3. Managing The
Stress Of Breathlessness
Home Health
Presented by
Gerri Virgil, M.S.N., R.N. Case Manager
3
4. Objectives
• Describe physiologic changes and physical signs, symptoms of
stress
• Identify use of non-pharmacologic modalities used to treat
breathlessness in COPD
• Practice performing progressive relaxation techniques
4
5. The Importance of Relaxation
Tension,
Anxiety,
&
Fear
Shortness Heart Rate Increases
Of Use of Oxygen Increases
Breath Bronchospasms
Exhaustion
Incapacitation
5
Source: The Lung Association
8. Non-Pharmacologic Agents
Non-pharmacologic agents used as palliative interventions
to relieve breathlessness.
• Progressive relaxation
• Breathing techniques
– Positioning
– Diaphragmatic breathing
– Purse lip breathing
8
9. Short-Term & Long Term Stress
9
Source: Is It Worth Dying For
Authors, Dr. Roberts S. Eliot and Dennis L. Breo
10. Sympathetic Nervous System
Use of the Sympathetic Nervous System to assist in alleviating
the stress of breathlessness. (Involuntary or autonomic nervous
system responses)
• Increases blood pressure
• Increases heart rate
• Rapid shallow breathing
• Sweaty palms
• Dry mouth
10
12. The Nervous System
Accelerates Slows
Respirations Respirations
In the Lungs In the Lungs
12
Outline of some of the effects of the sympathetic and parasympathetic nervous systems on various organs and glands.
13. The Nervous System
Sympathetic Parasympathetic
Nervous System Nervous System
Accelerates Slows
Respirations Respirations
In the Lungs In the Lungs
Lungs
13
Outline of some of the effects of the sympathetic and parasympathetic nervous systems on various organs and glands.
15. Non-Pharmacologic Agents
Progressive Relaxation
Systematic relaxation and contraction of specific muscle groups
in conjunction with diaphragmatic and pursed lip breathing.
Breathing Techniques
• Positioning – instruct client to lean
forward on forearms supporting upper
body.
• Diaphragmatic Breathing – leaning
forward on forearms, inhale deeply
(stomach goes in) hold approximately
3-4 seconds. Use pursed lip breathing
to exhale. 15
16. Non-Pharmacologic Agents
Purse Lip Breathing
Purse lip breathing involves
inhalation through the nose followed
by a slow exhalation usually 4-6
seconds through pursed lips.
Evidence shows decrease air trapping
by stenting the airways and
preventing dynamic airway collapse
averting panic attacks that
accompany severe breathlessness.
16
17. Non-Pharmacologic Agents
Progressive Relaxation
1. Choose a quiet spot where you will not be disturbed by other
people or telephones.
2. Play soft, soothing music, i.e., nature sounds.
1. Close your eyes. This makes it easier to concentrate.
2. Lean forward to on your arms, supporting the upper body.
Take in a deep breath. Your stomach goes in. Exhale. Your
stomach moves out. This is diaphragmatic breathing; most
people are “chest breathers.” Continue to breathe in and out
“slowly” with your diaphragm.
17
18. Non-Pharmacologic Agents
Progressive Relaxation
5. Take in a deep breath, stomach goes in, exhale over 4-6
seconds, slowly through pursed lips (stomach moves out).
Continue this part of the exercise for approximately 1-2
minutes.
6. Gradually, begin to tighten your toes and ankles, take in a
deep breath (stomach goes in) and tighten toes and ankles;
deep breathe out thru pursed lips, relax toes and ankles.
7. As you take in your next breath, tighten your toes, ankles,
lower legs… hold it, hold it.
8. Begin to exhale thru pursed lips, relax lower legs, ankles, toes.
18
19. Non-Pharmacologic Agents
Progressive Relaxation
9. As you inhale, (stomach goes in) tighten toes, ankles, lower
legs, thighs… hold your breath, stay tight, tight. Exhale thru
pursed lips, relax toes, ankles, lower legs, thighs.
10. Inhale (stomach goes in) and progressively tighten toes,
ankles, lower legs thighs, buttocks and tummy. Exhale
through pursed lips and relax muscles slowly.
11. Inhale (stomach goes in) and progressively tighten muscles
from toes to tummy, and now your chest muscles… exhale
through pursed lips and relax muscles.
19
20. Non-Pharmacologic Agents
Progressive Relaxation
12. Inhale (stomach goes in) and progressively tighten muscles
from toes to chest muscles, and now add your arms;
tighten your fists, scrunch up your face… hold it… hold it.
Exhale (through pursed lips) and progressively relax your
muscles.
13. Breathe in and out with your diaphragm 1-2 minutes more.
14. Bend over at the waist, and shake your arms and hands.
15. Slowly open your eyes.
20
