Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with ...

Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD)Whereas the evidence reviewed suggests a relationship between respiratory effort or work, chemoreceptorsand mechanoreceptors, the precise physical mechanism of dyspnea is still unclear. In order to facilitate thedevelopment of effective strategies for relief of this distressing symptom in individuals with progressivedisease, researchers continue to attempt to understand these mechanisms.Recommendation 1.1:All individuals identified as having dyspnea related to COPD will be assessed appropriately(See Figure 1 – COPD Decision Tree). Respiratory assessment should include:■ Level of dyspnea● Present level of dyspnea● Present dyspnea should be measured using a quantitative scale such as a visual analogue(Appendix C) or numeric rating scale (Appendix D)■Usual level of dyspnea● Usual dyspnea should be measured using a quantitative scale such as the Medical ResearchCouncil (MRC) Dyspnea Scale (Appendix E)■■■■■■■■■Vital signsPulse oximetryChest auscultationChest wall movement and shape/abnormalitiesPresence of peripheral edemaAccessory muscle usePresence of cough and/or sputumAbility to complete a full sentenceLevel of consciousness (Level of Evidence =IV)Discussion of Evidence:Dyspnea is a subjective symptom of physiological distress (Heinzer et al., 2003). A number of tools areavailable to measure dyspnea in the clinical and research settings (see Appendix F: Summary of DyspneaAssessment Tools). Two tools used by nurses to measure present dyspnea (Gift & Narsavage, 1998), or thedyspnea that the patient is experiencing at the moment are the visual analogue or numerical rating scale(see Appendix C & D). These tools are useful to assess the effectiveness of an intervention such as drugtherapy, position change, or relaxation exercises. However, they do not help explain what function thepatient is capable of, or what activities he is avoiding to prevent dyspnea (American Thoracic Society, 1999).22