Managing Breathlessness in Palliative Care: Health Variation 5 Essay

This essay examines high-priority nursing strategies for managing breathlessness in a palliative care setting, specifically focusing on the case of Mrs. Brown, a 62-year-old patient with COPD experiencing breathlessness. The essay delves into two key strategies: medication and oxygen therapy, crucial for improving patient comfort and well-being. The medication strategy explores the use of opioids for pain relief and benzodiazepines to manage anxiety, both of which can exacerbate breathlessness. The role of bronchodilators and other drugs, like corticosteroids, is also discussed. The second strategy, oxygen therapy, is presented as a means to increase oxygen levels in the blood and alleviate breathlessness, with a detailed explanation of different delivery methods, including nasal cannulas, masks, and transtracheal oxygen therapy. The essay emphasizes the importance of careful monitoring for potential side effects and complications associated with each approach, ensuring patient safety and optimal care. The conclusion reiterates the significance of palliative care in addressing the holistic needs of patients experiencing breathlessness and the need for nurses to be vigilant in implementing these strategies. The essay also includes relevant references to support the discussed strategies.

Running head: HEALTH VARIATION 5 PALLIATIVE CARE AND END OF LIFE 1
Health Variation 5 Palliative Care and End of Life.
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HEALTH VARIATION 5 PALLIATIVE CARE AND END OF LIFE 2
Health Variation 5 Palliative Care and End of Life.
Introduction
Palliative care can be defined as a holistic approach in dealing with signs that are beyond
the physical needs of a person so that the patient feels comfortable. In a certain case study, a
patient known as Mrs. Brown 62 years old presented with breathlessness that is due to COPD.
Effective management of breathlessness improves patient’s feelings of well-being and dignity.
Within the framework of this essay, there will be a discussion on the high priority nursing
strategies to manage Mrs. Brown’s case of breathlessness using the palliative approach.
Discussion
Medication is one of the best palliative approach that can be used to manage
breathlessness in Mrs. Brown. Several clinical trials have been conducted and results indicate
that there is a variety of drugs that subside breathlessness. The medicines can relieve symptoms
that worsens breathlessness such as pain as well as anxiety (Maddocks, Reilly, Jolley, &
Higginson, 2014). The nurse should prescribe or administer a group of drugs known as opioids.
Opioids are generally pain killers and are used to relieve pain due to breathlessness in Mrs.
Brown. Examples of opioids are morphine and they work by blocking transmission of pain
messages between neurons thus prevent them from reaching the brain .Mrs. Brown will therefore
not experience pain for some time. Since Mrs. Brown is anxious of potential death, it is
important to manage the anxiety since it worsens the symptoms. The group of drugs/medicines
that can be used to manage anxiety is Benzodiazepines. Benzodiazepines is a group of drugs that
work by stimulating neurotransmitter GABA in specific (Kvangarsnes, Torheim, Hole, &
Öhlund, 2013). The function of neurotransmitters is to transmit impulses from one to another.

HEALTH VARIATION 5 PALLIATIVE CARE AND END OF LIFE 3
They are usually released from the brain. The function of the released GABA (Gamma Amino
Butyric Acid) is to slow and calm things down. This reduces anxiety in patients and would be of
importance to Mrs. Brown. Examples of the benzodiazepines that can be prescribed to Mrs.
Brown include lorazepam and diazepam. In case of agitation, then Midazolam can be used.
Bronchodilators can be used to aid breathlessness. A good example is salbutamol which
clinical trials have indicated as effective in assisting patients with breathlessness. One of the
causes of breathlessness is narrow airways that makes it quite difficult for air to move in and out
of the lungs. The solution in this case is the administration of bronchodilators (Farquhar, 2017).
These drugs usually produce a relaxing effect on muscles which then widen and this makes
breathing easier. Furthermore, they assist in clearing of mucus and reducing inflammation. Other
important drugs include carbocisteine or saline nebulizers and corticosteroids. The saline
nebulizers utilize their ultrasonic power to fragment solutions into finer particles. In the case of
breathlessness, mucus blocks airways and therefore this drugs can be used to cough up the
sputum so that that airways are clear (Ekström, Nilsson, Abernethy, & Currow, 2015).
Eventually, it will be much easier for the patient to breath. Corticosteroids on the other hand
mimic the action of cortisol, a hormone that reduce inflammation of airways and this bolsters
breathing among patients with chronic conditions. If breathlessness persists, it is recommended
to switch medication that is given continuously by a syringe driver. Finally, palliative oxygen
can be used to manage breathlessness where oxygen is supplemented form an artificial source
like a tank then delivered through gas masks or cannula.
Even though drugs are effective in management of breathlessness, some of them like
opioids are very addictive since they elicit excitation among the users. Nurses ought to be very
careful and monitor the patients so that they only takes the recommended dose.

HEALTH VARIATION 5 PALLIATIVE CARE AND END OF LIFE 4
The other strategy is oxygen therapy. During respiration, the body takes in oxygen and
gets rid of carbon dioxide (Currow, Abernethy, & Ko, 2013). However, in the case of certain
chronic conditions like lung cancer, this might not be the case. This in return leads to low oxygen
levels in blood that can lead to impaired functions of vital organs. The best remedy for this is
oxygen therapy to avert consequences brought about by breathlessness. The rationale for this
therapy or nursing intervention is to increase the quantity of oxygen in circulation so as to
decrease breathlessness.
Oxygen therapy is an effective palliative approach to breathlessness since it can either be
administered at home or at the hospital. At the hospital, oxygen is delivered to the patient from a
central source which is mostly a tank that has humidified oxygen (Brown, 2016). A valve is then
installed which regulates the flow of oxygen to the patient. At home, the oxygen can be provided
through a canister or air compressor. In both approaches however, a nasal cannula, mask and tent
are used to deliver oxygen to the patient. Studies however recommend a cannula since it does not
compromise food and water intake as well as communication. Besides, the nurse can use trans-
tracheal oxygen therapy to deliver oxygen to the patient. In this method, a catheter is used
(Brown, 2016). The catheter is inserted into the trachea by the tracheostomy tube hence oxygen
bypass the mouth, nose and throat.
The nurse can use different types of oxygen delivery systems. Either compressed oxygen,
liquid oxygen or oxygen concentrator can be used. A flow meter and regulator are usually
attached to the tank. This method is preferred if Mrs. Brown does not need continuous supply of
oxygen (Ahmadi, Currow, & Ekström, 2017). It is also preferred when performing physical
activities. If Mrs. Brown needs liquid oxygen, then stationary tank can be used to store oxygen at
home. An electric oxygen delivery system can also be used where it extracts air from the room,

HEALTH VARIATION 5 PALLIATIVE CARE AND END OF LIFE 5
extracts oxygen which is then delivered to the patient through a nasal cannula. This method can
be used if the situation of Mrs. Brown gets worse such that she is need of constant supplementary
oxygen.
However, the nurse is supposed to be very careful with this strategy. The good thing is
that this method does not have any side effects. The only risk factor is that continuous use can
result to conditions like respiratory depression, oxygen toxicity as well as absorption atelectasis
(Yin, Yang, & Ye, 2018). Therefore, the nurse ought to look out for signs of the above
conditions such as persistent headaches, cyanosis around lips, confusion and irregular breathing.
The nurse should notify the relevant physician in case of such (Abernethy, Uronis, Wheeler, &
Currow, 2018). Other complications with oxygen delivery systems are nasal septum perforations
due to use of nasal cannula. Bacterial contamination also causes perforations that would
eventually result to pneumonia.
Conclusion
In conclusion, breathlessness is a condition in which the patient feels uncomfortably
aware of their breathing. This condition can be acute thus presented as an emergency as the case
with Mrs. Brown. Breathlessness is closely linked to anxiety and pain that makes the patient
uncomfortable. In order to optimize patient’s well-being and dignity, there is the need for
palliative care approach. This can either be achieved through medication or oxygen therapy.
After the nursing intervention, it is expected that the patient will be much relieved. However,
nurses should be very careful with the proposed strategies since they are associated with
complications such as perorations of the trachea.

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References
Abernethy, A. P., Uronis, H. E., Wheeler, J. L., & Currow, D. C. (2008). Pharmacological
management of breathlessness in advanced disease. Progress in Palliative Care,
16(1), 15-20. doi:10.1179/096992608x291243
Ahmadi, Z., Currow, D. C., & Ekström, M. (2017). Palliative oxygen for chronic
breathlessness. Current Opinion in Supportive and Palliative Care, 11(3), 159-164.
doi:10.1097/spc.0000000000000282
Brown, M. (2016). End of life care. Palliative Care in Nursing and Healthcare, 118-134.
doi:10.4135/9781473969384.n9
Brown, M. (2016). Dealing with ethical dilemmas. Palliative Care in Nursing and
Healthcare, 107-117. doi:10.4135/9781473969384.n8
Currow, D. C., Abernethy, A. P., & Ko, D. N. (2013). The active identification and
management of chronic refractory breathlessness is a human right. Thorax, 69(4),
393-394. doi:10.1136/thoraxjnl-2013-204701
Ekström, M., Nilsson, F., Abernethy, A., & Currow, D. (2015). Effects of opioids on
breathlessness and exercise capacity in chronic obstructive pulmonary disease: A
systematic review and meta-analysis. 1.12 Clinical Problems - COPD.
doi:10.1183/13993003.congress-2015.pa4805
Farquhar, M. (2017). Carers and breathlessness. Current Opinion in Supportive and
Palliative Care, 11(3), 165-173. doi:10.1097/spc.0000000000000281
Kvangarsnes, M., Torheim, H., Hole, T., & Öhlund, L. S. (2013). Narratives of
breathlessness in chronic obstructive pulmonary disease. Journal of Clinical Nursing,
22(21-22), 3062-3070. doi:10.1111/jocn.12033

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Maddocks, M., Reilly, C. C., Jolley, C., & Higginson, I. J. (2014). What Next in Refractory
Breathlessness? Breathlessness? Research Questions for Palliative Care. Journal of
Palliative Care, 30(4), 271-278. doi:10.1177/082585971403000405
Yin, H., Yang, L., & Ye, Q. (2018). A systematic review of the effectiveness of clinical
nurse specialist interventions in patients with chronic obstructive pulmonary disease
(COPD). Frontiers of Nursing, 5(2), 147-156. doi:10.2478/fon-2018-0019