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Dyspnea
Noted in many settings: Cancer 21-78% COPD 56% Terminal HIV/AIDS 68% CHF 61-70% CVA 37% ALS 50% Dementia 70% |
Assessment:
Patient's self report is gold standard for presence and severity of dyspnea |
Causes:
Bronchospasm Rales (fluid) Effusions Airway obstruction Thick secretions Hemoglobin low Anxiety Interpersonal issues Religious concerns |
Inhaled
beta agonists short albuterol, levalbuterol, pirbuterol beta agonists long salmeterol, formoterol anticholinergic ipratropium, tiotropium steroid beclomethasone, budesonide,cicelsonide, flunisolide,fluticasone, mometasone saline (for thick secretions) |
oral
glycopyrrolate (Robinul) 1-2 mg po q 4hrs prn secretions hyoscyamine (Levsin) 0.124 mg po/sl q 4hrs prn secretions atropine 1% ophth soln 1-2 drps sl q 4hrs prn secretions scopolamine patch 1-3 q 3days prn secretions |
opioids
hydrocodone 2.5-5 mg po q 4hrs codiene 30 mg po q 4hrs morphine sulfate 5 mg po q 4hrs oxycodone 5 mg po q 4hrs hydromorphone 1-2 mg po q 3-4 hrs |
anxiolytics
lorazepam alprazolam clonazepam other blood transfusion thoracentesis fan, air movement relaxation upright noninvasive ventilatory support therapeutic sedation |