GARMA, Bryan Neil C. Written Report Preceptor: Dr.

Rosales

Group 11 Subgroup 2

TREATMENT AND MANAGEMENT OF DYSPNEA

The first goal is to correct the underlying problem responsible for the symptom. If this is not
possible, one attempts to lessen the intensity of the symptom and its effect on the patient’s quality of
life

TREATMENT OF UNSTABLE PATIENT

• Administer Oxygen

• Consider intubation of the patient is gasping, apneic, or non- responsive

• Establish IV line and start fluid resuscitation

• Tension pneumothorax – Thoracentesis

• Obstructive pulmonary Disease – Bronchodilator

• Pulmonary edema – IV/IM furosemide

Unstable patients typically present with one or more symptom patterns:

• Hypotension, altered mental status, hypoxia, or unstable arrhythmia

• Stridor and breathing effort without air movement (suspect upper airway obstruction)

• Unilateral tracheal deviation, hypotension, and unilateral breath sounds (suspect tension
pneumothorax)

• Respiratory rate above 40 breaths per minute, retractions, cyanosis, low oxygen saturation

After patient has been stabilized;

• Reassess the patient’s airway, mental status, ability to speak, and breathing effort

• Check vital signs

• Thorough history taking and physical examination (i.e. breath sounds and observe skin colour)

MANAGEMENT STRATEGIES

1. Reduce ventilatory demand

2. Decrease sense of effort

3. Improve respiratory muscle function

4. Pulmonary rehabilitation
A. REDUCE VENTILATORY DEMAND

Treat the underlying causes

• Infection

• Pleural effusion

• Pneumothorax

• Pulmonary embolism

• Foreign bodies

• Congestive heart failure

Supplemental oxygen - should be administered if the resting O2 saturation is ≤88% or if the patient’s
saturation drops to these levels with activity or sleep.

Opioids - reduce symptoms of dyspnea, largely through reducing air hunger, thus, likely suppressing
respiratory drive and influencing cortical activity. Opioids should be considered for each patient
individually based upon the risk-benefit profile as regards the effects of respiratory depression.

Exercise training

B. DECREASE SENSE OF EFFORT AND IMPROVE RESPIRATORY MUSCLE

• Positioning (leaning forward)

• Energy conservation / pacing

• Airflow

• Relaxation/ Distraction/ Assurance

• Controlled breathing techniques / Physiotherapy

• Loose clothing

• Correct obesity

POSITIONING (LEANING FORWARD)

BREATHING TECHNIQUES

BREATHING EXERCISES

Experimental interventions

• cold air on the face

• chest-wall vibration, and

• Inhaled furosemide — to modulate the afferent information from receptors throughout the
respiratory system.