Shortness of Breath

JustBeachyNurse, LPN · Aug 31, 2015

Call the physician report your objective findings. I would not ask for a nebulizer treatment. Hopefully the physician knows her and can make a suggestion. I wouldn't assume especially if no objective findings of SOB--vitals, skin pink/warm/dry no diaphoresis, no retractions, no increased work of breathing

My late grandmother had episodes like that the treatment in her case was saline neb tx and a mild benzo low dose as her physician knew her. It was her way of describing her anxiety.

A patient of mine has mild increased work of breathing. VSS, no wheeze....until you give the neb.

AJJKRN · Aug 31, 2015

When in doubt I often call RT for their take on things (just before getting ahold of the MD) but it sounds like the Pt in question just needs a low dose Valium/Ativan/etc.

SilleLu · Aug 31, 2015

Ok, thanks! I wish I could share the whole story/history, but alas, could identify. And doctor actually came into the room before I even left and blew the patient off and did NOT order any breathing tx. I had just been wondering before doc walked in if I really needed to call for this complaint seeing nothing supported her claim and she is well known for shennanigans...

JustBeachyNurse, LPN · Aug 31, 2015

Seems the physician knows her games and you did your duty

toomuchbaloney · Sep 1, 2015

Most of the time when I have dealt with patients reporting shortness of breath with the sort of assessment findings you report I suspect that anxiety is the culprit.

CryssieD · Sep 1, 2015

Gastric distention can cause subjective feeling of SOB without objective evidence--it doesn't have to be extreme distention, either. Other than that, can't think of anything other than simple anxiety. You did the right thing though--we take patients at their word, but we don't give medications without appropriate indications for them; Proventil and other neb meds have side effects and contraindications like any other drugs, and we don't use them as placebos.

That said, I would always be alert to SOB as a potential harbinger of bad things to come--doesn't mean you have to jump on it right away, just keep eyes and ears open and remember to reassess a couple of times. Better safe than sorry!

Anna Flaxis, BSN, RN · Sep 1, 2015

I guess what I'm asking is, is shortness of breath as objective as pain - do we just take the patient's word for it?

Did you mean subjective?

Symptoms are subjective. They are what the patient feels. The patient feels short of breath.

Signs are objective. They are what we observe.

You painted a pretty good picture of someone with a subjective symptom of shortness of breath, but no outward objective signs of hypoxia.

A good CYA move would be to report it to the physician, and document appropriately. Let the physician decide what to do with the information.

Having said this, you've painted a pretty clear picture of someone with anxiety. Me, personally, I would explore that with the patient, taking care not to give the message that I think it's "all in their head". See how open they are to nonpharmacologic, independent nursing interventions such as taking slow, deep breaths, visualizing a place/situation where they feel calm and happy, distractions such as books, games, movies, or even simply folding some washcloths.

Sometimes people who are having a health crisis seemingly out of the blue, can be hypervigilant about different sensations in their body that they may not have paid much attention to before their current health crisis, and it can be helpful to explore that with them.

Pangea Reunited, ASN, RN · Sep 1, 2015

I would like to add that those symptoms also present with cardiac arrhythmias such as tachycardia, SVT, A fib/flutter.
OP, what were the cardiac S and O?

I had a very dramatic patient keep telling me that she "couldn't breathe". Her respiratory rate, 02 SAT, etc. were all fine and her lungs sounded clear. I was pretty annoyed and didn't take her seriously, because that particular patient had an "issue" every five minutes. It was later determined that she'd had an acute MI.

Anna Flaxis, BSN, RN · Sep 1, 2015

I had a very dramatic patient keep telling me that she "couldn't breathe". Her respiratory rate, 02 SAT, etc. were all fine and her lungs sounded clear. I was pretty annoyed and didn't take her seriously, because that particular patient had an "issue" every five minutes. It was later determined that she'd had an acute MI.

And this is exactly why you report it to the physician anyway.

amoLucia · Sep 1, 2015

In the past, I have had the sensation of SOB. By all S&S, nothing is evident, but I 'feel it' and it's NOT anxiety. What I find myself doing is

'sucking for air', that is, taking a deep breath AFTER I've already taken a normal breath. It's like a double breath (or yawn) is needed to fill my lungs. It's very subtle; I doubt you'd ever see me do it - it just happens all so fast. Just reflexive but it is a real feeling with a real intervention.

And I need to be sitting upright. So when someone tells you they need to be 'UP' to breathe, don't fuss

SilleLu · Sep 1, 2015

Did you mean subjective?
Symptoms are subjective. They are what the patient feels. The patient feels short of breath.
Signs are objective. They are what we observe.
You painted a pretty good picture of someone with a subjective symptom of shortness of breath, but no outward objective signs of hypoxia.
A good CYA move would be to report it to the physician, and document appropriately. Let the physician decide what to do with the information.
Having said this, you've painted a pretty clear picture of someone with anxiety. Me, personally, I would explore that with the patient, taking care not to give the message that I think it's "all in their head". See how open they are to nonpharmacologic, independent nursing interventions such as taking slow, deep breaths, visualizing a place/situation where they feel calm and happy, distractions such as books, games, movies, or even simply folding some washcloths.
Sometimes people who are having a health crisis seemingly out of the blue, can be hypervigilant about different sensations in their body that they may not have paid much attention to before their current health crisis, and it can be helpful to explore that with them.

Yes, sorry. I started to word my question in a different way, then when I reworded it didn't change it....thanks for catching that!