How Do You Treat Shortness Of Breath At The End Of Life?
Shortness of breath can occur at the end of someone’s life and can be overwhelming and scary to think about. We do have interventions and medications available to help with this situation. This page is a quick reference guide for caregivers to help get through these episodes of breathlessness.
Dyspnea (feeling of breathlessness) has numerous etiologies. These can range from chest wall/organ pathology, abdominal issues (constipation/distension), to underlying metabolic problems.
Our Goal is to not focus on the why but treat the symptom now and then focus on a why if we need to at a later time.
Focus on the basics first.
- Oxygen – Is patient receiving oxygen? Is it turned on? Is the tubing kinked?
- Excess Fluid – Is there evidence of excess fluid overload? Swelling of face/hands/feet? Patient may need extra diuretics (lasix, etc.). Call the nurse and ask them to guide you.
- Positioning – Sit the patient up. Elevate the head of the bed to 30 degrees if they cannot site up.
- Increase air movement – position a fan at the patient or open a window.
- Stop any tube feeds or IV fluids that are running.
- Cough? If there is a cough that is new, consider aspiration of saliva or stomach contents. Ask the nurse about possible infection and need for antibiotics.
- Break into your comfort kit – Treat with morphine. Morphine helps with the feeling of shortness of breath and helps relax the patient. Start off slow and with small doses and go up as you need to until you get symptoms under control.
- Does the patient have underlying allergies or COPD? Treat with allergy medications (antihistamines). Use inhalers as prescribed to help open up airways especially if you hear wheezing.
- Consider cough syrups and suppressants as prescribed by the hospice to help control symptoms.
- Consider anti-anxiety medications if anxiety is worsening (ativan – also part of your comfort kit).
- Check for fever. If patient is febrile, treat with tylenol and ask the hospice nurse about possible infection and need for antibiotics.
Treatment with small doses of morphine does NOT hasten death. A patient will become drowsy, lethargic, unresponsive, and difficult to arouse before the respiratory centers are affected and respiratory suppression occurs.
How Can Hospice Help?
Hospice focuses on addressing the patient’s symptoms and addressing any underlying comorbidities that may be affecting quality of life. One of the biggest focuses for hospice care is quality of life including pain and other symptom management.
At Lenity Light Hospice, we accomplish this by scheduling regular nursing visits to assess the patient for any uncontrolled symptoms. Anything that needs to be addressed is done so under the guidance of physicians. Medications are adjusted until pain and other symptoms are controlled.
Hospice is available to the patient and caregivers 24/7 and will provide various specialties to help take care of a patient. These include physicians, nurse practitioners, nurses, CNAs (nurse aides), volunteers, therapists, chaplains, social workers and other staff. Hospice also covers most medications, supplies (gloves, briefs, bandages, etc.), medical equipment (hospital bed, commode, shower chair, wheelchairs, walkers, bed side tables, oxygen, etc.).