusion, headaches that subsides with continued use or by lying down, and ankle edema.

Nursing Diagnoses

Fluid volume excess related to compromised regulatory mechanism of decreased glomerular filtration resulting in sodium and fluid retention.

Fatigue related to circulation causing poor oxygenation of tissues; immobility caused by enforced bedrest to decrease oxygen needs; nutrition causing inability to absorb nutrients with poor perfusion to organs; stress caused by life-threatening condition.

Disturbance of sleep pattern related to illness resulting in interrupted sleep caused by nocturnal dyspnea. Anxiety related to threat to or change in health status resulting in inability to manage feelings of uncertainty and apprehension regarding the life-style changes.

Ineffective individual coping related to situational crisis of illness and possible recurrence, inability to cope or problem solve.

source :http://gino-memoirofaschizo.blogspot.com/search/label/Medical%20Surgical%20Nursing