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Dyspnea
is "a term used to characterize a subjective experience of
breathing discomfort that consists of qualitatively distinct sensations
that vary in intensity. The experience derives from interactions
among multiple physiological, psychological, social, and environmental
factors, and may induce secondary physiological and behavioral
responses" (American Thoracic
Society, 1999). Dyspnea is the most common manifestation of
lung diseases and frequently is the presenting complaint of individuals
with cardiac dysfunction. Fifteen million people in the United
States suffer from chronic obstructive pulmonary disease (COPD)
and an equal number are afflicted with asthma. Treatments for
these diseases are often limited and patients are left with chronic
symptoms that impair the quality of their lives. Furthermore,
there is a growing appreciation for the role that dyspnea plays
in the discomfort and suffering of many patients at the end of
life. Those dying from end-stage cardiopulmonary disease as well
as from intra-thoracic malignancies often complain more of breathing
discomfort than of pain. Although narcotic analgesics may be very
effective at relieving dyspnea, the side effects, including depression
of consciousness and respiration, make them less than ideal therapies.
Question
1.3
Consider
the following scenario: A patient is admitted to the intensive
care unit with asthma symptoms. Despite aggressive bronchodilator
therapy, she remains extremely uncomfortable and the decision
is made to intubate her and place her on mechanical ventilation.
Subsequently, however, you find that the patient's breathing is
not in synchrony with the ventilator and she appears distressed.
Arterial blood gases are within the normal range. The problem
at this point is likely to be:
 | The
patient is anxious |
 | The
patient continues to have dyspnea despite the work being done
by the ventilator |
 | The
patient is having pain from the endotracheal tube |
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