This document summarizes a tele-continuing nurse education session on approaching shortness of breath (dyspnea). It provides administrative details about the session and instructions for submitting attendance. It then discusses what dyspnea is, common causes, and ways to assess and manage it. Specific strategies covered include using oxygen therapy, fans, relaxation techniques, medications like opioids and diuretics, as well as non-pharmacological approaches like energy conservation. It also cautions that opioids can cause toxicity and hasten death if not managed properly. The next session in the series will focus on medication safety during enteral feeding.

1. Tele-Continuing Nurse Education
conducted by GeriCare
Topic: Approach to Shortness of Breath (Dyspnea)
Date: 13 Jan 2020
Speaker: SSN Henry Kong
C41 Geriatric Clinic
Palliative Medicine
Khoo Teck Puat Hospital

2. Administrative
• Send your nursing home attendance and any feedback to:
– ktph.gericare@ktph.com.sg
– Attendance with SNB No. Within 1 week ( with staff designation and SNB no.)
• Next Tele-CNE Presentation will be:
– Topic: Medication Safety (Administering medication through enteral feeding/NGT)
– 13 Apr (Mon) 2020 @ 2.00 – 3.00 pm
– By: Ms Sarah Low (Senior Clinical Pharmacist, Yishun Health)

3. DYSPNEA
By SSN Henry Kong
C41 Geriatric Clinic
Palliative Medicine
Khoo Teck Puat Hospital

5. WHAT IS
IT?
 A subjective feeling of
breathlessness
 Can cause significant distress
and anxiety in patients
 Secondary physiological and
behavioural responses
 “Hunger for air”
 Constantly dying again and
again
(Wu, 2014)

6.  Cancer- related (E.g. Lung cancer, malignant pleural effusion)
 Non cancer-related (E.g. COPD, Heart failure, Pneumonia, anemia)
 Prostatism (and cannot pee) and constipation
 Psychosocial (“feeling breathless thinking about breathlessness”)
 Spiritual

8. RESPIRATORY DISTRESS OBSERVATION
SCALE (RDOS)

9. NURSING
MANAGEM
ENT
 Oxygen therapy
 Blowing fan at face
 Energy conservation
 Chest PT
 Suctioning

11. C
O
M
F
O
R
T
Call for help. Calming voice and approach among patient and
caregivers.
Observe closely and assess dyspnea for ways to respond
Medications to be tried
Fan to face may decrease SOB
Oxygen therapy as previously found useful
Reassure and use relaxation techniques
Timing interventions to reduce dyspnea. Work together- reassess-repeat

12. PHARMACOLOGY
Inhalers Opioids Benzodiazepines
Diuretics Antibiotics

13. Giving opioids will hasten death.

14. OPIOI
D
TOXIC
ITY
Pinpoint
pupils
Respiratory
rate < 12
breaths per
minute
Myoclonic
jerks
Drowsiness