MANAGEMENT OF BREATHLESSNESS

Introduction:

Breathlessness can be defined as common as well as a subjective symptom which is commonly faced by the victim during the end of life. However, there are several pieces of evidence suggesting that breathlessness can occur in anytime due to some biological disturbance, such as infect in lungs, pulmonary fibrosis and poor blood circulation in the alveolus. Management of breathlessness is the system in which health professional use proper pharmacological and non-pharmacological treatment methods for assisting patient to breathe in normally. This essay is going to discuss the comprehensive overview of breathlessness and the roles of health professionals and nurses in order to manage the condition. Moreover thus essay also will explain the current treatments process assessment methods that are used by health professions in order to cure the situation of breathlessness. By depicting one case-study ion patient suffering from pulmonary fibrosis, this essay is going to discuss the breathlessness in pulmonary fibrosis condition. Finally, this essay will make a suitable conclusion to represent the main points that are highlighted in the overall discussion.

Overview of roles staffs and nurse in the critical care department:

According to O’Donnell et al. (2016), dyspnoea or breathlessness is the sensation of distress and difficulties in breathing. The evidence-based report suggests that patient with dyspnoea are generally admitted in the critical care or palliative care department in hospitals in order to provide them with the immediate ventilation support. Based on the National Health Service (NHS) guidelines, nurses, staffs and other health and social care workers need to be highly trained in managing breathlessness inpatient in a critical care unit (NHS, 2019). It is important for nurses to have proper awareness about how-to access to the health needs of a patient suffering from dyspnoea. As stated by Başoğlu (2017), in order to manage the breathlessness, nurses and health assists would be aware of using immediate remedies in order to support patient with relevant treatment proves. For example, nurses need to understand the proper meaning of dyspnoea. Moreover, the nurse would be highly professional in order to minimise the abnormalities in the ventilation system in the critical care unit. In the case of treating the chronic lung disease which is the potential cause of dyspnoea, nurses would use proper therapeutic and non-therapeutic remedies in order to normalise the breathing process. As per the NHS guidelines, nurses would have proper knowledge regarding all types of physical measures that need to be used in terms of improving the overall respiratory muscle performance and health condition of the patient (NHS, 2019). Nurses should have proper knowledge about using the narcotic and sedative agents as per the doctor's prescription in order to reduce the distress faced by patients with dyspnoea. According to Chan et al. (2016), one of the major roles of nurses in the management of breathlessness is empowering the patient. In the therapeutic nursing process, nurses need to make positive interaction with patients suffering from dyspnoea, in order to access the altered physiology of the patient's body. Moreover, through making proper verbal and non-verbal communication with patients and their families, nurses are able to sense the severity of illness in case patient suffering from chronic breathlessness.

On the contrary Oxley and Macnaughton (2016) argued that, in case of patients suffering from dyspnoea, which are admitted in the critical care unit, it difficult for staffs to communicate interact directly with them, the reason behind the issues is inability of patient suffering from breathlessness to describe their own health condition in front of the health professional and nurses. In this aspect nurse should focus on accessing the current health status of patient ion regular basis, which would assist them, to understand whether the patient is getting recovered. Based on the NICE [National Institute of Care and Excellence] guidelines, along with maintaining communication, nurses are also responsible for making the strong nurse-patient relationship (NICE, 2019). According to Lok (2016), in the critical care unit, nurses need to focus on maintaining string partnership with the patient. In this partnership working process, nurses are responsible to involve the patient in their own recovery by making the patient about their health condition, required remedies and health precaution. Moreover, through partnership working, nurses are able to make strong relations not only with the patient but also with their families in terms of getting proper information regarding the previous medic history, preference and psychology of the patient.

On the contrary Bezjak et al. (2017) mentioned that, in critical care unit, partnership working process sometimes creates the conflict and misunderstanding among a patent, nurses and family members’ that can interfere with the outcomes of the treatment process. The therapeutic relationship is unimportant in palliative care in terms of dealing with a patient with breathlessness, which assists nurses to provide proper patient’s autonomy and respect. Based on the NHS guidelines, in critical care unit nurses would tale a holistic approach to providing proper metal and physical support to the patient suffering from dyspnoea. This holistic approach is associated with providing the best care and support to the patient, assessing their needs, provide proper ventilation support and reduce the level of distress and discomfort that the patient experiences due to breathlessness.

Overview of breathlessness:

Assessment:

When it comes to discussing the overview of breathlessness, it is important to describe the reason and outcomes of this physical condition (Chin and Booth, 2016). World Health Organisation described that breathlessness as the distinct clinical situation the can persist in spite of optimal use of effective therapeutic resources. Different disorders such as chronic respiratory disease, lung infection, pulmonary fibrosis, neuro-macular disorders and terminal cancers are associated with the occurrence of breathlessness. The patient who is admitted in the critical care unit due to breathlessness are provided with mechanical ventilation system in order to provide sufficient oxygen to brain cells. The overall assessment of the condition during breathlessness is base on the result of the therapeutic and non-therapeutic treatment process in the assessment process, first, the patient needs to be admitted in the emergency or critical care unit, where they can get all the immediate treatment facilities as ventilation process and digital monitoring of lung function. Once patient is admitted, then the main goal of assessment is to determine the severity of breathlessness and the need to intubation as well as oxygenation (Ekström et al. 2015). Unstable patient will have symptoms like abnormalities, hypoxia, unstable arrhythmia and poor intravenous access of oxygen. Subsequent management and immediate health assessment of patient with dyspnoea mainly depend on the immediate diagnosis based on proper medical history, ancillary studies and physical examination. Majority of the research shows that dyspnoea actually occurs due to h cardiac disorders and pulmonary disease. Other important causes for dyspnoea are psychogenic disorder, upper airway obstruction, poor neuromuscular condition and metabolic acidosis. In order to assess the current health status of dyspnoea patients, health professions generally focus persistent history findings such as chest pain, orthopnea, oedema, cough and sore throat (Spathis et al. 2017). In case of assessing healthy children suffering from breathlessness, doctors focus on checking the pulmonary muscle contraction, condition of epiglottis and foreign body aspiration. Physical sign which acts the preliminary determination of breathlessness is fever, wheezing, cyanosis, stridor, rales and absence of breath sounds. Is patient with dyspnoea is admitted into critical care unit in the hospitals, health professional performs different tests such as ventilation, perfusion scan blood gases, spiral computed tomography and D-diimer tests.

Treatment:

The overall treatment process of the breathlessness can be classified into two methods such as pharmacological and non-pharmacological methods (Gysels et al. 2016.). The overall pharmacological process of managing and assessing the dyspnoea is associated with providing relevant medication that will assist patients in improving their overall breathing process. Through using the different psychological test and the medical process such as ventilation, perfusion scan blood gases, spiral computed tomography; health professionals are able to assess the overall activity of the lung and heart in the current biological situation. In the case of using the pharmacological treatment process of breathlessness physical examination, clinical testing and checking of the current pulmonary activities are performed by the health professionals. In order to treat the breathlessness, health professions prescribe the relevant narcotic drugs that can assist improve the oxygen circulation into the overall body of the patient. Moreover, health professionals in the critical care unit use appropriate medication process in order to examine the condition of patient’s pulmonary and cardiac muscles, abdominal muscles and cells and the current activities of lung. On the contrary Collier et al. (2015) argued that sometimes, narcotic drugs are not effective for treatment of breathlessness for patient admitted in critical care unit as these drugs have severe impact on their brain and heart. In terms of diagnosing dyspnoea, health professional use the pharmacological treatment methods which are associated with providing the medicines based on current physical condition and expected health outcomes of patients. For example, of the patient with dyspnoea have severe brain injuries and pulmonary disturbances and then doctors focus on prescribing the relevant dose of inhaler which would not pose any side effect in brain and pulmonary activities.

On the other hand, non-pharmacological process is also applied in terms of treating breathlessness. Based on the NICE summary report, it can be stated that there are several effective non-pharmacological treatment processes of breathlessness such as walking aids, Breathing training, neuroelectrical muscle stimulation and vibration of chest wall. According to Collier et al. (2015), in non-pharmacological process, health professionals use other procedures except medicines in teams of treating the disease. It has been seen that with using the non-pharmacological treatment process, it is possible to cure the breathlessness at the advanced stage. By using acupressure or acupuncture, counselling, distractive auditory stimuli and support programs, health professional are able to enhance the activity of lung in the patient and reduce the distress of breathlessness. moreover, evidence base report suggests that, by conducting the therapies, breathing training and muscle relaxation process, the health professional are able to treat the breathlessness in the advanced stage. On the contrary Cabezón-Gutiérrez et al. (2016) argued that, based on some evidence and current research database, the therapies and muscle relation process that is used in the non-pharmacological process of threatening breathlessness is nit useful in providing proper relief to patient. In this aspect, the Cochrane review suggests that non-pharmacological intervention is highly useful in case of treating the patient with COPD [chronic obstructive pulmonary disease. Regular use of inhaler and medicines some times are unable to increase the proper activity of lung and the pulmonary muscles. On the other hand, regular therapies, exercises and the muscle relaxation process that is used in the non-pharmacological; methods are highly effective in order to reduce the chances of patient to face the severe breathlessness. In this aspect, Simon et al. (2016) mentioned that although non-pharmacological process of treating breathlessness is not effective in advance stage, it is able to reduce the severity of the disease. Patient with breathlessness faces the huge difficulties in getting fresh oxygen from the outside environment due to improper contraction and relaxation of their pulmonary muscles. In this stage the application of proper medication is not sufficient to get the immediate recovery of patent, rather health professionals need to focus on providing the non-pharmacological remedies. In critical care unit, along with medication, therapies and counselling are important for the patient suffering from breathlessness which would assist them to develop their physical, emotional and psychological strength. According to Haywood et al. (2019.), in most of the cases of breathlessness, patient needs proper mental, emotional and psychological support along with timely medicines and foods. This can be possible through integration of the both the pharmacological and non-pharmacological process. Based on the guidelines of NICE, the health professional in critical care unit needs to focus on both the pharmacological non-pharmacological process in order to treat the breathlessness.

Breathlessness in pulmonary fibrosis:

Brief discussion on pulmonary fibrosis:

Pulmonary fibrosis is chronic lung disease that is mainly developed due to the thickening of the lung tissues that make it difficult for lung to work in proper manner (Adams et al. 2016.). In the pulmonary fibrosis condition, lung has scarred and damaged tissues that are unable to transfer the oxygen to the alveoli properly. In case of the advanced stage of the pulmonary fibrosis, patient is unable to breathe in a normal manner. This situation of lung is known as idiopathic fibrosis. In idiopathic fibrosis, condition lung has some irreversible damages that cannot be cured properly. In this aspect, health professionals use medication and therapies in order to cure idiopathic fibrosis (Hobbs et al. 2017).

Symptoms of pulmonary fibrosis are as follows:

• Shortness of breath
• Dry cough
• Aching joints and muscles
• Unexpected weight loss
• Fatigue
• Widening and rounding of the fingertips and toes

Case study:

From a recent case study report of 63 years old male, it is seen that the patient has been admitted into hospital with combined idiopathic pulmonary fibrosis (IPF) and pulmonary emphysema (CPFE). Eh he had a history of high rate smoking. However, he quit smoking after 2003. The clinical examination of this patient shows that he has symptoms of dyspnoea, with pulmonary fibrosis. (Refers to appendix)

Pulmonary fibrosis and breathlessness:

Pulmonary fibrosis and dyspnoea (Breathlessness), is one of the most common symptoms of pulmonary fibrosis (Hutchinson et al. 2015). Patient with pulmonary fibrosis suffers from breathlessness while performing any physical activities or exercises. Moreover, in the advanced stage of pulmonary fibrosis, which is known as idiopathic fibrosis, patient can face the breathlessness in any time of the day. Based on the analysis of the case study, it can be stated that pulmonary fibrosis is a condition in which patient can face the breathlessness even at the time of rest during the advanced stage of this diseases. According to World Health Organisation, patient with pulmonary fibrosis have scars and damaged into the tissues around the air sac or alveolus (Wollin et al. 2015). These scaring can be caused by several biological, environmental and medical factors. Environmental factors are silica dust, coal dust, hard meal dust and animals and birds dropping, medical factors are the radiation treatment, medicines, antibiotics, anti-inflammatory drugs and heart medication.

The clinical intervention and analysis process that is undertaken for patient in the case study shows that pulmonary fibrosis is one of the important causative factors of breathlessness. According to (), clinical intervention suggests that, in idiopathic fibrosis condition, the thickening of lung tissue increases at a higher rate which restricts oxygen supply to the bloodstream in proper manner, leading to the breathlessness in patient. In the selected case study, as the patient has combined idiopathic pulmonary fibrosis (IPF) and pulmonary emphysema (CPFE), he has a higher amount of scars around air sacs. As stated by Tomassetti et al. (2016), for trachea, the oxygen enters into the lung alveoli’s, which transfer the oxygen to the blood vessel for distributing it into the bloodstream. However, as the patient in the case study has an advanced stage of pulmonary fibrosis, it is difficult for him to take oxygen normally from the environment; this is why he needs to immediate support of ventilation. On the contrary Raghu et al. (2017) argued that, in many cases of pulmonary fibrosis, patients are provided with proper medication and therapies which assist to normalise their breathing process, rather than using ventilation methods. Moreover, the recent medical evidence suggests that, in modern medical science, advanced stage of pulmonary fibrosis is treated with proper therapies and antibiotics which can partially normalise the breathing process. After that when patient is able to take oxygen far better than the previous condition, they are provided with proper medication and inhalers in order to make the breathing normal.

As stated by Lacharite-Roberge et al. (2018), bronchioles have many air sacs that are known as alveolus. Inside these air sacs, oxygen passes to the thin blood capillaries, from which oxygen mixes with the bloodstream. Scars in the lung tissues fill the gaps between and around the air sacs, thereby limiting the transfer of oxygen into the bloodstream. If remain untreated, the scars increase in faster rates which make lung unable to take deep breaths, which cause a high level of breathlessness inpatient. The clinical intervention in a case study highlights that pulmonary fibrosis is one of the important reason behind dyspnoea. In the advanced stage of pulmonary fibrosis which is known as idiopathic fibrosis, patents have a very low capacity of taking breathe in a normal way. In most cases of idiopathic fibrosis, the patient needs ventilation support in order to get the oxygen in an artificial manner.

Treatment process:

Although pulmonary fibrosis is a chronic disease that can b cured properly, the adverse effect it is disease can be reduced by using proper medication, therapies and controlling process.

Medications;

• In order to reduce the effect of pulmonary fibrosis, different drugs can be used. As stated by Ibrahim et al. (2018), the recent medical team uses methotrexate (Trexall, Otrexup), which is able to kill the cancerous cells in the lung in order to normalise the breathing condition in the patient. On the other hand, doctors also use cyclophosphamide, which deals with the damage and scar in the lung tissues. Through using this medication, the medical team is able to reduce the distress of the patient during the breathlessness.
• Sometimes, Corticosteroids are also used by eh doctors in order to the pulmonary fibrosis and breathlessness. In the selected case study, the patient was prescribed with corticosteroids that assisted the patient in order to health the lung infections.

Therapy:

Sometimes, medication is not enough for reducing the distress of patient suffering from breathlessness (Richeldi et al. 2017). In this aspect oxygen therapy is one of the important processes that assist patient to improve the oxygen distribution in the bloodstream. In the selected case study, the patient is provided with oxygen therapy, which assists him to improve the overall oxygen supply into the heart.

Pulmonary rehabilitation:

This is the process, in which medication and therapies are used in order to regain the normal condition of pulmonary tissues. On the contrary Lacharite-Roberge et al. (2018) argued that most of the evidence shows that although therapies and medication are used, the proper rehabilitation of lung is not possible, as it is the chronic condition. However, modernisation of medical science assists the health professionals in order to improve the tissue condition in the ling in order to improve the overall oxygen support.

Conclusion:

From the above-mentioned discussion, it can be concluded ht, breathlessness is the situation in which people are unable to take oxygen in proper manner to meet the body's oxygen demand. Moreover, the overall oxygen supply into the different blood vessel also reduce during breathiness condition, there are several reasons that are associated with breathlessness. Pulmonary fibrosis is one of the main reasons of breathlessness, as lung alveoli are unable to transfer the oxygen the blood vessel. Patients having pulmonary fibrosis, is unable to take proper breathing. There are several treatment processes such as education and therapies in order to deal with this condition. Although breathless is one of the chronic condition that cannot be cured properly by the medication and therapies, it is possible to reduce the effect of the health situation in order to prevent the distress or patient.

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Appendix:

Case study:

From a recent case study report of 63 years old male, it is seen that, the patient has been admitted into hospital with combined idiopathic pulmonary fibrosis (IPF) and pulmonary emphysema (CPFE). He had a history of high rate smoking,. However he quit smoking after 2003. The clinical examination of this patient shows that he has symptoms of dyspnoea, with pulmonary fibrosis. Clinical examination has been conducted along with high resolution tomography, in order to understand current situation of lung and oxygen supply into heart. Patient has been provided with intravenous cyclophosphamide, short-term anticoagulation treatment and N-acetylcysteine. During the treatment process the patient has also received the triple combination of exacerbation therapy. In order to normalise the overall oxygen supply to the heart the long-term oxygen therapy has also been conducted for the patient. Through this clinical process and innovation treatment process, finally the level of dyspnoea has been reduced. Te overall improvement of the lung function has also been seen.