Dyspnea: Causes

DYSPNEA
 Shortness of breath (SOB), also known as dyspnea or dyspnoea ,is a feeling of not being able

to breathe well enough.
 Dyspnea is the subjective awareness of breathlessness.
 This is a subjective sensation of breathing , from mild discomfort to feelings of suffocation.
 It is a sign of a variety of disorders and is primarily an indication of inadequate ventilation or of

insufficient amounts of oxygen in the circulating blood.
 Dyspnoea represents one of the most frequent cardinal (primary) symptoms globaly
 It usually is the result of increased work of breathing.
CAUSES
 Dyspnea may be due to cardiopulmonary disease or to disorders of the skeletal , endocrine,

metabolic, neurologic, or hematologic systems.
 Other causes are physiologic dyspnea of pregnancy, drugs,psy-chogenic, and obesity.

GRADES OF DYSPNEA
PHYSIOLOGY OF DYSPNEA
 Three main components contribute to dyspnea: afferent signals , efferent signals, and central
information processing.
 The central processing in the brain compares the afferent and efferent signals and dyspnea
results when a mismatch occurs between the two, such as when the need for ventilation
(afferent signaling) is not being met by physical breathing (efferent signaling).
 The afferent receptors allow the brain to assess whether the efferent or motor commands to
the ventilatory muscles are effective, meeting the required demands of airway pressure, air
flow, and /or lung movement.
 When these respond inappropriately to the command, the intensity of the dyspnea increases.
 The sensory cortex is simultaneously activated when motor signals are sent to the chest wall,
resulting in the conscious sensation of muscular effort and breathlessness.
 There is also a strong psychological component to dyspnea, as some people may become aware
of their breathing in such circumstances but not experience the distress typical of the condition
TYPES
 Orthopnea - it is the sensation of dyspnoea in the recumbent position, relieved by sitting or

standing.
 Paroxysmal nocturnal dyspnea (PND) - it is a sensation of dyspnoea that awakens the patient,
often after 1 or 2 hours of sleep, and is usually relieved in the upright position.
 Trepopnea - it is a sensation of dyspnoea that occurs in one lateral decubitus position as

opposed to the other.
 Platypnea - it is a sensation of dyspnoea that occurs in the upright position and is relieved with
recumbency.
CLINICAL PRESENTATION
 Cleared audible ,Labored breathing
 Anxious distress facial expression
 Flared nostrils
 Tightness in the chest,changes in movement of chest ,ribs and abdomen
 Cyanosis
 Heart palpitations
 Changes in respiratory rate
DIAGNOSTIC MEASURES
 The history and physical exam should ascertain whether there are any ongoing cardiovascular,
pulmonary, musculoskeletal, or psychiatric illnesses.
 Key components of the history to collect include onset, duration, and occurrence with rest or
exertion.
 Auscultation of heart and lung sounds. ABG analysis
 Chest X-ray
 ECG and ECHO
 PFT ( Pulmonary function test),Bronchoscopy
MANAGEMENT
 O2 therapy to maintain saturation
 Semifowlers position
 Administration of oxygen
 Administration of Bronchodilator
 Relieve anxiety
 Deep breathing and coughing exercises
 Postural drainage
 Psychotherapy
 Relaxation training
COUGH
 It is a sudden ,often involuntary ,forceful release of air from the lungs .
 Cough is an explosive expiration that clears and protects the airways.
ETIOLOGY
 Upper respiratory infection
 COPD
 Bronchietasis
 Interstitial lung disease
 GERD
 Cigarette smoking
 Conjestive heart failure
 Asthma
PHYSIOLOGY OF COUGH
 The Cough reflex, which has 5 components :cough receptors, afferent nerves , cough center
(medulla), efferent nerves , and effector organs.
 The afferent limb of the cough reflex includes the sensory branches of the trigeminal, glossopha-
ryngeal, and vagus nerves.
 Inflammatory, mechanical, chemical, or thermal stimulation of the receptors and sensory

pathways can trigger cough.
 The efferent limb includes the recurrent laryngeal and spinal nerves that innervate the
expiratory and laryngotracheo-bronchial musculature.
 Lesions in the nose, pharynx, larynx, bronchi, lungs, pleura, or abdominal viscera can cause
cough.
TYPES OF COUGH
DIAGNOSTIC PROCEDURES
 History and physical examination
 Bronchoscopy
 Lung scan
 PFT
 Sputum analysis
 Chest X- ray
MANAGEMENT
 Antitussives – cough suppressants
 Expectorants – drugs to help out drain secretions
 Bronchodilators
RESPIRATORY OBSTRUCTION
 It is an airway obstruction, a blockage in the airway.
 It may partially or totally prevent air from getting into your lungs.
 They require immediate medical attention to prevent death
CAUSES
 In the luumen ,e.g-foreign body ,blood clot ,vomitus ,sputum plug
 In the wall ( aiway tract wall) ,e.g- epiglottitis ,laryngeal oedema ,anaphylaxis ,neoplasm
 Outside the wall ,e.g- trauma (facial ,neck) ,thyroid mass , hematoma , Airway burn
CLINICAL MANIFESTATION
 Marked respiratory distress
 Unusual brething sounds
 Dyspnea ,Stridor , fatigue ,cyanosis
 Facial swelling, prominence of neck veins
 Absence of air entry into the chest, and tachycardia.In an unconscious or sedated patient
 Agitation ,choking ,confusion
 Gasping of air ,wheezing ,panic
 Changes in consciousness
DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Chest and neck Xray
 CT scan
 Bronchscopy
MANAGEMENT
 Onstruction caused by inflammatory or allergic reactions may be treated with bronchodilators

drugs , corticosteroids ,and administration of oxygen
 Heimlich maneuver (suspected foreign body aspiration,complete obstruction )
 Oropharyngeal airways
 Endotracheal intubation (transnasally or orally)
 Corticosteroids
NURSING MANAGEMENT
 Monitoring the patient sign of respiratory obstruction
 Monitor the patient oxygen saturation
 Administer the oxygen
 Assess the patient level of consciousness
 If Patient intubated perform suctioning procedure
 Administer corticosteroids

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DYSPNEA

 Shortness of breath (SOB), also known as dyspnea or dyspnoea ,is a feeling of not being able

 Dyspnea is the subjective awareness of breathlessness.

 This is a subjective sensation of breathing , from mild discomfort to feelings of suffocation.

 It is a sign of a variety of disorders and is primarily an indication of inadequate ventilation or of

 It usually is the result of increased work of breathing.

 Dyspnea may be due to cardiopulmonary disease or to disorders of the skeletal , endocrine,

 Other causes are physiologic dyspnea of pregnancy, drugs,psy-chogenic, and obesity.

 Orthopnea - it is the sensation of dyspnoea in the recumbent position, relieved by sitting or

 Trepopnea - it is a sensation of dyspnoea that occurs in one lateral decubitus position as

 Cleared audible ,Labored breathing

 Anxious distress facial expression

 Tightness in the chest,changes in movement of chest ,ribs and abdomen

 Changes in respiratory rate

 Auscultation of heart and lung sounds. ABG analysis

 ECG and ECHO

 PFT ( Pulmonary function test),Bronchoscopy

 O2 therapy to maintain saturation

 Deep breathing and coughing exercises

 It is a sudden ,often involuntary ,forceful release of air from the lungs .

 Cough is an explosive expiration that clears and protects the airways.

 Upper respiratory infection

 Interstitial lung disease

 Conjestive heart failure

 Inflammatory, mechanical, chemical, or thermal stimulation of the receptors and sensory

 History and physical examination

 Antitussives – cough suppressants

 Expectorants – drugs to help out drain secretions

 It is an airway obstruction, a blockage in the airway.

 They require immediate medical attention to prevent death

 In the luumen ,e.g-foreign body ,blood clot ,vomitus ,sputum plug

 Marked respiratory distress

 Unusual brething sounds

 Dyspnea ,Stridor , fatigue ,cyanosis

 Facial swelling, prominence of neck veins

 Agitation ,choking ,confusion

 Gasping of air ,wheezing ,panic

 Chest and neck Xray

 Onstruction caused by inflammatory or allergic reactions may be treated with bronchodilators

 Heimlich maneuver (suspected foreign body aspiration,complete obstruction )

 Monitoring the patient sign of respiratory obstruction

 Monitor the patient oxygen saturation

 Administer the oxygen

 Assess the patient level of consciousness

 If Patient intubated perform suctioning procedure

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