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tachypnea symptom.



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Mar 20, 2009 12:28 AM

tachypnea symptom.


6 years as a hospice nurse, and i recently had a new situation tha36-5t i was not sure how to handle symptom control. this patient was actively dying, peaceful,unresponsive,pain-free,afebrile...yet, so tachypneic! his respiratory rate, though non-labored , was 36-52 rr./min. regular for over 12 hours before he finally passed. there seemed to be no associated distress-and i felt that using roxanol to slow him down did not seem appropriate, somehow. it was like he was 'finishing a race'-which of course he was...and i let him do it. any comments? his underlying disease was motor neuron (als)and he was not congested.getting occas.dosing of roxanol to assure comfort only. any ideas on cause or treatment options, or your own experiences -let me know. thank you!


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27 Comments
No. 1
from leslie :-D
Old Mar 20, 2009, 10:19 AM
Updated Mar 20, 2009 at 10:52 AM by leslie :-D

Default Re: tachypnea symptom.
respiratory failure is almost always the final outcome with als.
and roxanol, ativan would have been most appropriate.
roxanol is always indicated for dyspnea.
i'm sorry your pt experienced that...

leslie

eta: Symptom Management of the Patient With Amyotrophic Lateral Sclerosis: A Guide for Hospice Nurses

www.medscape.com/viewarticle/578915

may need to register at medscape.
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No. 2
from ghillbert
Old Mar 20, 2009, 10:47 AM

Default Re: tachypnea symptom.
I am not hospice. But if I had a patient who was imminently dying, with a RR up to 50bpm, you'd better believe I'd be giving morphine.
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No. 3
from leslie :-D
Old Mar 20, 2009, 02:22 PM

Default Re: tachypnea symptom.
Originally Posted by oncalllorraine View Post
it was like he was 'finishing a race'-which of course he was...and i let him do it. any comments?
and yes, i do have 1 final comment.
i think you let this pt down.
i'm upset, esp as a hospice nurse, you should have known better that tachypnea is a sign of distress.

that's all i'll say in terms of criticism.

leslie
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No. 4
from truern
Old Mar 20, 2009, 03:52 PM

Default Re: tachypnea symptom.
Just wondering how you knew a patient with a RR that high was peaceful and painfree if he was unresponsive??
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No. 5
from leslie :-D
Old Mar 20, 2009, 04:28 PM

Default Re: tachypnea symptom.
Originally Posted by truern View Post
Just wondering how you knew a patient with a RR that high was peaceful and painfree if he was unresponsive??
what bothers me, is folks with als almost always anticipate and fear their forthcoming resp insufficiency.

leslie
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No. 6
from GrumpyRN63
Old Mar 24, 2009, 12:01 AM

Default Re: tachypnea symptom.
I had this same circumstance w/ a pt yesterday. Unresponsive, eyes open, gaze fixed, working @ 50/min, I considered the pt to be quite distressed, switched her to Haldol 1 mg sl, doubled her mso4 to 20 mg q2hr, slapped an extra fentanyl patch on, upped her 02, anything I had in my arsenal to ease/manage the sx's. She passed about 6 hrs after my visit, I did the pronouncement, family said she was able to calm down moderately prior to her passing, whatever she was 'working through' might have been pain free (never had pain), but it certaintly wasn't peaceful , I couldn't let that continue until she ' worked it out', dyspnea is distress ie suffering, it requires tx, I wouldn't let an animal go thru that, JMTC
I also don't understand how someone could be breathing @ 36-50 and it be non-labored?
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No. 7
Old Mar 24, 2009, 05:07 PM

Default Re: tachypnea symptom.
Always use Roxanol for pain/increased respirations.
Resp that are above 20 is indicative that something is wrong.
We are taught in nursing school to watch for abnormals.
I would have used Roxanol 20mg/ml ; 0.25ml - 0.5ml sl 1 q1 hr prn.
I second the comments of Lesie and Truern
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No. 8
from mc3
Old Mar 25, 2009, 04:58 PM

Default Re: tachypnea symptom.
Sorry, but yikes! 36-52? Imagine how you'd feel if you were breathing that hard? Death isn't a race to the finish line. The rate alone would tell me it's labored breathing. As the others have said, Roxanol and Ativan should have been used. As much I hate it, this is how we learn from our mistakes...
mc3
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No. 9
from Whispera
Old Mar 25, 2009, 11:43 PM

Default Re: tachypnea symptom.
Sometimes the only way a dying patient can indicate pain (physical, emotional, spiritual) is through increased heart or respiration rate. I think the patient in question was in intense pain.

Warm hugs for your caring--next time you will know what to do!
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