Question

1. Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort. (Learning Objective 9) What nursing measures should the nurse use to manage the patient’s dyspnea? The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses?

Answer 1

9)The nursing measures to manage his dyspnea are

• Provide propped up position or a semi fowler's position ,this will expand the lung capacity
• Teach breathing exercise like purse lip method this will increase the residual oxygen and eliminate the carbondioxide level
• Monitor oxygen saturation level and vital signs to have patients baseline data
• Avoid allergic triggers which can cause exacerbation of breathlessness
• Administration of medication as per order
• Nebulize the patient at proper interval

The nursing measures to meet his physiological needs are

• Provide small and frequent meals
• Plan a diet with patient preferences as the priority
• Encourage patient to do mild activity of daily living which can improve the appetite
• Administer appetite stimulizer as per order if any
• Provide food in a high Fowler position so that patient can breath and prevent aspiration