Managing TheStress Of Breathlessness Home Health Presented by Gerri Virgil, M.S.N., R.N. Case Manager 3
Objectives• Describe physiologic changes and physical signs, symptoms of stress• Identify use of non-pharmacologic modalities used to treat breathlessness in COPD• Practice performing progressive relaxation techniques 4
The Importance of Relaxation Tension, Anxiety, & FearShortness Heart Rate Increases Of Use of Oxygen Increases Breath Bronchospasms Exhaustion Incapacitation 5 Source: The Lung Association
Short-Term & Long Term Stress 9 Source: Is It Worth Dying For Authors, Dr. Roberts S. Eliot and Dennis L. Breo
Sympathetic Nervous SystemUse of the Sympathetic Nervous System to assist in alleviatingthe stress of breathlessness. (Involuntary or autonomic nervoussystem responses)• Increases blood pressure• Increases heart rate• Rapid shallow breathing• Sweaty palms• Dry mouth 10
The Nervous System Accelerates Slows Respirations Respirations In the Lungs In the Lungs 12Outline of some of the effects of the sympathetic and parasympathetic nervous systems on various organs and glands.
The Nervous System Sympathetic Parasympathetic Nervous System Nervous System Accelerates Slows Respirations Respirations In the Lungs In the Lungs Lungs 13Outline of some of the effects of the sympathetic and parasympathetic nervous systems on various organs and glands.
Non-Pharmacologic AgentsProgressive RelaxationSystematic relaxation and contraction of specific muscle groupsin conjunction with diaphragmatic and pursed lip breathing.Breathing Techniques• Positioning – instruct client to lean forward on forearms supporting upper body.• Diaphragmatic Breathing – leaning forward on forearms, inhale deeply (stomach goes in) hold approximately 3-4 seconds. Use pursed lip breathing to exhale. 15
Non-Pharmacologic AgentsPurse Lip BreathingPurse lip breathing involvesinhalation through the nose followedby a slow exhalation usually 4-6seconds through pursed lips.Evidence shows decrease air trappingby stenting the airways andpreventing dynamic airway collapseaverting panic attacks thataccompany severe breathlessness. 16
Non-Pharmacologic AgentsProgressive Relaxation1. Choose a quiet spot where you will not be disturbed by other people or telephones.2. Play soft, soothing music, i.e., nature sounds.1. Close your eyes. This makes it easier to concentrate.2. Lean forward to on your arms, supporting the upper body. Take in a deep breath. Your stomach goes in. Exhale. Your stomach moves out. This is diaphragmatic breathing; most people are “chest breathers.” Continue to breathe in and out “slowly” with your diaphragm. 17
Non-Pharmacologic AgentsProgressive Relaxation5. Take in a deep breath, stomach goes in, exhale over 4-6 seconds, slowly through pursed lips (stomach moves out). Continue this part of the exercise for approximately 1-2 minutes.6. Gradually, begin to tighten your toes and ankles, take in a deep breath (stomach goes in) and tighten toes and ankles; deep breathe out thru pursed lips, relax toes and ankles.7. As you take in your next breath, tighten your toes, ankles, lower legs… hold it, hold it.8. Begin to exhale thru pursed lips, relax lower legs, ankles, toes. 18
Non-Pharmacologic AgentsProgressive Relaxation9. As you inhale, (stomach goes in) tighten toes, ankles, lower legs, thighs… hold your breath, stay tight, tight. Exhale thru pursed lips, relax toes, ankles, lower legs, thighs.10. Inhale (stomach goes in) and progressively tighten toes, ankles, lower legs thighs, buttocks and tummy. Exhale through pursed lips and relax muscles slowly.11. Inhale (stomach goes in) and progressively tighten muscles from toes to tummy, and now your chest muscles… exhale through pursed lips and relax muscles. 19
Non-Pharmacologic AgentsProgressive Relaxation12. Inhale (stomach goes in) and progressively tighten muscles from toes to chest muscles, and now add your arms; tighten your fists, scrunch up your face… hold it… hold it. Exhale (through pursed lips) and progressively relax your muscles.13. Breathe in and out with your diaphragm 1-2 minutes more.14. Bend over at the waist, and shake your arms and hands.15. Slowly open your eyes. 20
Non-Pharmacologic AgentsProgressive RelaxationPerform exercise at least 4 times a day for 3-4 minutes.Sit still for at least5 minutes afterdoing exercise toalleviate possiblelightheadedness.Enjoy! 21