functional dyspnea


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dyspnea

 [disp-ne´ah]
breathlessness or shorthess of breath; labored or difficult breathing. 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. adj., adj dyspne´ic.

Dyspnea can be symptomatic of a variety of disorders, both acute and chronic. Acute conditions include acute infections and inflammations of the respiratory tract, obstruction by an inhaled foreign object, anaphylactic swelling of the tracheal and bronchial mucosa, and traumatic injury to the chest. Chronic disorders usually fall into the category of chronic airflow limitation, or are associated with pulmonary edema and congestive heart failure. A fat embolism resulting from the release of fat particles from bone marrow at the time of a fracture of a long bone also can cause dyspnea.


Patient Care. The dyspneic patient has some degree of difficulty in meeting the basic physiologic need for adequate levels of oxygen in the blood and the transportation of that oxygen to all cells of the body. Whatever the cause of dyspnea, the plan of care begins with treating the patient and providing adequate oxygenation.

A thorough assessment of the patient's condition is necessary in order to ascertain the extent of the problem and the urgency of the need. A current and past history are obtained and a physical examination completed as soon as possible. If the patient is acutely short of breath, corrective measures should be instituted promptly. In cases of acute respiratory distress, it may be necessary to intubate the patient, begin oxygen therapy, and obtain laboratory arterial blood gas data. If there is airway obstruction, clearing the airway is necessary, or a tracheotomy may be performed.

If the patient is suffering from an acute attack of dyspnea and has a history of chronic airflow limitation, certain nursing measures can help relieve anxiety and improve ventilation. The patient should respond favorably to a calm, reassuring manner and an explanation of what is being done to relieve the shortness of breath. High Fowler's position or orthopneic position with the arms resting on pillows on an overbed table will help improve chest expansion. Helping the patient relax muscles not needed for breathing conserves oxygen and promotes rest. If abdominal distention, ascites, or a massive tumor interferes with chest expansion and produces dyspnea, having the patient lie on one side and supporting the abdomen with pillows may provide some relief.

Once dyspneic patients are comfortable and less apprehensive, they may need instruction in prolonged, controlled exhalation. If they already know how to do pursed-lip breathing (inhaling slowly through the nose and exhaling slowly through pursed lips), they may need to be reminded of it and encouraged to use it to improve breathing.

Special observations and methods of assessment of a patient who has dyspnea include: auscultation of the chest for abnormal breath and voice sounds, lung aeration, rales, and rhonchi; inspection of the chest for respiratory rate and rhythm and for symmetrical expansion; inspection of the skin, lips, and nail beds for cyanosis; and percussion of the chest for abnormal resonance. Results of arterial blood gas analyses should be monitored and the patient observed for fatigability when engaged in various levels of activity.
exertional dyspnea dyspnea provoked by physical effort or exertion.
functional dyspnea respiratory distress not associated with organic disease and unrelated to exertion; often associated with anxiety states.
paroxysmal nocturnal dyspnea respiratory distress related to posture (especially reclining at night), usually attributed to congestive heart failure with pulmonary edema.

func·tion·al dysp·ne·a

shortness of breath without apparent underlying disease.
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