STUDY - Technical - New Dacian's Medicine
Dyspnea
(Classical / Allopathic Medicine)
Commonly a symptom
of cardiopulmonary dysfunction, dyspnea is the sensation of
difficult or uncomfortable breathing. It's usually reported as
shortness of breath. The severity varies greatly and may be
unrelated to the severity of the underlying cause. Dyspnea may
be of sudden or gradual onset.
Most people
experience dyspnea when they overexert themselves, but the
severity depends on their overall physical condition. In a
healthy person, dyspnea is quickly relieved by rest.
Pathologic causes of dyspnea include pulmonary, cardiac,
neuromuscular, and allergic disorders. Anxiety may also cause
shortness of breath. (Because dyspnea is subjective and may be
exacerbated by anxiety, patients from cultures that are highly
emotional may complain of shortness of breath sooner than
those who are more stoic about symptoms of illness.)
ALERT:
If a patient complains of dyspnea:
- assess him for signs of respiratory distress, such as tachypnea, cyanosis, restlessness, and accessory muscle use
- administer oxygen, and initiate emergency measures, if necessary.
If the patient can answer questions without increasing his distress, perform a focused assessment.
If a patient complains of dyspnea:
- assess him for signs of respiratory distress, such as tachypnea, cyanosis, restlessness, and accessory muscle use
- administer oxygen, and initiate emergency measures, if necessary.
If the patient can answer questions without increasing his distress, perform a focused assessment.
HISTORY:
Ask the patient if the shortness of breath began suddenly or gradually. Is it constant or intermittent? Does it occur during activity or while at rest?
Ask the patient if he has had dyspneic attacks before. If so, have the attacks increased in severity? What aggravates or alleviates the attacks?
Review the patient's medical history for orthopnea, paroxysmal nocturnal dyspnea, progressive fatigue, upper respiratory tract infection, deep vein phlebitis, immobility, recent trauma, and other disorders.
Ask the patient if he has a productive or nonproductive cough or chest pain.
Ask the patient about tobacco use and exposure to occupational irritants or toxic fumes.
Ask the patient if the shortness of breath began suddenly or gradually. Is it constant or intermittent? Does it occur during activity or while at rest?
Ask the patient if he has had dyspneic attacks before. If so, have the attacks increased in severity? What aggravates or alleviates the attacks?
Review the patient's medical history for orthopnea, paroxysmal nocturnal dyspnea, progressive fatigue, upper respiratory tract infection, deep vein phlebitis, immobility, recent trauma, and other disorders.
Ask the patient if he has a productive or nonproductive cough or chest pain.
Ask the patient about tobacco use and exposure to occupational irritants or toxic fumes.
PHYSICAL
ASSESSMENT:
Look for signs of chronic dyspnea, such as accessory muscle hypertrophy (especially in the shoulders and neck). Also look for pursed-lip exhalation, finger clubbing, peripheral edema, barrel chest, diaphoresis, and jugular vein distention.
Check blood pressure and auscultate for crackles, abnormal heart sounds or rhythms, egophony, bronchophony, and whispered pectoriloquy.
Palpate the abdomen for hepatomegaly.
Look for signs of chronic dyspnea, such as accessory muscle hypertrophy (especially in the shoulders and neck). Also look for pursed-lip exhalation, finger clubbing, peripheral edema, barrel chest, diaphoresis, and jugular vein distention.
Check blood pressure and auscultate for crackles, abnormal heart sounds or rhythms, egophony, bronchophony, and whispered pectoriloquy.
Palpate the abdomen for hepatomegaly.
SPECIAL
CONSIDERATIONS:
Monitor the dyspneic patient closely. Be as calm and reassuring as possible to reduce his anxiety. Help the patient into a comfortable position, usually high Fowler's or forward leaning.
Monitor the dyspneic patient closely. Be as calm and reassuring as possible to reduce his anxiety. Help the patient into a comfortable position, usually high Fowler's or forward leaning.
PEDIATRIC
POINTERS:
Normally, an infant's respirations are abdominal, gradually changing to costal by age 7. Suspect dyspnea in an infant who breathes costally, in an older child who breathes abdominally, or in any child who uses his neck or shoulder muscles to help him breathe.
Both acute epiglottitis and laryngotracheobronchitis (croup) can cause severe dyspnea in a child and may even lead to respiratory or cardiovascular collapse.
Normally, an infant's respirations are abdominal, gradually changing to costal by age 7. Suspect dyspnea in an infant who breathes costally, in an older child who breathes abdominally, or in any child who uses his neck or shoulder muscles to help him breathe.
Both acute epiglottitis and laryngotracheobronchitis (croup) can cause severe dyspnea in a child and may even lead to respiratory or cardiovascular collapse.
AGING ISSUES:
Older patients with dyspnea related to chronic illness may not be aware initially of a significant change in their breathing pattern.
Older patients with dyspnea related to chronic illness may not be aware initially of a significant change in their breathing pattern.
PATIENT
COUNSELING:
Tell the patient that oxygen therapy isn't necessarily indicated for dyspnea. Encourage a patient with chronic dyspnea to pace his daily activities.
Tell the patient that oxygen therapy isn't necessarily indicated for dyspnea. Encourage a patient with chronic dyspnea to pace his daily activities.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)