Dyspnea : for Nursing

Dyspnea for nursing student

1. DYSPNEA NIPIN KALAL M.Sc. Nursing Medical S urgical N ursing

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 night Nocturnal Dyspnea occur in lie down Orthopnea Dyspnea in right or left lateral lying position Trepopnea Dyspnea in Upright position Platypnea

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-inflammatory Asthma Antibiotics Pneumonia Antibiotics, Chest tube Pneumothorax Diuretics, Nitrate Heart failure Anxiolytic Anxiety Anti- tussives COPD

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