Dyspnea in the Palliative Care Patient

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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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Justin M., M.D. -

I wanted to share some feedback on this piece that I received from Dr. Stephen Singh, a director with the Canadian Society of Palliative Care Physicians.

First, he wanted to point out that although I use the term "palliative patients", a much more appropriate phrase would be "patients requiring palliative care". I think this is a very important distinction that underlies a lot of the fears people have about palliative care. In current practice, the label "palliative" can completely change the way a patient is approached. We have to remember the patient still comes first.

Second, he agrees that IV opioids are valuable up front, but highlights an important reason to change to oral or subQ once an effective dose has been determined: the length of action of IV opioids is too short and we don't want the effect of these medications to wear off.

Chuck S., M.D. -

Loved the talk agree with above changes. Another way to treat dyspnea that I learned when a colleague was dying of mesothelioma was nebulized morphine (standard titrated dose) have used several times since with often dramatic success in alleviating the dyspnea while leaving the patient awake and conversant with family. Confess that I haven't done any research on the topic so pure anecdote that I share. Have noticed best success in patients with primary lung problems (lung cancer, end state COPD etc.)

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