| VNAA Best Practices
- All patients admitted to hospice are screened for dyspnea during the initial nursing assessment (Dyspnea Screening HIS J2030) and if found to be present, receive treatment within 1 day of the screening (Dyspnea Treatment HIS J2040).
- Non-pharmacological interventions to reduce shortness of breath include: positioning and comfort, environmental, use of a fan, mindful breathing, Oxygen, reduction of anxiety, and relaxation techniques. See Table “Interventions to Reduce Shortness of Breath” for detailed information.
- Medications can include opioids (morphine or fentanyl) and benzodiazepines (lorazepam) used as an adjunct. See Table “Interventions to Reduce Shortness of Breath – Medications” for detailed information.
- Other respiratory symptoms such as cough, increased secretions and wheezing should be addressed.
- Interventions can be combined or intensified until the patient is comfortable.
- Specific assessment approaches and interventions will vary depending on whether the patient is verbal and cognitively aware enough to describe symptoms and symptom relief.
- For patients who cannot communicate respiratory distress, caregivers should provide objective assessment for signs of dyspnea and dyspnea relief.
- See VNAA Procedure Manual 18th Edition P 181.
End of Life Palliative Care Resource Center (EPERC): This RWJ Foundation funded resource center includes a portfolio of educational materials and training programs. It offers a series of helpful “Fast Fact” clinical summaries related to end of life care, including “Dyspnea at the End of Life Fast Fact #027.” This brief summary provides information on assessment and treatment of patients with dyspnea.
- The End of Life Curriculum Project includes a comprehensive training module on dyspnea assessment and management. The curriculum is a joint project of the US Veterans Administration and SUMMIT, Stanford University Medical School. It is funded by a grant to the Veterans Administration Nationwide Palliative Care Network by the National Library of Medicine.
References: Dyspnea
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The resources and links above were evaluated by the VNAA Best Practices Work Group. All are resources are publicly available on the Internet. Please retain all logos and citations where authors/originators are listed on these resources. For questions or comments about these resources, contact us.
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