Intervention | Dose | Mode of action | Rationale |
Optimal positioning, usually upright with arms elevated and supported | Whenever patient reports dyspnea or displays respiratory distress | Increases pulmonary volume capacity | Increases air exchange which may improve oxygenation and carbon dioxide clearance and reduce inspiratory effort |
Balance rest with activity | Guided by dyspnea/respiratory distress | Decreases excessive oxygen consumption | Prevents hypoxemia |
Space nursing care | |||
Oxygen as indicated by goals of therapy; not useful in normoxemia or when the patient is near death and in no distress | Variable, guided by goals of therapy and patient characteristics | Improves the partial pressure of oxygen; reduces lactic acidemia | Treats hypoxemia |
Cold cloth on face | As needed | Trigeminal nerve stimulation; action on dyspnea unknown | Anecdotal reports of patient relief; inexpensive; easy to perform |
Opioids, such as morphine or fentanyl | Low dose titrated to the patient's report of dyspnea or display of dyspnea behaviors is effective; oral or parenteral; no evidence to support inhaled administration; no evidence on dosing regimens | Uncertain direct effect; reduced brainstem sensitivity to oxygen and carbon dioxide; altered central nervous perception | Strong evidence-base supports effectiveness |
Benzodiazepines, such as lorazepam or midazolam | Low doses titrated to the patient's report of dyspnea or display of dyspnea behaviors; no evidence for benzodiazepine regimens | Anxiolysis | Fear or anxiety often accompanies dyspnea |
Do you want to add Medilib to your home screen?