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ELNEC A Grade Exam Questions with 100% Correct Answers| Already Passed
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ELNEC A Grade Exam Questions with100% Correct Answers| Already
Passed
Dyspnea - ✔✔- the subjective experience of breathing discomfort or unsustainable
- most reported symptom by patients with life-limiting illness
-can be frigtnening
- most commong reason for ED visits
Assessing Dyspena - ✔✔- rate 0-10 (subjective)
- factors that improve/worsen
- chest pain? or other symptoms with
it? -anxiety
- effect daily functioning/sleep
- other things the pt has that could make it worse. cough?
Other facts:
- RR and O2 sat don't always correlate with feelings of breathlessness
- The intensity of dyspnea may not be related to the extent of the disease
Clinical Report of Dyspnea - ✔✔- it is used to determine underlying pathopysiology
to develop the most effective treatment plan
- only do test after risk/benefit ratio, pt wishes, and prognosis
- assessment should include acute or chronic dyspnea, hx of smoking, heart or
lung disease, or concurent med conditions
,Physical Examination of Fatigue - ✔✔Elevated Jugular Pressure
Bilateral crackles
RR and depth
Use of accessory muscles
Pain with respiratory movement
Functional status
Purse lip breathing
Cyanosis
Inability to speak
Pharmacologic Tx of Dyspnea - ✔✔- look at underlying cause: fluid
overload (diuretics), pneumonia (ABX)
COPD (bronchodialators)
gold standard: opioids (improves dyspnea with no impact on respirtory and blood gases
or life expectancy)
- small doses of oral or parenteral opioids (educate patients that they are not just used
for pain)
second line: anxiolytics, midazolan, corticosteriods
Non-Pharmacologic Tx of Dyspnea - ✔✔- fans, open windows, and air conditioners
circulate air to ease the sensation fo breathlessness
-counseling may include the use of cognitive-behavioral, interpersonal,
and complementary strategies to help with anxiety associated with dyspnea
- purse slip breathing slows respiratory rate and decreases small airway collapse
, -energy conservation techniques can save energy and reduce fatigue and allow patients to
maintain independence and control
- elevation of the head of bed reduce choking sensation and promotes expansion.
place patients arms on pillows promotes air exchange
education of pateint and family reduces anxiety
music as a form of relation and distraction and a calm. cool environment
Oxygen therapy with dyspnea - ✔✔O2 therapy can be used for hypoxia but
not dyspnea
- a trial of O2 can be used but should be used cautiously
it a patient does not receive relief from dyspnea with O2 it should be stopped
acute ill: O2 goal 94-98%
at risk of hypercapnic respiratory failure: 88-92%
Symptom Management and Assessment: Essential Elements - ✔✔- Consider
the biopsychosocial/ spiritual model of pain for all symptoms
- Follow the nursing process- assess, plan, intervene, and evaluate
- Work collaboratively with the interdisciplinary team
- Remeber that uncontrolled symptoms create suffering and distress
Symptom Management: Consideration to Older Adults - ✔✔- often have
several symptoms with multiple comorbidities
- majority of hospice diagnoses are on-cancer related and are more related to illnesses
with heavy symptom burden
Ex: COPD, CHF, dementia
- experience social isolation: don't want to burden other
Physical Symptoms - ✔✔- Fatigue
- Dyspnea
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