Symptom: Breathing Difficulty

Initial Grading Reminder

CTCAE grading of breathing difficulty:

Grade 1 (Mild): Shortness of breath with moderate exertion
Grade 2 (Moderate): Shortness of breath with minimal exertion; limiting instrumental ADLs
Grade 3 (Severe): Shortness of breath at rest; limiting self-care ADLs
Grade 4 (Life-threatening): Urgent intervention indicated

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Have you had any difficulty breathing in the past? How much worse is it now? Do you have asthma or emphysema? 

Grade the symptom

Ask the patient:

When are you short of breath? Are you short of breath at rest or only when you do something like walk or go up the stairs? If you take it easy, does it get better? Is it affecting your ability to take care of yourself?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any chest pain? Any swelling in your legs? Do you have any weakness or numbness or tingling?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    A patient with severe or life-threatening SOB  or new-onset SOB needs to be seen immediately, with an ED referral as necessary.

    Patients with any of the red-flag symptoms need to be seen immediately. Patients with chest pain need to go to the ED.

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    Nursing Assessment of Potential Causes

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    Differential Diagnosis

    What do you suspect is the cause of the breathing difficulty?