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Dyspnea (Nursing)

by Rhonda Lawes

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    00:01 Now here's a little bit easier one. I bet you already know this.

    00:03 What is dyspnea? It's difficulty, d-y-s, in breathing.

    00:09 Remember, anytime you see those letters, d-y-s, that means difficulty.

    00:14 And whatever comes next means what you're having difficulty in.

    00:17 So dyspnea means difficulty in breathing. Now what about middle aged dyspnea? Well, symptoms of dyspnea like cough or sputum production have these common causes.

    00:31 So if someone has difficulty with breathing or having a cough, they have this extra sputum production, here's some common causes.

    00:39 Number one, especially with someone who's a little bit older is heart failure.

    00:44 So a problem with congestive heart failure is fluid buildup on their lungs.

    00:49 So if I know someone's been diagnosed with CHF and they tell me they're having increasing dyspnea or shortness of breath, that catches my attention. COPD, emphysema, bronchitis.

    01:01 If they're telling me they're having an increase in dyspnea, this might be because they're having an exacerbation of their COPD.

    01:09 Now, if someone has interstitial lung disease, it means they're having a problem right in the tissue of their lungs.

    01:14 There's multiple diseases that can cause that.

    01:17 That could also cause shortness of breath.

    01:18 As could an embolus, a thromboembolic disease like something of a pulmonary embolus.

    01:24 So, those are some of the things -- kind of the four quick things I would think about if I had a patient, a little bit older, they tell me they're short of breath, boom, boom, boom.

    01:32 These are the first four I'm going to be thinking through in differential diagnosis in my brain.

    01:38 Okay. Now let's talk about some other ones.

    01:40 Some of these are not as common, but they're definitely possibilities.

    01:45 Now, this is chronic obstructive asthma.

    01:49 This one, we're kinda seeing the overlap between asthma and COPD.

    01:53 We want you guys to be really current.

    01:56 So let me break it down to say why -- what we're talking about when we say chronic obstructive asthma.

    02:01 Some patients with chronic asthma, there's really not a clear distinction from COPD.

    02:07 We can't really tell what part's the asthma, what part's the COPD.

    02:10 So you heard -- you will hear that referred to as COPD asthma overlap.

    02:16 Let me give you an example of a patient.

    02:18 Like if we have a patient who has asthma since they're a little kid, but they smoke cigarettes for 15 years in their 20s and 30s.

    02:26 Now you could see them in their 50s with a combination of asthma and COPD.

    02:32 Will we know which part of this is the asthma and which part is the COPD? Not necessarily. And that's not the most important point anyway.

    02:40 The most important part is recognizing that these two diseases can have overlap.

    02:45 And just keep that in mind when the healthcare team is working on devising a treatment plan.

    02:50 We wanna make sure that their plan is adapted to reflect.

    02:53 They've got both of these diseases.

    02:55 They have overlap, but we also need to make sure that we're treating the asthma and the COPD.

    03:01 Now, chronic bronchitis with normal spirometry, like cannot really happen. It really can't.

    03:09 So chronic bronchitis means they're having this productive cough for three months in two successive years.

    03:16 So that's the definition of chronic bronchitis.

    03:19 But a very small portion of cigarette smokers can have a chronic productive cough for three months in two successive years but they don't have any airflow and limitations if we do the pulmonary function tests.

    03:31 So, what's the same in chronic bronchitis as far as COPD? Well, that's chronic obstructive pulmonary disease.

    03:38 So they have that hockey cough, right, for three months and two successive years.

    03:44 But they have an -- they notice it -- a problem on their pulmonary function test.

    03:50 They have obstructive pulmonary disease.

    03:53 But some smokers, and I'm talking a very small portion have the chronic cough.

    03:58 But when you do their pulmonary function test, they're okay.

    04:01 So we don't really consider them as having COPD.

    04:04 Now, they may develop COPD if they keep smoking, but in some of the treatments we use for COPD, it may improve the cough that they have.

    04:13 But technically, we don't consider them to have COPD.

    04:17 Now, central airway obstruction.

    04:20 Now that's an uncommon one, but it can be potentially life-threatening.

    04:23 That's why I just wanted to make you aware of it.

    04:25 Now, there's numerous benign or malignant processes that can mimic COPD with kind of a slow progressive dyspnea with exertion, then they have dyspnea with even minimal activity.

    04:36 Remember, that's always a sign of deterioration.

    04:39 Where initially they only have shortness of breath when they're being really active.

    04:44 But then as the disease progresses, they end up having shortness of breath just sitting still.

    04:50 So, central airway obstruction, that just refers to obstruction of airflow in the trachea and main stem bronchi.

    04:59 So it's different than the other ones that we've talked about.

    05:02 It's pretty uncommon, but if it does happen it can be potentially life-threatening.

    05:07 Now, bronchiectasis is a word you may or may not have heard before.

    05:11 You probably recognize bronchi, so you know we're obviously still in the respiratory system.

    05:16 But it's an abnormal widening of the bronchi.

    05:20 Now, first you would think, "Wow. Well, can't you breathe easier with that?" No.

    05:24 Here's what goes along with it. Now, there's an abnormal widening of the bronchi, but you also have these chronic and recurring infections.

    05:33 So you have -- the airways are inflamed, they're easily collapsible and it has some obstruction to airflow.

    05:40 So you have increased shortness of breath and this extra sputum.

    05:44 So yeah, you've got a widening of the bronchi but it's filled with gunk, you have infections, your airways are inflamed and that's why this causes the shortness of breath.

    05:54 So, thinking of bronchiectasis, widening of the bronchi, but you have chronic and recurrent infections, a cough, lots of sputum.

    06:04 And so, this can become a real problem for your patient.

    06:08 Now, when it's diagnosed, they're gonna go on the patient's clinical symptoms and they'll do a CAT scan. They'll see bronchial wall thickening and dilation on the CAT scan and that will be included with the patient's clinical symptoms, what they report and the results of the CAT scan will help the healthcare team diagnose bronchiectasis.

    06:27 Now, tuberculosis is something you probably know a lot just from being in the community.

    06:33 But tuberculosis is one possible cause of dyspnea.

    06:37 So, it puts a patient at risk for other diseases if their immune system is compromised.

    06:42 That can become a really complex topic, but it actually is one of the things we would think through when a patient experiences dyspnea.

    06:51 Now, constrictive bronchiolitis.

    06:54 Remember, *itis always means some type of inflammation.

    06:57 Bronch, we're thinking of airways.

    06:59 So, constrictive bronchiolitis is most commonly seen following an inhalation injury.

    07:05 Okay. So someone inhales something, this causes damage to the lung.

    07:10 We end up with constriction of that. That's the cause of the difficulty of breathing.

    07:15 So it can also happen after a transplant, maybe a bone marrow or a lung transplant.

    07:19 Or it can happen with someone who has rheumatoid lung or inflammatory bowel disease.

    07:24 That's that inflammation causing the problem.


    About the Lecture

    The lecture Dyspnea (Nursing) by Rhonda Lawes is from the course Respiratory Assessment (Nursing).


    Included Quiz Questions

    1. Difficulty breathing
    2. Difficulty swallowing
    3. Painful urination
    4. Shallow breathing
    1. Congestive heart failure
    2. Chronic obstructive pulmonary disease (COPD)
    3. Interstitial lung disease
    4. Thromboembolic disease
    5. Urinary retention
    1. Bronchiectasis
    2. Tuberculosis
    3. Central airway obstruction
    4. Chronic obstructive airway
    1. Tuberculosis
    2. Chronic obstructive asthma
    3. Central airway obstruction
    4. Cystic fibrosis

    Author of lecture Dyspnea (Nursing)

     Rhonda Lawes

    Rhonda Lawes


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