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Dyspnoea: Assessment and Management

Have you ever felt breathless after climbing a flight of stairs? You probably feel an uncomfortable sensation of breathing! How do we then assess and manage dyspnoea, a common symptom experienced by palliative care patients? Watch on to find out more! -- Recap 📝 Dyspnoea = breathlessness: a subjective sensation of an uncomfortable awareness of breathing. It is a frequent symptom, occurring in 50-70% of dying patients. Causes of Dyspnoea: Physical illnesses e.g. pneumonia, chronic obstructive pulmonary disease (COPD), and organ failures. Psychological issues e.g. anxiety, fear, and depression. Assessment of Dyspnoea: Getting patients to self-report is the best way to assess dyspnea as it is a subjective symptom. 1. Numerical rating scale. The patient rates dyspnoea on a scale of 0 (no breathlessness) to 10 (worst breathlessness). 2. Respiratory Distress Observation Scale (RDOS) RDOS comprises the following components: • Heart rate per minute (HR/min) • Respiratory rate per minute (RR/min) • Restlessness, where the patient moves around non-purposefully. • Abnormal breathing patterns such as the patient's abdomen moving in when breathing in • Use of accessory muscles • Grunting when the patient breathes out • Nasal flaring where the patient's nostrils are widened during breathing • Look of fear such as eyes wide open, facial muscles tense, etc. Non-pharmacological interventions: • Modifying activity • Modifying environment • Providing touch and comfort. Pharmacological measures, there are 2 main treatment goals: • To look for reversible causes and treat the underlying conditions, for example providing antibiotics for lung infections. • To relieve dyspnoea by using opioids such as morphine and fentanyl and/or benzodiazepines. Animation transcript: https://bit.ly/3lnk1jr References 1. Booker R. Causes and management of chronic breathlessness in adults. Nurs Times. 2004;100:46-7, 49-50. 2. Lanken PN, et al. An official American Thoracic Society clinical Policy Statement: Palliative Care for Patients with Respiratory Diseases and Critical Illnesses. American Thoracic Society Documents. Am J Respir Crit Care Med. 2008;177(8):912-27. 3. Campbell ML, Templin T, Walch J. Patients who are near death are frequently unable to self-report dyspnea. J Palliat Med. 2009;12:881–884. 4. Gift AG, Narsavage G. Validity of the numeric rating scale as a measure of dyspnea. Am J Crit Care. 1998;7(3):200-204. Content experts: Dr. Ho Peiyan and Dr. Laurence Video producer: Perry Lee Voiceover: Henry Kong This video is done in collaboration with GERI Institute - https://www.geri.com.sg/ All rights are reserved to GeriCare and there should not be any reproduction, publication, or adaptation to any part of the video content without prior approval from GeriCare. #GCPowerFacts #GCTrainingHub --- GeriCare PowerFacts is a series of free bite-sized and engaging educational videos, covering topics across Geriatric Care and Palliative Care. For more information, visit our website at https://www.gericarenorth.com/powerfacts