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Other causes: Cancer treatment e.g. radiotherapy, chemotherapy
Ascites/abdominal distension
Anaemia
Fatigue
Muscle weakness/cachexia (NB. Nutrition) March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Who does it affect? 65% of lung cancer patients experience dyspnoea (Twycross 1986)
Most common symptom along with cough (Higginson 1989)
70% of patients with cancer experience breathlessness in last 6 weeks of life (Higginson 1989)
Historically a pharmacological approach used March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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How does someone with breathlessness feel? Scared
Panic
Helpless
Hot
Anxious
Agitated
Restless
Tired/exhausted March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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How will they look? Sweaty
Flushed
Tired
Uncomfortable
Snatching at breath
Agitated
Blue March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Someone who is breathless may say: March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. “I need to open all the windows” “I’m going to die” My chest feels tight” “I thought I was going to suffocate.” “is something terrible going to happen?” “I can’t get enough air in”<br>
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March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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THE IMPACT OF BREATHLESSNESSHow does it feel? Frightening and debilitating experience
Affects individual’s ability to function
Fighting for life/thoughts of death
Panic/Anxiety
Loss of control March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. BREATHLESSNESS Restricted
mobility Distress Disruption in
Relationships/sexual
functioning Anxiety Inability to work Financial Hardship Restricted social
functioning Depression Inability to perform ADL’s Fear of Suffocation Sleep disturbance Fatigue<br>
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ENERGY RESOURCES REQUIRED FOR BREATHING At rest = 2.3%
Heavy exercise = 3.4%
Severe lung disease = over 33% (Naifeh 1994) March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Factors Affecting Breathing: Activity
Posture
Heat/cold
General disability
Anxiety
Pain March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. Breathlessness
On Exertion Breathlessness
At Rest Terminal
Breathlessness Non pharmacological
Approach Pharmacological
Approach<br>
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Education: EMPOWERS the patient
Basic anatomy and physiology of the lungs
Reassurance – breathlessness is not harmful
Breathing is automatic with volume control
↑ awareness of breathing pattern, posture and body tension
Speech and eating
Breath holding March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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TOOL BOX March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Tool Box: Coughing –
Huffing technique –not to be done with residents with suspected/confirmed COVID-19
Frozen green grape
Drinking iced drinks, lemon, lemon barley, buttercup syrup
Lozenges, linctus
Root ginger in boiling water – inhale, drink
Suck ice March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Tool Box: Fan – Schwartzstein et al, 1987 - –not to be done with residents with suspected/confirmed COVID-19
Bath robe
Shower-steam, window open, not too hot
Provide walking aids
Effort – breathe out on exertion
Stairs
Walking
Sit – stand March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Tool Box: Relaxation techniques – visualisation
- Deep breathing exercises
- Music
Meals – smaller
Drinking – straws
Jar of Energy
Sleeping position March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Tool Box: Breathing control:
Increasing awareness of breathing pattern
Efficient breathing - not snatching
Expiration on effort
Yogic breathing – involving abdominals
Rectangle breathing (this works really well!!) March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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POSITIONING: High side lying March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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POSITIONING: Relaxed sitting: March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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POSITIONING: Forward Lean Sitting March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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POSITIONING: Forward Lean Standing March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Finally .................... Ask your patient what they find most useful when they are experiencing an episode of breathlessness – you are then much better prepared to help them.
Thank you March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Case Study Lucy is a 64 year old lady with a four year diagnosis of breast cancer.
She has been married for 40 years and has two grown up children both with their own families.
She has always been very sociable and active.
She lives in a house with stairs.
Her breathlessness has been worsening for the past 12 months.
She has been referred to us at the Martlets for breathlessness management. March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Lucy’s description of her breathlessness: Beyond fear
Terrifying
Gasping
Petrified
Horrible Catch 22 situation
Think you are going to die
Drowning sensation
Worst experience ever
Life is dragged from you March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Before Walls closing in
Everything was a battle
↓ Quality of life
Breathlessness controlling me
Felt left out
Lost part of my personality
Losing friends
Not a person – an object March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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After Changed my life
Took back control
Saved my life
Techniques work 100%
Reasonably normal life
Quality of life for first time in 18/12
No fear
I can talk for England March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Relationship with husband BEFORE AFTER Totally and utterly useless
Headless chicken
Angry at him
Didn’t want to be alone with him
I wanted him to help Unbelievable
Fantastic
Comfortable, work together
Want to be with him now
Stronger between us March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Coping strategies that Lucy learnt to use: Breathing control
Awareness of next activity
Talking – when to take the next breath in
Planning
Pacing
Use fans
Don’t rush
Recognising early signs of anxiety March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>
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Thank you for listening Any questions? March 2020 RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE.<br>