DYSPNEA In Advanced Lung Cancer Patients - PowerPoint Presentation

Slide1

DYSPNEA In Advanced Lung Cancer Patients

By: Cindy

Stegman

RN BSN

Alverno

College MSN 621

Spring 2010

stegmacm@alverno.eduSlide2

How to navigate this tutorial:To advance to next slide click on boxTo advance to previous slide click on box

To return to MAIN MENU click on box

If you see the return button

click on it to return to QUESTION slide.Hover over the underlined text for an explanation/definitionSlide3

To educate RNs and LPNs on the pathophysiology

of advanced lung cancer associated with dyspnea

At the end of the tutorial the learner will be able to:

Identify

pathophysiology of advanced lung cancer associated with dyspnea

Discuss key assessment components of the advanced lung cancer patients experiencing dyspnea

Describe evidence-based interventions for the advanced lung cancer patients experiencing dyspnea

PURPOSE & OUTCOMESSlide4

Clip art, 2010Pathophysiology of advanced lung cancer

Anatomy of normal lung function

Causes

of dyspnea

Mechanisms of dyspnea

Genetic relationship

Evidence-Based Nursing Interventions

Stress & Immune/Inflammatory response

Nursing assessment

Case Study

Nursing-Sensitive Outcomes

Content of Tutorial

At any time during tutorial you may click to come to this screen and select next topic.

Let’s get started… taking a DEEP breath and relax!Slide5

Anatomy ofNormal Lung Function

Click each circle in the diagram to recognize the anatomy of the lungs

1

2

3

5

4

Trachea:

Is the tube that runs from your larynx to just above your lungs. The trachea divides into TWO large branches called the bronchi.

Bronchi:

Entering the lung, the bronchi divide into the left and right side of lung. They continue to branch & divide into smaller bronchi.

Bronchioles:

Smallest conducting airways at the terminal end of the bronchi. At the most distal end gas exchange takes place.

Pleura:

A thin serous membrane that lines the thoracic cavity & cushions the lungs.

Alveolar sacs:

Cup-shaped structures which are the smallest functional unit of the lungs.

Porth

, 2005Slide6

Physiology of Normal Breathing:Automatic, quiet

Movement that control ventilation are integrated by neurons located in:

Medulla & Pons (Respiratory Center)

GOAL of Breathing: Oxygenation of the blood and removal of Carbon dioxide.

Scroll across each picture

Porth

, 2005

)Slide7

What Stimulates your respiratory system to increase breathing?

Receptors

Click on star to

receive answerSlide8

Chemoreceptors - Peripheral

chemoreceptors

: Located in the carotid and aortic bodies - Central

chemoreceptors: Located in the Respiratory center in the Medulla & pons

2) Lung & Chest wall Receptors

- Stretch

(smooth muscle)

-

Irritant

(Airway of epithelial cells)

-

Juxtacapillary

or J receptors

(alveolar wall)

Jantarakupt

, P. &

Porock

, D. (2005). Slide9

A nurse walks into a room and observes a patient breathing rapid and shallow. Respiratory rateis 32 breaths/min and pulse ox at 80% on roomair. What receptors

alerted the

respiratory center to turn ON ?

Incorrect.These receptors are located in the medulla & pons and stimulate the resp. center when there are high levels of carbon dioxide in the blood.

Central Chemoreceptors

Incorrect.These receptors are located in smooth muscle and do not stimulate the respiratory center when there is LOW oxygen in the blood.

Incorrect

In this situation because this scenario did not mention crackles in the lungs that would suggest pulmonary edema.

Correct!!

These receptors alert the respiratory center when there is LOW oxygen in the blood

J Receptors

Stretch

Receptors

Peripheral

ChemoreceptorsSlide10

What Causes Lung Cancer?

Repeated

EXPOSURE to

Carcinogens

Transforms: Normal cell into Malignant

Clip Art, 2010

Hoffman, A. & Gift, A. (2007)

Cells in the respiratory

membrane that line the

bronchi become

THICK &

HARDEN

Cilia

become

Stiff (Unable to sweep debris away)

Genetic DamageSlide11

Lung Cancer Cell Dividing

Lung cancer cells are highly invasive & may extend into the mediastinum or pleural cavity

Lung network is highly vascular and metastasis occurs early

Distant metastasis may occur in the brain, liver, bones, or kidneys Hoffman, A., & Gift, A. (2007)Permission from http://images.wellcome.ac.uk/Slide12

What we know increases risk for development of Lung Cancer Active

tobacco exposure

Passive smoke exposure (Second hand) Shared environment Asbestos (school, home, work, person-person)

Environmental exposure (Radon & heavy metals) Nickel, arsenic

National Cancer Institute, 2010

Clip Art, 2010

Clip Art, 2007

Clip Art, 2007

Clip Art, 2007Slide13

Research in the works…Study produced by:

National Cancer Institute

National Human Genome Research Institute

National Institutes of healthStudy that was printed in 2004 in the American Journal of Human GeneticsStudy involved:

52 families with a minimum of Three 1st-degree family members affected by either lung, throat, or laryngeal cancer

Used 392 known genetic markers & compared the alleles of each affected and non-affected family member

National Cancer Institute, 2010Slide14

Research in the works Cont…Discovered: A region on

Chromosome 6

(susceptibility to Lung caner)

WORK is needed to:Look closer in this REGION to find the exact GENE that causesthis susceptibility

National Cancer Institute, 2010

Clip Art, 2010Slide15

Mechanisms of Dyspnea

Divided into

3 pathologies:

Chemical Stimulation Neural Stimulation Emotional Stimulation

Clip Art, 2007Slide16

Chemical Stimulation

Central respiratory

chemoreceptorsPeripheral

respiratorychemoreceptors

PaCO2

PaO2

Eliminate Carbon Dioxide

American Thoracic Society. (1998).

Clip Art, 2007

Clip Art, 2007

Jantarakupt

, P. &

Porock

, D. (2005)Slide17

Neural StimulationNeural Pathways for breathing receive signals from receptors in:

- Lungs

- Skin

- Muscles - JointsThese receptors are called “Mechanoreceptors” - Stretch receptors in (trachea, bronchi) are stimulated with lung expansion

- Irritant receptors (epithelium of airways) stimulated by smoke, pollens, fungi, cold air, & mold -

Movement of lower and upper extremities stimulate receptors in muscles & joints - Painful

stimuli will elicit mechanoreceptors within the skin

Jantarakupt

, P. &

Porock

, D. (2005)

Once mechanoreceptors are stimulated they will cause an individual to breathe fasterSlide18

Emotional Stimulation

Emotional distress

Anxiety

Anger DepressionTHE CAUSE & EFFECT relationship is unclear but…Emotional changes CAN stimulate the

respiratory center, which in turn AFFECTS the Individual’s breathing pattern

Clip art, 2007

Jantarakupt

, P. &

Porock

, D. (2005). Slide19

Dyspnea is a distressing and debilitating symptom that cancer patients may experience. - It is SUBJECTIVE

(what the patient says)

- An uncomfortable, frightening experience

(Clip art, 2007

Dyspnea is estimated to occur in 15-55% at the time of diagnosis and up to 18-79% during the

last week of life Oncology Nursing Society. (2010). Slide20

Stress and Dyspnea: What’s the CONNECTION?

Stress response or General Adaptation Syndrome (GAS) is meant to protect an individual

during ACUTE episodes stress. If the GAS is continually stimulated by chronic stressors,

this can be a threat to an individual’s homeostasis.

Porth, C., (2005)

Clip Art, 2010Slide21

Stress and DYSPNEA Cont…Dyspnea: Acute or Chronic

Advanced

Lung Cancer

PATIENT

Physical &

Psychological Stress

ALERT:

STRESS

RESPONSESlide22

Stress and Dyspnea Cont…Results:

In release of

catecholamines

(such as epinephrine and norepinephrine) and cortisol, which: Increases heart rate

Dilates the bronchioles

Stress causes Vasoconstriction to…-

Skin: which becomes Pallor and cold

GI tract:

which causes nausea, No bowel sounds, & digestion stops

Kidneys:

which decreases urinary output

Porth

, C., (2005)

)

Inflammatory and Immune response stops!Slide23

Physical

Behavioral

ADAPT

to ACUTE STRESS

WHAT factors

AFFECT

our ability to ADAPT

to STRESS??

Endocrine-Neurotransmitter pathway… PRODUCE

CHANGESSlide24

Click on each circleSevere emotional distress often disrupts physiological function and limits an individuals ability to make appropriate choices related to adaptive needs. If a dyspnea is present, this is causing emotional distress and affecting their ability to enjoy daily activities due to the stress of not being able to breathe.

Sleep-Wake Cycles

Hardiness

Mental Health

Status

Nutrition

Sleep is the most restorative function in which tissues are regenerated. If an individual cannot sleep at night, due to dyspnea, this is affecting their ability to restore their energy.

Malnutrition is one of the most common causes of immunodeficiency. Most advanced lung cancer patients have major issues with nutrition due to loss of appetite & weight loss from treatment &/or disease process itself.

A personality characteristic which includes: A sense of purpose in life and to view stressors as a challenge rather than a threat. If dyspnea is affecting their hardiness, the individual will see this stressor as a threat and slowly become susceptible to sadness.

Porth

, C. (2005)Slide25

What happens if DYSPNEA continues to stimulate our Stress Response

??Slide26

Exhaustion OCCURS!

Coping mechanisms

are depleted.

WEAR & TEAR on the SystemChronic stress will occur & LEAD to:

Loss of AppetiteSleep disturbanceDepression

What does this mean for an advanced lung cancer patient if this cycle continues ?

Porth

, C., 2005

Clip Art, 2007Slide27

Immune & Inflammatory responses diminish which means:

The advanced lung cancer patient is at an

increased risk for infections

The

AGING advancedlung cancer patient has

less ability to adapt to environmental stressors

Decreases their

immune

responsiveness

&

ability

to heal wounds

Porth

, C., 2005

Clip Art, 2007Slide28

Aging can be viewed as a low-grade chronic inflammatory state which is termed as “inflammaging

”

Porth

, C. 2005 & Franceschi, C. & Bonafe, M. 2003

If the GAS is constantly stimulated, what does this mean for the aged

advanced lung cancer patient?

Due to the thymus decreasing in size as we age , this affects

T-Cell

function within the body. Ultimately, compromises the immune system responsiveness to heal wounds.

Due to

inflammaging

, this can cause chronic activation of inflammatory responses. Eventually, leads to the infiltration of macrophages, lymphocytes, & fibroblasts, which causes persistent swelling and scar formation to occur.

Click on

ARROW

twiceSlide29

Cancer-Related Causes of DYSPNEA:

Direct

cause of the cancer

Indirect result of the cancerResult of cancer treatment

OtherSlide30

DIRECT Primary or metastatic cancer to lung

Pleural tumor

Pericardial effusion

Ascites

Permission from http://images.wellcome.ac.uk/

Tyson, L. (2006)

INDIRECT

Anemia

Pneumonia

Pulmonary emboli

CachexiaSlide31

Dyspnea from Treatment

1) Surgery

2) Radiation (which can cause)

- Pulmonary Pneumonitis - Pulmonary fibrosis

Polovich, M., Whitford, J., & Olsen, M. (2009).

Clip Art, 2007

3) Chemotherapy agents that can either cause:

- Pulmonary Edema

Cytoxan

,

Gemzar

,

Methotrexate

,

Mitomycin

- Pulmonary

Pneumonitis

/Fibrosis Cytoxan

(later development), Gemzar (later sign of fibrosis),

Bleomycin (Pneumonitis

), Methotrexate, CarmustineSlide32

Obesity Age

Asthma

CHF or COPD

Co-Morbidities that causeDysnpea

Clip art, 2007

Other:

- Anxiety

DiSalvo

, W., at el., (2008)Slide33

Oncology Nursing Society (ONS)In 2003, ONS developed their own definition of oncology nursing-sensitive patient outcomes

(NSPO’s), which focused around:

Oncology Nursing Society, 2003

Patient’s problems are significantly affected by nursing interventions.Interventions developed within the scope of nursing practice; are sensitive to nursing care and represent the consequences or effects of nursing interventions

-Result in changes in patients' symptom experience, functional status, safety, psychological distress, and/or costSlide34

NSPO’s for Dyspnea:

Symptom Management

Decrease in patient’s perception of breathlessness

Patient maintains activity level within capabilitiesRespiratory rate remains at comfortable levelPatient is able to manage episodes of dyspnea

2) Psychosocial Distress

- Promoting relaxation and stress reduction - Education and support to patients and their families

Crowley. (2005) & ONS PEP, (2008) Slide35

ASSESSMENTSUBJECTIVE (Pt’s

own

description, feeling, of breathlessness)

- At rest - With activity - Assess dyspnea with a Visual Analog scale - Number Scale (1-10) - Mild-Moderate-Severe

2) VITAL SIGNS - Respiratory rate (Rate, Irregular, Depth)

- Weight

Clip Art, 2007

Clip Art, 2007Slide36

Assessment Cont…3) CARDIOPULMONARY:

- Accessory Muscle use

- Edema

- Tachycardia - Underlying cause (fever, etc.) - Auscultation -Wheezes, crackles, cough - Secretions (amount, consistency)

4) INTEGUMENTARY:

- Pallor (Anemia) - Cyanosis (Low oxygen, hypoxia)

Itano

, J. &

Taoka

, K. (2005)

Clip Art, 2007Slide37

Assessment Cont…5) MENTAL STATUS - Restlessness

- Confusion

- Memory Difficulties

6) PSYCHOSOCIAL Distress: - Depression - Anxiety - Fear

Clip art, 2007Slide38

G. S. is a 65 year-old man diagnosed with Stage IV Lung cancer in October 2009 His presenting symptom at the time of diagnosis is rib pain.

During the next few weeks, G.S has received several radiation treatments to his ribs.

- After his radiation treatment, G.S has also received system chemotherapy. (Up to this point, G.S. has tolerated this treatment fairly well)December of 2009 (post radiation/chemotherapy tx) G.S had a

PET scan that showing worsening enlargement of primary tumor.January 2010

G.S. was switched to salvage Taxotere chemotherapy regimenOver the next few weeks to months

G.S. is seen in the clinic with increased weakness, hypotension, nausea, and dehydration.

ContinuedSlide39

Today March 2010, G.S is seen in the clinic: - G.S. is looking frail & ashen in color - Knees down bilateral has +3 pitting edema - Oxygen saturation measuring at 87% on room air - No appetite

- Lost of five pounds since February

- Denies any pain

- C/o of shortness of breath with activity - Uses a walker to assist with ambulation - C/O of insomnia, due to trouble breathing at night - On auscultation: fine wheezes heard throughout bases of lungsHOME MEDICATION: MS

Contin 30 mg BID

Fluconazole 200 mg

Ativan

0.5-1 mg every 8 hrs PRN

Oxycodone

5 mg

(1-3) every 2 hrs

PRN

Slide40

These are all possible Nursing Interventions to help relieve G.S’s DYSPNEA.Click on all the buttons at the bottom to understand WHY?

Suggest to G.S to get a prescription of Morphine Sulfate in an immediate release

capsules to help relieve his dyspnea

B) On assessment, heard audible wheezes in upper lung fields. Suggest an albuterol inhaler treatmentSuggest to G.S to take his Ativan before strenuous activities & before sleep to help relieve his anxiety

D) G.S. oxygen saturation on room air was 87%. Supplement oxygen to help relieve his dyspnea.

Due to the edema (swelling) in his legs, ask his physician for an order of lasix

Suggest to his wife to place a fan on G.S’s face and nose, as this might help relieve his dyspnea or use breathing techniques to slow down his breathing during periods of dyspnea.

Educate G.S on relaxation techniques & encourage G.S to sleep in his recliner to keep upper body

at least at 45-90 degree angel to help with sleep.

A

B

C

D

E

F

GSlide41

Opioids on Cancer-RelatedDyspnea

Immediate-release oral agents

Parenteral RECOMMENDED for Practice: Morphine

(most common) Hydromorphone (

Dilaudid)

WHEN OXYGEN OR REST

DO NOT

RELIEVE

DYSPNEA

NCCN, 2010,

DiSalvo

, W., Joyce, M., Tyson, L.,

Culkin

, A., & Mackay, K., 2008, & Oncology Nursing Society, 2008.Slide42

Theory of OPIATESAct at central/peripheral

opioid

receptors sites &

central nervous system (Respiratory center)Respiratory drive at rest and activity

Block respiratory responses to hypoxia

&

hypercapnia

Wickham, R. (2002) & Gift, A. & Hoffman, A. (2007)

MORPHINE

Opioids have a depressant effect on the central nervous system, which alleviate dyspnea by blocking the neural signals to

hypoxia

&

hypercapnia

.Slide43

Recommendations:Treating COUGH/DYSPNEA/ or AIR HUNGER

- 2-10 mg Morphine orally every 4 hr

prn

- 1-4 mg Morphine IV every 4 hr prn 1) RE-ASSESS patient 2) SIDE EFFECTS: dysphoria

, dizziness, drowsiness, urinary retention, constipation.Re-assure patient:

Opiates will help them rest without the feeling of “suffocation”

REMEMBER!!

Naïve

Vs

Tolerant

LOWER

dose of Morphine used to treat Dyspnea,

BUT

Action

of Morphine for dyspnea is

shorter

than its analgesic effects!

Jantarakupt

, P. &

Porock

, D. (2005), NCCN, 2010, & Wickham, R. (2002).

NCCN, 2010Slide44

Patient/Family MYTHS &

FEARS

about

OPIOIDsADDICTION - Reassure patient they are taking opioids to relieve their cancer-related dyspnea. Dyspnea can change from day to daydepending on the progression of their disease state. As nurse

providers, reassure patient that the dosage may increase in the future due to repeated administration of that opioid

dose. The body will eventually build up a tolerance for that dose of opioids and the individual will not be receiving the desired effect.

Over SEDATION - Reassure patient we will be monitoring them while receiving opioids

- This is for palliative treatment of dyspnea, so titrating the

opioid

dosage may be necessary to get the desired effect.

- As the individual transitions from palliative care to hospice…

Retain increased amounts of carbon dioxide

Causes

Sleep & a comatose state to occur with the dying patient regardless if opioids are administered or not

DYING

patient’s breathing is now more rapid & shallow

Wickham, R. (2002) & Johnston, M. (2007).

Clip Art, 2010Slide45

QUIZAre extended-release opioids just as effective as

immediate-release?

CORRECT!

Immediate-release opioids have been shown to be effective in practice when treating dyspnea.

Sorry Extended-Release opioids have NOT been established to show effectiveness towards treating dyspnea

FALSE

TRUE

In the case of G.S, immediate-release opioids are an appropriate intervention,

because he has already has been exposed to opioids.

REMEMBER

… he is

opioid

tolerant, so G.S. might need to repeat the dose more frequently to treat the

DYSPNEA. As nurse providers, we need to console & support G.S. if he has any

fears of using

opiods

, because sedation & addiction can be a fear patients have with

opioid

usage. KEEP the patient’s GOAL in mind & reassure G.S. that this intervention will be able to get him through tough periods of dyspnea to be able to endure certain activities.Slide46

BronchodilatorsInhaled or Nebulized

B2 –

adrengergic

agonist Albuterol

decreasesWORKLOAD of the lungs

Nebulized Opioids??

Believed to “TARGET” stretch and irritant receptors in the lungs

SYSTEMIC

TOXICITY

Jantarakupt

, P. &

Porock

, D. (2005) &

Kallet

, R., (2007

)

NOT Recommend for Practice Due to:

Insufficient Evidence

Bronchodilators relaxes smooth muscles within the bronchiolesSlide47

CORRECT On assessment you heard wheezing throughout lung fields to suggest vasoconstriction within bronchioles. An albuterol treatment would be an appropriate intervention for G.S’s dyspnea.

Sorry



Short-Acting bronchodilators are more effective for patient’s who have either air flow obstruction such as COPD, asthma, or patient’s with lung cancer & is presenting with wheezing throughout lung fields to suggest vasoconstriction. Quiz

Which option is correct to suggest an albuterol inhaler to treat G.S’s dyspnea?

G.S complained of shortness of breath while walking to the bathroom?

On auscultation, you heard wheezes throughout G.S.’s lung fields

Wickham, R. 2005Slide48

BenzodiazepinesLorazepam

Diazepam

Recommended Dosages:

Ativan: 0.5-1 mg orally or IV q 4 hrs prnDiazepam: 2 mg po/SQ/IV q 12 hours

(NCCN, 2010)Sedative action

ANXIETY that stimulates dyspnea!!

DO NOT WORK DIRECTLY ON THE LUNGS

Jantarakupt

, P., &

Porock

, D., (2005) & NCCN, (2010). & Wickham, R., (2002)Slide49

Sorry Benzodiazepines do not directly work on the lungs to relieve dyspnea. Benzodiazepines are used for their sedative use to decrease anxiety that is commonly associated with dyspnea.

Quiz

True or False

: Do benzodiazepines work directly on the lungs to relieve Dyspnea?

TRUE

YES Benzodiazepines treat anxiety associated with dyspnea and do not directly treat dyspnea. In G.S’s case, this can help his anxiety & let him be able to sleep at night with out the fear of suffocation.

FALSESlide50

OXYGEN

Increase oxygen saturation (SaO2)

- Hypoxia is present DYSPNEA

Lowers respiratory

RATE Lowers respiratory EFFORT

Non-hypoxic Patients?

FEAR and Anxiety

Jantaarakupt

, P. &

Porock

, D.

(2005)

Patient’s with advanced lung cancer have less ability to remove carbon dioxide or transport oxygen to other parts of the body due to the physical changes cancer makes within lung tissue. Patient’s with a history of COPD will be at higher risk of retaining CO2.

CAUTION!!

CO2 Retainers

Click on box

Clip Art, 2007Slide51

QuizTrue or FalseOxygen therapy is ONLY for patient’s who are truly hypoxic?

Incorrect

Oxygen therapy is primarily used for hypoxic patients, but in cases of advanced lung cancer patient’s who are experiencing dyspnea, oxygen has been proven to help relieve the feeling of shortness of breath.

True

Correct

Oxygen therapy can be used for hypoxic & non-hypoxic advanced lung cancer patient’s experiencing dyspnea. CAUTION should be used when titrating oxygen if patient is a CO2 retainer. In the case of G.S. he is truly hypoxic when his oxygen saturation was at 87% on room air. Oxygen therapy would be an appropriate intervention to treat his dyspnea.

FalseSlide52

OTHER Treatments:

Steroids & NSAIDS

Side effects of steroids: Gastric toxicity, fluid retention, hyperglycemiaLasix

Given when a patient is experiencing:Pulmonary congestion

Lower extremity edema

INFLAMMATION in the LUNGS to

relieve dyspnea

Gift A. & Hoffman, A. (2007).

More effective for patient’s with pre-existing conditions such as COPD

LASIX is given for fluid overload to

Decrease the demand on the heart

Jantarakupt

, P. &

Porock

, D., 2005 & Wickham, R. 2005Slide53

What is the relationship betweenG.S’s lower extremity edema and him experiencing DYSPNEA?

In G.S.’s situation, there could be multiple factors causing his lower leg edema, such as malnutrition, medications, and/or worsening of his lung cancer involvement . The edema is causing his heart to pump harder to compensate for the extra fluid, which is causing G.S. to have dyspnea at rest &/or with activities.

Lasix

would be an appropriate short term fix to help with the edema in lower extremities & relieve dyspnea.CLICK ON

Hoffman, A. & Gift, A. (2007)Slide54

Breathing Techniques Pursed-lip and diaphragmatic breathing (Shown to optimize lung function, decrease stress, & relax

the breathing for that patient)

2)

Increase airflow (generated by a FAN) - Face - Nose(Gives the perception of more airflow to the individual, which may reduce the feeling of dyspnea) 3) Providing COOLER temperatures

- Decrease the feeling of dyspnea

DiSalvo

, W., Joyce, M., &

Belansky

, H. (2009)

Clip Art, 2007

Clip Art, 2007Slide55

4) Positioning - Sitting up (expansion of lungs)5) Promoting Relaxation

Stress Reduction

-

Massage - Reducing external noise(Decrease anxiety & stress associated with dyspnea) 6) Emotional & Psychosocial Support

(Coaching and support have been shown to decrease the feeling and anxiety associated with dyspnea)

Clip Art, 2007

Andry

, J. (2008) & Tyson, L (2006)Slide56

Key Points to REMEMBER:Dyspnea is a SUBJECTIVE feeling & a debilitating symptom that patients

experience.

Key ASSESSMENT skills are crucial to help understand the underline cause of the

dyspnea and/or the treatment options.Be consciously aware of evidence-based interventions that are already incorporated into nursing practice, whether the dyspnea is oncology related or not.Dyspnea is a symptom that can CHANGE from day to day. Reassure the patient of this and the multiple interventions we can help to relieve dyspnea.

Lastly, keep the patient’s GOAL in mind. Are the interventions appropriate and will the patient be able to enjoy certain activities with some of the side effects that may occur. Just remember to communicate & educate patients on these

interventions and just maybe, we can give them a little relief from their dyspnea!

KEY POINTS

TO

REMEMBERSlide57

REFERENCES:Guyton, A. & Hall, J. (2006). Blood Cells, Immunity, & Blood Clotting. Schmitt, W. &

Gruliow

, R. Medical Physiology (11

th e.d.) pp. 439-450. PA: Elsevier IncDiSalvo, W., Joyce, M., Tyson, L., Culkin, A., & Mackay, K. (2008). Putting Evidence Into Practice: Evidence-Based Interventions for Cancer-Related Dyspnea. Clinical Journal of Oncology Nursing. 12(2) pp. 341-352.Jantarakupt

, P. & Porock, D. (2005). Dyspnea Management in Lung Cancer: Applying the Evidence From Chronic Obstructive Pulmonary Disease. Oncology Nursing Forum. 32(4), pp. 785-795.Johnston, M. P. (2007). Oncology Nursing. In Langhorne, M., Fulton, J., & Otto, S.

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http://www.ons.org/Research/NursingSensitive/

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Itano

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Esper

, P. &

Kuebler

, K. (Eds.).

Dyspnea.

(2

nd

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th

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., pp. 258- 274). St. Louis: Elsevier Saunders.

Franceschi

, C. &

Bonafe

, M. (2003). Centenarians as a model for healthy aging.

Biochemical Society Transactions.

31(2) pp: 457-461.Slide58

Polovich, M., Whitford, J., & Olsen, M. (2009). Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Oncology Nursing Society, pp. 234-244.

Stedman’s Medical Dictionary for the Health Professions and Nursing. (2005). (5

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