Management of dyspnea in a patient with lung cancer.

257 N ine months prior, S.P., a 64-yearold woman, was diagnosed with stage IV non-small cell lung cancer with distant metastases to the bone. Her large tumor burden had compressed both her trachea and esophagus several months earlier, leading to gastrostomy-tube placement for nutrition and tracheostomy for airway management. Palliative radiation was used to shrink the tumor size and allow for removal of the tracheostomy tube, leaving an open area covered with gauze in the middle of her neck—a reminder of her previous struggles with breathing. Unfortunately, the cancer progressed and S.P. was admitted to the hospital for evaluation and management of dysphagia. On morning rounds, S.P. was found sitting straight up in bed, expressing fright, and gasping in an attempt to catch her breath. The 2 L per minute of oxygen she was receiving by nasal cannula provided no relief, as she mouthed “help me.” Backup was called immediately and an oxygen mask placed because of an initial oxygen saturation reading of 88% by pulse oximeter. Despite an increase to 94% on oxygen, S.P. continued to gasp while anxiously holding the nurse’s hand. S.P. was clearly in a panic as the nurse asked her to try pursed-lip breathing while demonstrating the technique in sync with her attempts. Despite increased oxygen saturation and pursedlip breathing, S.P was still in distress. Morphine had been ordered as needed in anticipation of a dyspneic event, but S.P. initially refused, believing she would become too lethargic, prompting the need to find other measures to provide relief. Supportive care was required to aid S.P.’s fear and dyspnea. The lights in her room were dimmed, the door closed, and soft music played to help subdue her anxiety. Although her breathing did Management of Dyspnea in a Patient With Lung Cancer