NURSING STUDY RESOURCE
PALLIATIVE CARE ASSIGNMENT:
Understanding and Managing Breathlessness
This document is intended as a nursing study aid. It should not be submitted as
original work.
INTRODUCTION TO THE TOPIC
This assignment will discuss what breathlessness in people with palliative care
needs, the impact on patients and family members as a symptom of long term
condition or end of life. This essay will also explore the palliative management of
breathlessness and supportive interventions to help individuals with breathlessness
to cope and manage the symptom.
BACKGROUND OF BREATHLESSNESS
According to Elbehairy et al. (2018) breathlessness often occurs with 10% of older
people in the United Kingdom. Critically ill children or children with life-
limiting illnesses often experience symptoms which affect their quality of life, an
example of these symptoms can be breathlessness (Elbehairy et al., 2018). It is
normal for people to run out of breath after physical exertion, for example,
running to catch a bus, sudden movements like getting off the bed or having a
feeling of anxiousness. Breathlessness ( or dyspnea ) is a global issue which can
occur in people with nonmalignant or malignant tumours (Chin & Booth, 2016). Acute
breathlessness could occur for a short period of time, whilst chronic dyspnoea is a
persistent breathlessness for a longer period of time, often starts gradually to
weeks, months or even years. Breathlessness is referred to as a feeling of
shortness of breath or difficulty in breathing (British Lung Foundation, 2019).
Dyspnea is closely associated with increased anxiety (or fears), limited physical
mobility, reduced chances of survival, and negative impacts on quality of life
(Anzueto & Miravitlles, 2017). This symptom sometimes develops when an individual
is predisposed to several environmental factors, either internal environments
(within the body) or the external environments (Anzueto & Miravitlles, 2017). These
predisposing factors include excessive smoking, acute or chronic diseases (examples
include cardiac conditions, renal diseases, or pulmonary diseases like asthma),
illness progression, psychological issues or anxiety, treatment-related causes,
(Marie Curie, 2019). Although, a study showed that an individual’s body mass index
of more than 25 kg/m2, or people aged above 60 years, and inactivity can also lead
to a predisposition in the patient to experience breathlessness (Elbehairy, et al.,
2018).
When breathlessness is not managed or persists for a long period, it can result in
hypoxia or hypoxemia with a decreased level of consciousness and other symptoms
(Dresden, 2018).
Dyspnea encompasses a range of sensations, air hunger, rapid breathing, a feeling
of increased effort, which are highly subjective. Perceptions of dyspnea can vary
between patients, and it affects the physical, social, spiritual and psychological
aspects of the individuals experiencing the symptom (Hayen, Herigstad & Pattinson,
2013).
This has impacts on patients and their family members considerably, it is also a
noticeable cost to the healthcare system, (Chin & Booth, 2016). The standard of
life of relatives and that of the patients can be highly affected in the aspects of
physical effects, psychological distress, and social problems. The family members
of patients often go through emotional trauma such as depression and anxiety
(Duggleby, Schroeder, & Nekolaichuk, 2013). In some severe cases, a family member
may have to give up work to take on an active role in the care of the patient. It
, has also been shown that breathlessness is a classic symptom of a chronic
obstructive pulmonary disease (COPD), advanced stage of cancer, and congestive
cardiac failure (O’Donnell et al., 2016).
PALLIATIVE MANAGEMENT OF BREATHLESSNESS
It is often difficult to understand the precise cause of breathlessness in patients
and this makes management more difficult (Bonk, 2012). Healthcare professionals
caring for individuals with life-limiting illnesses or diseases should respect
their clients’ beliefs, provide holistic care and understand their values (Al-
Shahri, 2016). This is important in other to adopt the person-centred approach (Al-
Shahri, 2016).
Assessment of breathlessness depends on the circumstances or the aetiology. There
are instruments for assessing breathlessness, many of which have been validated for
chronic obstructive pulmonary disease (Tan et al., 2017) . The visual analogue
scale, Borg scale, and numerical rating scales are the commonly used scales,
healthcare providers find these scales easy to use (Tan et al., 2017).
In order to support patients receiving palliative care, healthcare professionals
should have a holistic approach that includes the spiritual, psychiatric,
existential, philosophical, psychosocial, and psychological aspects of palliative
care, (Al-Shahri, 2016).
In the management of breathlessness, a tool was developed by the collaboration of
the Respiratory Network which had encouraged a holistic care approach and it is
applicable at the time of diagnosis and during management, (Hopkinson & Baxter,
2017). Campaigns were developed to encourage patients to visit their general
practitioners whenever they experience a symptom of breathlessness. An aide-
memoire SPACE was used as the tool for holistic care approach (Hopkinson & Baxter,
2017). The aide-memoire encompasses five important themes- Smoking, Pulmonary
disease, anxiety or psychological factors, cardiac diseases, and exercise or
fitness. Smoking cessation can reduce the consequence of chronic breathlessness
(Hopkinson & Baxter, 2017).
An integrated palliative care approach is needed, an approach which makes use of
all significant therapeutic options, collaborative efforts from health and social
care professionals, the patients and informal and formal caregivers. The approach
should entail therapies that would acknowledge the dynamic interrelation of the
body, mind and the spirit (Gysels & Higginson, 2011). Different healthcare
professionals use different strategies or approaches and these include both
pharmacological and non-pharmacological interventions (Smallwood et al., 2018). One
single intervention is unlikely to palliate dyspnea.
It is a complex symptom that requires a complex intervention with different skills,
strengths and personal attributes within the care team members (Gysels & Higginson,
2011). Breathlessness often requires an emergency response, a symptom which needs
immediate interventions. Assessment is essential in order to determine the
severity, type (either acute or chronic), and the duration of the breathlessness
(Coccia et al., 2016). Patients can give an idea of how severe the breathlessness
is for them. Healthcare providers should understand the reasons or predisposing and
precipitating factors to dyspnea and their fears (Chin & Booth, 2016).
Palliative care specialists, respiratory doctors focused on pulmonary
rehabilitation and palliative medicine doctors recommended anxiety management,
handheld fan and breathing techniques (Smallwood et al., 2018). Breathlessness can
be managed according to cause and patients preferences (Pickstock, 2017). If the
symptom is of chronic obstructive pulmonary disease (COPD) origin, pulmonary
rehabilitation will provide symptomatic relief. Bronchodilation through nebulizers,
oral corticosteroids will reduce obstructions in the airways, and often easing
airflow. In cases of respiratory infections, antibiotics could be administered. A
multidisciplinary team of healthcare providers in the management of breathlessness
can reduce the severity of the symptom, reduce frequent hospital visits and improve
PALLIATIVE CARE ASSIGNMENT:
Understanding and Managing Breathlessness
This document is intended as a nursing study aid. It should not be submitted as
original work.
INTRODUCTION TO THE TOPIC
This assignment will discuss what breathlessness in people with palliative care
needs, the impact on patients and family members as a symptom of long term
condition or end of life. This essay will also explore the palliative management of
breathlessness and supportive interventions to help individuals with breathlessness
to cope and manage the symptom.
BACKGROUND OF BREATHLESSNESS
According to Elbehairy et al. (2018) breathlessness often occurs with 10% of older
people in the United Kingdom. Critically ill children or children with life-
limiting illnesses often experience symptoms which affect their quality of life, an
example of these symptoms can be breathlessness (Elbehairy et al., 2018). It is
normal for people to run out of breath after physical exertion, for example,
running to catch a bus, sudden movements like getting off the bed or having a
feeling of anxiousness. Breathlessness ( or dyspnea ) is a global issue which can
occur in people with nonmalignant or malignant tumours (Chin & Booth, 2016). Acute
breathlessness could occur for a short period of time, whilst chronic dyspnoea is a
persistent breathlessness for a longer period of time, often starts gradually to
weeks, months or even years. Breathlessness is referred to as a feeling of
shortness of breath or difficulty in breathing (British Lung Foundation, 2019).
Dyspnea is closely associated with increased anxiety (or fears), limited physical
mobility, reduced chances of survival, and negative impacts on quality of life
(Anzueto & Miravitlles, 2017). This symptom sometimes develops when an individual
is predisposed to several environmental factors, either internal environments
(within the body) or the external environments (Anzueto & Miravitlles, 2017). These
predisposing factors include excessive smoking, acute or chronic diseases (examples
include cardiac conditions, renal diseases, or pulmonary diseases like asthma),
illness progression, psychological issues or anxiety, treatment-related causes,
(Marie Curie, 2019). Although, a study showed that an individual’s body mass index
of more than 25 kg/m2, or people aged above 60 years, and inactivity can also lead
to a predisposition in the patient to experience breathlessness (Elbehairy, et al.,
2018).
When breathlessness is not managed or persists for a long period, it can result in
hypoxia or hypoxemia with a decreased level of consciousness and other symptoms
(Dresden, 2018).
Dyspnea encompasses a range of sensations, air hunger, rapid breathing, a feeling
of increased effort, which are highly subjective. Perceptions of dyspnea can vary
between patients, and it affects the physical, social, spiritual and psychological
aspects of the individuals experiencing the symptom (Hayen, Herigstad & Pattinson,
2013).
This has impacts on patients and their family members considerably, it is also a
noticeable cost to the healthcare system, (Chin & Booth, 2016). The standard of
life of relatives and that of the patients can be highly affected in the aspects of
physical effects, psychological distress, and social problems. The family members
of patients often go through emotional trauma such as depression and anxiety
(Duggleby, Schroeder, & Nekolaichuk, 2013). In some severe cases, a family member
may have to give up work to take on an active role in the care of the patient. It
, has also been shown that breathlessness is a classic symptom of a chronic
obstructive pulmonary disease (COPD), advanced stage of cancer, and congestive
cardiac failure (O’Donnell et al., 2016).
PALLIATIVE MANAGEMENT OF BREATHLESSNESS
It is often difficult to understand the precise cause of breathlessness in patients
and this makes management more difficult (Bonk, 2012). Healthcare professionals
caring for individuals with life-limiting illnesses or diseases should respect
their clients’ beliefs, provide holistic care and understand their values (Al-
Shahri, 2016). This is important in other to adopt the person-centred approach (Al-
Shahri, 2016).
Assessment of breathlessness depends on the circumstances or the aetiology. There
are instruments for assessing breathlessness, many of which have been validated for
chronic obstructive pulmonary disease (Tan et al., 2017) . The visual analogue
scale, Borg scale, and numerical rating scales are the commonly used scales,
healthcare providers find these scales easy to use (Tan et al., 2017).
In order to support patients receiving palliative care, healthcare professionals
should have a holistic approach that includes the spiritual, psychiatric,
existential, philosophical, psychosocial, and psychological aspects of palliative
care, (Al-Shahri, 2016).
In the management of breathlessness, a tool was developed by the collaboration of
the Respiratory Network which had encouraged a holistic care approach and it is
applicable at the time of diagnosis and during management, (Hopkinson & Baxter,
2017). Campaigns were developed to encourage patients to visit their general
practitioners whenever they experience a symptom of breathlessness. An aide-
memoire SPACE was used as the tool for holistic care approach (Hopkinson & Baxter,
2017). The aide-memoire encompasses five important themes- Smoking, Pulmonary
disease, anxiety or psychological factors, cardiac diseases, and exercise or
fitness. Smoking cessation can reduce the consequence of chronic breathlessness
(Hopkinson & Baxter, 2017).
An integrated palliative care approach is needed, an approach which makes use of
all significant therapeutic options, collaborative efforts from health and social
care professionals, the patients and informal and formal caregivers. The approach
should entail therapies that would acknowledge the dynamic interrelation of the
body, mind and the spirit (Gysels & Higginson, 2011). Different healthcare
professionals use different strategies or approaches and these include both
pharmacological and non-pharmacological interventions (Smallwood et al., 2018). One
single intervention is unlikely to palliate dyspnea.
It is a complex symptom that requires a complex intervention with different skills,
strengths and personal attributes within the care team members (Gysels & Higginson,
2011). Breathlessness often requires an emergency response, a symptom which needs
immediate interventions. Assessment is essential in order to determine the
severity, type (either acute or chronic), and the duration of the breathlessness
(Coccia et al., 2016). Patients can give an idea of how severe the breathlessness
is for them. Healthcare providers should understand the reasons or predisposing and
precipitating factors to dyspnea and their fears (Chin & Booth, 2016).
Palliative care specialists, respiratory doctors focused on pulmonary
rehabilitation and palliative medicine doctors recommended anxiety management,
handheld fan and breathing techniques (Smallwood et al., 2018). Breathlessness can
be managed according to cause and patients preferences (Pickstock, 2017). If the
symptom is of chronic obstructive pulmonary disease (COPD) origin, pulmonary
rehabilitation will provide symptomatic relief. Bronchodilation through nebulizers,
oral corticosteroids will reduce obstructions in the airways, and often easing
airflow. In cases of respiratory infections, antibiotics could be administered. A
multidisciplinary team of healthcare providers in the management of breathlessness
can reduce the severity of the symptom, reduce frequent hospital visits and improve
