A client with end-stage chronic obstructive pulmonary disease (COPD) is admitted to the palliative care unit. The client is experiencing severe dyspnea at rest, anxiety, and reports feeling "like I cannot get enough air." The goal of care has shifted entirely to comfort measures. Which nursing actions are appropriate to include in the plan of care? Select all that apply.
- Administer prescribed low-dose oral morphine sulfate.Answer
- Direct a small electric fan to blow cool air gently across the client's face.Answer
- CInstruct the unlicensed assistive personnel (UAP) to monitor for changes in the client's work of breathing.
- DMaintain continuous pulse oximetry to ensure oxygen saturation remains above 95%.
- ETell the client's anxious family, "Do not worry, everything will be fine once the medications start working."
- Assist the client into a high Fowler position with the arms resting on an overbed table.Answer
Answer
The correct actions include administering low-dose oral morphine sulfate, directing a cool fan across the client's face, and assisting the client into an orthopneic (high Fowler with arms resting forward) position.
In end-of-life care for severe respiratory disease, the primary goal shifts from disease modification to symptom management. Dyspnea is a distressing symptom that should be treated aggressively to ensure comfort. Low-dose opioids, such as morphine, reduce the central respiratory drive and alleviate the sensation of breathlessness. Non-pharmacological interventions, including positioning the client in an orthopneic position (high Fowler with arms resting forward on a table) and using a fan to blow cool air across the face, stimulate the trigeminal nerve, maximize lung expansion, and decrease the perception of dyspnea.
Step-by-Step Solution
Key Concept
Palliative management of dyspnea and end-of-life comfort measures