Symptom: Wheezing

Initial Grading Reminder

CTCAE grading of wheezing:

Grade 1: Detectable airway noise with minimal symptoms
Grade 2: Moderate symptoms; medical intervention indicated; limiting instrumental ADLs
Grade 3: Severe respiratory symptoms limiting self-care ADLs; oxygen therapy or hospitalization indicated
Grade 4: Life-threatening consequences; urgent intervention indicated

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Do you have emphysema or asthma? Have you had issues with wheezing in the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Note: More sudden onset would be suggestive of pneumonitis.

Grade the symptom

Ask the patient:

Can you hear a wheezing noise when you breathe? Do you hear that noise all the time or just when you’re doing an activity? Are you short of breath all the time or just when you lie flat, when you walk, use stairs, or do an activity? 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

    Patients with new-onset moderate or worse (or worsening) wheezing should be seen.

    Patients with any of the red-flag symptoms should be seen immediately.

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    Nursing Assessment of Potential Causes

    [tab category='Pneumonitis' header="Pneumonitis - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize'][tab category='Neuropathy' header="Neuropathy - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize']

    Differential Diagnosis

    What do you suspect is the cause of the wheezing?