COUGH AND

DYSPNEA
 DYSPNEA
INTRODUCTION
• Dyspnea is a highly subjective symptom that
often is not associated with visible signs of
distress,such as Tachypnea,Diaphoresis,or
cyanosis.
• Patients with primary lung tumors,lung
metastases,pleural effusion or restrictive lung
disease may experience significant dyspnea.
 The causes of the dyspnea can be
identified and treated in some cases ,the
burdens of additional diagnostic
evaluation and treatment aimed at the
physiologic problem may outweigh the
benefits
 The treatment of dyspnea varies
depending on the patients general
physical condition.
 DEFINITIONS
“Dyspnea is the term used when the subject is
conscious of the increased respiratory
effort .In other words difficulty in breathing.”
[R.Chandra Mouli]
“Dyspnea is a symptom common to many
pulmonary and cardiac disorders,particularly
when there is decreased lung complicance or
increased airway resistance.”
[Suresh K.Sharma,S.Madhavi]
 ETIOLOGY
 Dyspnea may associated with neurologic or
neuromuscular disorders(eg;Myasthenia
gravis,Guillain-Barre syndrome,Muscular
dystrophy,post-polio syndrome) that affect
respiratory function .
 Dyspnea occurs after physical exercise in
people without disese.
 Dyspnea is a common at the end of the life in
patients with a variety of disorders.
 MANAGEMENT OF DYSPNEA

This can be achieved by pursuing one or,more

strategies including both pharmacological
and non-pharmacological interventions.
MANAGEMENT OF
DYSPNEA

PHARMACOLOGIAL
NON-
INTERVENTIONS
PHARMACOLOGICL
INTERVENTIONS
 PHARMACOLOGICAL
INTERVENTIONS

•OXYGEN THERAPY
•MEDICATION
 NON-PHARMACOLOGICAL
INTERVENTIONS
1. Deep breathing and coughing
exercises,diaphramatic breathing and
pursed lip breathing.
2. Chest physiotherapy
3. Postural drainage
4. Chest percussion and chest vibration
5. Psychotherapy
6. Exercise training and Relaxation training
7. Acupuncture
OXYGEN THERAPY
 Supplemental oxygen can reverse
hypoxemia.If lack of oxygen is the cause
of dyspnea ,oxygen may be the only
required therapy.
 Patients who can’t breath enough oxygen
from the air may be given supplemental
oxygen to inhale from
tanks/cylinders.Devices that concentrate
oxygen already in the air maybe also
prescribed.
MEDICATIONS

 Opoids may reduce physical and mental

distress and exhaustion,and improve the
patients quality of life.
 Opoids,steroids,bronchodilators and
antianxiety medication maybe helpful for
some people.Steroids drugs are used to
reduce the inflammation and swelling of
lymph vessels in the lungs.
 Bronchodilators are prescribed to open
up the bronchioles (small airways)in the
lungs.
 Bronchodilators such as Albutamol 2.5
mg prn /q4h via Nebulizer and
Ipatropium (atrovent)125mcg prn/q6h
and 250 mcg prn/q6h via Nebulizer treat
reversible bronchospasm.
COMPLICATIONS
 Acute disease of the lungs produce a
more severe grade of dyspnea than do
chronic diseases.
 Sudden dyspnea in healthy person
indicate pneumothorax ,acute respiratory
obstruction,allergic reaction or
myocardial obstruction.
 In immobilized patients sudden dyspnea
denote pulmonary embolism.
 Orthopnea may found in patients with
heart disease and occasionally with
patient with COPD.
 Dyspnea with expiratory wheeze occurs
with COPD.
 Noisy breathing may results from a
narrowing of the airway or localized
obstruction of a major bronchus by a
tumor or foreign body.
 The presence of both inspiratory and
expiratory wheezhing usually signifies
Asthma.
 Dyspnea can occur with other disorders
like;
 Cardiac disease
 Anaphylactic reactions
 Severe anemia
NURSING ASSESSMENT AND
NURSING INTERVENTIONS
 As with assessment of pain ,reports of
dyspnea by patients must be believed.
 The nurse should conduct a careful
assessment of the psychosocial and
spiritual components of the dyspnea.
 Physical assessment parameters include;
 Symptom intensity ,distress and
interference with activities(scale 0 to 10)
 Assessment of fluid balance
 Measurement of abdominal grith
 Temperature
 Sputum quantity and character
 cough
 Auscultation of lung sounds
 The physical assessment findings may assisst
in locating the source of the dyspnea and
selecting the nursing interventions to relieve
the symptom.
 Pharmacological intervention is aimed at
modifying lung physiology and improving
performance as well as altering the perception
of the symptom.
 Low doses of opids are very effective in
relieving dyspnea.
 Dyspnea may be exacerbated by
anxiety ,and anxiety may trigger episodes of
dyspnea,setting of respiratory crisis in
which the patient and family may panic.
 For patients receiving care at home,patient
and family instruction should include
anticipation and management of crisis
situations and clearly communicted
emergency plan.
RELIEF MEASURES

 The management of dyspnea is aimed at

identifying and correcting its cause.
 Relief of the symptom sometimes is
achieved by placing the patient at rest
with the head elevated position(high
fowler’s position).
 In severe case,by administering oxygen.
 NURSES RESPONSIBILITY
 It is important to assess the patient’s rating
of the intensity of breathlessness,the effort
required to breath and the severity of the
breathelessness or dyspnea.
 Patients use a variety of terms and phases
to describe breathlessness and the nurse
needs to clarify what terms are most
familiar to the patient and what these terms
means .
 Visual analogue or other scales can be used
to assess changes in the severity in the
dyspnea over time.
 COUGH
INTRODUCTION
 Cough is a reflex that produces the lungs from
the accumulation of secreations or the
inhalation of foreign body .
 It can be a symptom of a number of disorders
of the pulmonary system or it can be
suppressed in other disorders.
 Cough results from irritation of the mucous
membranes anywhere in the respiratory tract.
 Cough may indicate serious pulmonary disease.
DEFINITION

 “Cough is a reflex that protects the lungs

from the accumulation of secreation of
foreign bodies.its presence or absence
can be diagnostic clue because some
disorders cause coughing and others
suppress it.”
[Brunner and Suddarth]
ETIOLOGY

The cough reflex may be;

 Impaired by weakness or paralyses of the
respiratory muscles.
 Prolonged inactivity.
 Presence of a nasogastric tube.
 Depressed function of the medullary
centers in the brain.
eg;anesthesia,brain disorders
TYPES OF COUGH

 Dry cough
 Hacking cough
 Brassy cough
 Wheezing cough
 Loose or severe cough
RESULTS OF COUGH
 A dry,irritated cough is characterized of an
upper respiratory tract infection of viral
origin or it may be a side effect of ACE
inhibitory therapy.
 An irritated,high pitched cough can be
caused by laryngotracheitis.
 A brassy cough is result of a tracheal lesion.
 Severe or changing cough may indicate
Bronchogenic carcinoma.
 Coughing at night indicate the onset of
left side heart failure/bronchial asthma.
 A cough in the morning with sputum
production indicate bronchitis.
 Coughing after food intake indicate
aspiration of material into the
tracheobronchial tree.
 Violent coughing causes bronchial
spasm,obstruction,and further irritation
of the bronchi and result in syncope.
 A severe,repeated or uncontrolled cough
that is non-productive is exchausting and
potentially harmful.
COMPLICATIONS

o Cough results from irritation of the

mucous membranes anywhere in the
respiratory tract.
o The stimulus that produces a cough may
arise from an infectious process or form
an airbone irritant ,such
as;smoke,smog,dust/gas.
o A persistant and frequent cough can be
exhausting and cause pain.
NURSING MANAGEMENT
NURSING DIAGNOSIS

 Ineffective airway clearance:-in ability to

clear secreations or obstructions from the
respiratory tract to maintain a clear airway.
 Impaired gas exchange:-excess or definit in
oxygenation and/or CO2 elimination at the
alveolar capillary membrane.
 Risk for aspiration:-at risk for entry of
gastrointestinal secretions,oropharyngeal
secretions,solids,or fluids into
tracheobronchial passage.
NURSING INTERVENTIONS
 Respiratory monitoring:-collection and
analysis of patient data to ensure airway
patency and adequate gas exchange.
 Airway management:-facilitations of
patency of air passages.
 Airway suctioning:-removal of airway
secretions by inserting a suction catheter
into the patients oral airway and trachea.
 Aspiration precautions:-prevention or
minimization of risk factors in the
patient at risk for aspiration.
NURSING OUTCOMES
 Respiratory status;airway patency:-
extent to which the tracheobronchial
passages remain open.
 Respiratory status;gas exchange:-the
alveolar exchange of CO2 and O2 to
maintain arterial blood gas
concentration.
 Respiratory status;ventilation:-
movement of air in and out of the lungs.
 RELIEF MEASURES
 Cough suppressants must be used with
caution,because they may relieve the cough but
do not address the cause of cough.
 Drinking warm beverages may relieve cough
caused by throat irritation.
 The use of first generation antihistamines with
decongestant for treatment of acute cough or
upper airway cough syndrome secondary to
rhinosinus disease instead of over the counter
cough expectorants or suppresants(ie,cough
syrups ,cough drops)
NURSES RESPONSIBILITY

 To help determine the course of

cough,the nurse describe the cough.
 Nurse inquires about the onset and the
time of coughing.
 Nurse should explore the effect of a
chronic cough on the patient and the
patients view about the significance of
the cough and its effect on his or her life.
THANK YOU