Breathlessness and lung cancer help

Home Health Columnist / Guide · Apr 11, 2005

need a little more info here. where is lung cancer located? i'm unfamiliar with a furman tube but guessing patient has a lung abscess that is being drained.

depending on cancer site or abscess location if trying to lye flat, tumor/abcess may be pressing against airway or occluding part of lung. many lung ca patients find sleeping in a recliner chair helpful.

what other meds is she taking? is she trying to sleeping lying down or in a hospital bed with head elevated? using a nebulizer prior to sleep sometimes helps.

i'd see if sublingual morphine helps rather that oral med going to the gut.

check out these threads which include info on nebulized morphine.

copd

dyspnea article

will check back later

leslie :-D · Apr 11, 2005

i agree w/roxanol sl;

bed in semi to high fowler's;

and often i find that if i put a fan towards their face, it relieves much of that air hunger.

also agree w/karen about bronchodilator neb rx's or duoneb is quite effective....personally even my pts with lung ca, i still use the mask rather than the inhaler and none have ever minded....even if it does seem smothering, it really is well tolerated. but the duoneb has the albuterol as well as a steroid component.

keep us updated and good luck....

leslie

vasnyder · Apr 12, 2005

Patient tumor right lower lung, Furman tube to drain the secretions from the cancer She like her own bed and props self on pillows. The doctors who are caring for her are lung specialists and didn't feel a nebulizer would help at all. The doubled her oxycontin to 20 mg bid with roxanol 10 mg q 1-2 hr prn and ativan 0.5 mg q 4 hr prn. The docs want to try this first. Also I am suppose to remove the Furman tube since we are not getting much secretions out at all anymore.

Home Health Columnist / Guide · Apr 12, 2005

and often i find that if i put a fan towards their face, it relieves much of that air hunger.

:smackingf

How could I have forgotten to include having a fan in the patients room???!!!XX!!!??? Such an easy basic intervention that I've seen help with breathlessness. Some pts like the box fans on the floor, others small table top models.

I've had success with patients using a TV bolster pillow on their bed, turned upside down with arms facing wall to act as a slant pillow; some use regular way to be able to sleep at night.

lung specialists and didn't feel a nebulizer would help at all

Well if breathless nees that much of a problem, pt should be given a chance to try nebulizer tx to see if it helps breathlessness. The pulmonologist who helped educate me and my nursing colleagues would try anything in the name of patient comfort and improving quality of life.

I'm glad to hear the patient is not experiencing pain with current meds. Explain to pt that roxanol can help with breathlessness too, just not for pain.

Best wishes to you and your pt.

Mazzi · Apr 14, 2005

I have a lady right now who is on O2, taking MSIR prn and oxycontin q 12 hr.
She feels each night she is suffocating. I asked the doctor for an inhaler because she complains she feels feels so doped up on the meds now. She ha a Furman tube to drain her lung-not much out-only 20-60 cc 3 x wk. Any ohter ideas would be helpful. Also she says she has no pain so I hate to keep increasing the pain meds.

We frequently use nebulized Morphine. 2mg in 2-3ml of NS. (sugar free) q 4hr/prn

jerseyRN · Apr 19, 2005

I've encountered a lot of resistance (from supervisors) when it looks to me like nebulized morphine is worth a try. somebody, somewhere had a bad reaction... no one remembers exactly what... and now we don't use it anymore. In fact I have never seen it, but have had a couple of cases where nothing much seemed to really relieve the SOB.

Have you had unwanted side effects? What's important to look for with this tx?

jerseyRN · Apr 19, 2005

does the patient get "a buzz"?

Mazzi · Apr 20, 2005

does the patient get "a buzz"?

No buzz....I have not found pt complaining of any s/e. It is not at all like systemic morphine. I works in the lungs only. I suppose a little amount actually goes into the blood stream but not enough to worry about. All I know is that most of the pts get relief.

RRT/RN · Apr 20, 2005

i agree w/roxanol sl;
bed in semi to high fowler's;
and often i find that if i put a fan towards their face, it relieves much of that air hunger.
also agree w/karen about bronchodilator neb rx's or duoneb is quite effective....personally even my pts with lung ca, i still use the mask rather than the inhaler and none have ever minded....even if it does seem smothering, it really is well tolerated. but the duoneb has the albuterol as well as a steroid component.
keep us updated and good luck....
leslie

Duoneb doesn't contain any steroid. It is albuterol and atrovent which are both bronchodilators.

Has anyone ever heard of nebulizing lasix? We actually did this with one of our cancer patients and is was effective in relieving the air hunger. Not sure of the exact mechanism of action and only used this method on this one patient...

leslie :-D · Apr 20, 2005

Duoneb doesn't contain any steroid. It is albuterol and atrovent which are both bronchodilators.
Has anyone ever heard of nebulizing lasix? We actually did this with one of our cancer patients and is was effective in relieving the air hunger. Not sure of the exact mechanism of action and only used this method on this one patient...

sorry, you're right.....was thinking of advair.

as for nebulized lasix, never heard of it; only po and iv. that's not to say that other countries don't use it- it just hasn't been approved by the fda, to my knowledge.

i imagine lasix would relieve air hunger with those afflicted w/pulmonary congestion/htn/chf but the writer was unclear if this patient had any of those diagnoses.

leslie

Ashera, LPN · Apr 20, 2005

The mso4 nebs are used a lot at my hospice. And yes, I've seen lasix used as a neb too - with ns. Don't know quite how that helps but it did in one case. Fan is an excellent idea and also propped up in bed.