Breathlessness and Noisy Breathing
Breathlessness can be uncomfortable for patients, but it can also make feelings of anxiety worse. Drugs such as morphine can reduce the sensation of breathlessness as can simpler ways such as hand held fans to give the patient a feeling of air on their face.
Near the end of life, mucus can build up causing noisy breathing. Some patients may not find this upsetting and it may not mean that breathing is more difficult. However, if a patient does seem distressed by it, the medical team may clear the mucous by suctioning. If mucus is still causing distress, the patient may be given drugs to dry up mucus production.
Definition/Description of Breathlessness
• One of the most frightening and distressing symptoms for patients, families, and caregivers
Shortness of breath
Smothering feeling
Inability to get enough air
Suffocation
Sense of drowning
• Prevalence in the life-threateningly ill: 12%–74%, depending on the diagnosis and the stage of illness
• Fortunately, for the majority of patients, relief can be relatively straightforward
• Yet lack of understanding of breathlessness and the medications to manage it, and the fear of adverse effects, frequently lead to inadequate relief and unnecessary suffering for the patient, family, and caregivers
• Respiratory rate, pO2, blood gas determinations DO NOT correlate with the feeling of breathlessness
• The only reliable measure is patient self-report
Some patients may not report breathlessness
However, when asked about walking, they may indicate that breathlessness prevents them from walking at their usual pace or distance
• Families and caregivers need to be aware that what they see may be very different from the patient’s experience
• Time spent to understand the patient’s wishes for symptom control, and to communicate management strategies to the patient, family, and caregivers, will minimize misunderstanding and onlookers’ distress
However, 15-20% of critical care patients continue to die during their hospital admission. End-of-life care therefore remains a necessary core skill for critical care teams.
Families should be invited to participate in end-of-life care provision to enhance awareness of dying and develop family-centred care.
There are sessions which:
• introduce you to the principles of symptom management
• describe the assessment and management of commonly occurring symptoms in end-of-life care, e.g. pain, breathlessness, nausea and vomiting, and constipation
• discuss the assessment of mood and management of mood-related conditions, e.g., depression and anxiety
• describe the management of symptoms that demand an urgent response, e.g., spinal cord compression, seizures, and bleeding
• discuss the management of the final phase of life, including death rattle, agitation and restlessness and how to verify death
• discuss symptom management in more challenging situations, e.g., when the person has learning difficulties or mental health problems, or when symptom management is complicated by other co-morbidities
• describe the management of a variety of other symptoms, including fatigue, sore mouth, and wound care, in the context of end-of-life care
https://web.archive.org/web/20211117131805/https://portal.e-lfh.org.uk/Component/Details/392011
MANAGEMENT OF RESPIRATORY SYMPTOMS IN PALLIATIVE CARE
References:
https://bit.ly/webinar-mpi-2021-drikasyamsul
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IKA SYAMSUL HUDA MZ
