Dyspnoea is the subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. It arises from an imbalance between the respiratory motor drive and the actual mechanical response of the respiratory system. Receptors in the upper airways, lungs, and chest wall send signals to the cerebral cortex via sensory pathways like the vagus nerve. When the respiratory muscles work harder against airway resistance or a stiff chest wall, the brain perceives this mismatch as breathlessness.
In Nigerian hospitals, dyspnoea frequently stems from a mix of infectious, cardiovascular, and environmental triggers.
Dyspnoea is broadly categorized as acute or chronic based on its onset. Acute dyspnoea develops over minutes to hours, often signaling emergencies like pulmonary embolism or acute asthma exacerbations. Chronic dyspnoea lasts longer than four weeks and is typical of conditions like chronic obstructive pulmonary disease or heart failure. Clinical presentation often includes use of accessory muscles, nasal flaring, cyanosis, and audible wheezing or crackles during auscultation.
A thorough nursing assessment starts with evaluating the vital signs, noting tachypnoea, tachycardia, and oxygen saturation drops. Ask the patient about precipitating factors, relieving positions, and the exact duration of the discomfort. Observe for signs of respiratory distress such as intercostal retractions, tracheal tugging, and paradoxical abdominal breathing. Auscultate lung fields systematically to identify absent breath sounds, wheezes, or crepitations.
| Test | Purpose in Dyspnoea | Expected Finding in Distress |
|---|---|---|
| Pulse Oximetry | Measures oxygen saturation | SpO2 below 92% on room air |
| Chest X-ray | Views lung fields and heart size | Infiltrates, cardiomegaly, or fluid |
| Peak Flow Meter | Measures expiratory airflow speed | Reduced peak expiratory flow rate |
| Full Blood Count | Checks haemoglobin and white cells | Low Hb or elevated white cells |
Diagnostic tests help pinpoint the underlying pathology so medical and nursing interventions can be targeted accurately.
Emergency care for acute severe dyspnoea prioritizes maintaining a patent airway and ensuring adequate oxygenation. Administer high-flow oxygen immediately if saturation is low. Position the patient upright in a high Fowler's posture to ease diaphragmatic descent. Prepare suction equipment, bronchodilator nebulizers, and emergency crash carts. Monitor vital signs continuously while awaiting medical review.
Pharmacological management relies on prescribed bronchodilators, corticosteroids, diuretics, or antibiotics depending on the root cause. Nurses must administer these medications accurately and watch for adverse drug reactions. Non-pharmacological measures are equally vital. Teach controlled breathing techniques like pursed-lip breathing to prolong exhalation and reduce air trapping. Provide a calm, well-ventilated environment to lower anxiety, which often worsens breathlessness.
Untreated or poorly managed dyspnoea can lead to severe hypoxia, respiratory failure, metabolic acidosis, and cardiac arrest. Discharge education focuses on helping patients recognize early warning signs of worsening respiratory status. Instruct patients to avoid known triggers such as heavy dust, smoke, and strong chemical fumes. Emphasize adherence to prescribed inhalers and maintenance medications to prevent recurrent hospital admissions.