Palliative Care: The Distress of Dyspnea

Betty R. Ferrell, RN, PhD

Disclosures

April 29, 2011

Case Presentation: A Cancer Patient With Dyspnea

Mrs. Jacobs is a 72-year-old woman who was diagnosed 2 months ago with stage IV lung cancer. She began chemotherapy but discontinued treatment after 3 weeks as a result of extreme fatigue. She has opted for supportive care so that she can be as functional as possible because she cares for her 92-year-old mother and her 80-year-old husband who is on chronic dialysis. Today Mrs. Jacobs comes to the cancer center's urgent care clinic complaining of dyspnea. She is also visibly distressed and is accompanied by her panicked husband who pleads, "Do something! Don't let her suffocate like this!" The nurse in urgent care responds to the patient and caregiver, aware that the symptom of dyspnea is one of the most frightening symptoms of lung cancer and that expert assessment is needed.

History and Admission Assessment

Mrs. Jacobs was admitted to the oncology unit. Her chest x-ray was unchanged from the last x-ray taken 8 weeks ago prior to beginning chemotherapy. The x-ray reveals hyperinflated lungs with multiple nodules scattered in both lungs and bulky lymphadenopathy. She is hyperventilating and highly anxious.

The results of her blood gases are: ph 7.46, pCO2 32, PaO2 53, and HCO3 28.

Her oxygen saturation is 85% on room air, which improved to 92% with 3 L/min of oxygen via nasal cannula. Other laboratory results were normal:
WBC count: 4 x 103/mm3
Hgb: 10.5 g/dL
Platelets: 224,000
BUN: 15 mg/dL
Creatinine: 8 mg/dL

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