Dyspnea : for Nursing
- 1. DYSPNEA NIPIN KALAL M.Sc. Nursing Medical Surgical Nursing
- 2. Dyspnea ‘’Dyspnea’’ meaning : Dys : Difficult, Painful Pneumea : Breath • Dyspnea can be defined as the feeling of an uncomfortable need to breath. • Dyspnea is defined as abnormal or uncomfortable awareness of breathing in the context of what is normal for a person according to his or her level of fitness and exertional threshold for breathlessness.
- 3. Types of dyspnea Dyspnea occur at nightNocturnal Dyspnea occur in lie down Orthopnea Dyspnea in right or left lateral lying positionTrepopnea Dyspnea in Upright positionPlatypnea
- 4. Causes of dyspnea : Pulmonary Upper airway Foreign body Laryngospasm Epiglottises trauma Bronchi Asthma Bronchitis Bronchiolitis Bronchogenic carcinoma Alveoli Pneumonia Emphysema Pulmonary contusion ARDS Toxic inhalation
- 5. Causes of dyspnea : Pulmonary Interstitium Pneumoconiosis Pulmonary embolism Pulmonary fibrosis Thoracic cage Pneumothorax hemothorax Effusion Respiratory musculoskeletal Rib fracture Flail chest Guillain barre syndrome Myasthenia gravis
- 6. Causes of dyspnea : Cardiac Heart failure Myocardial infarction Cardiomyopathy Valvular dysfunction LVH Pericarditis Arrhythmia Cardiac temponade
- 7. Causes of dyspnea : Cardiac & Pulmonary COPD with pulmonary hypertension & cor pulmonale Chronic pulmonary emboli Trauma
- 8. Causes : Non cardiac & Non pulmonary Metabolic condition : anemia, diabetic ketoacidosis, acidosis Pain in chest wall Neuromuscular disorder : multiple sclerosis, muscular dystrophy Nasal obstruction Nasal polyps Septal deviation Enlarge tonsil Functional : Anxiety, panic disorder, hyperventilation
- 9. Health history & physical assessment • Health history : • Past medical history : Cardiac diseases, pulmonary disease, metabolic disease. • Psychosocial history : panic disorder, stress, tension, anxiety • Family history : asthma, hypertension, allergies • Recent health history : trauma, chest wall pain, limiting respiration • Occupational history : working area, dust allergy • Subjective complains : Dyspnea on exertion Orthopnea , Paroxysmal nocturnal dyspnea, Edeme
- 10. Physical assessment • Anxiety : anxiety disorder • Nasal polyps, septal deviation : dyspnea to nasal obstruction • Jegular vein distention : congestive heart failure • Decrease bruit or pulse : peripheral vascular disease with coronary artery disease. • Cyanosis and clubbing : severe hypoxemia • Increase anteroposterior chest diameter : emphysema • Wheezing : asthma, pulmonary edema • Rales : alveolar fluid • Tachycardia : anemia, hypoxia, heart failure • Murmur : valvular dysfunction • S3 : congestive heart failure
- 11. Diagnostic evaluation Chest radiograph (CXR): weather cardiac or pulmonary P ECG Pulmonary function test(PFT) Echo CT scan of chest Treadmill test Lung Biopsy ABG Coronary angiography Cardiac cause Pulmonary cause
- 12. Medical management • Treatment of dyspnea is directed at the cause. Bronchodilator, Anti-inflammatoryAsthma AntibioticsPneumonia Antibiotics, Chest tubePneumothorax Diuretics, NitrateHeart failure AnxiolyticAnxiety Anti-tussivesCOPD
- 13. Nursing management • Positioning • Oxygen therapy • Suctioning • Chest physiotherapy • Postural drainage • Liquid intake • Proper ventilation • Breathing exercise • Spirometery • Vital signs • Proper rest • Limited activity • Psychological support/ avoid anxiety