Relaxation technique to ease dyspnea: a tool for oncology nurses.

Mr. B, a 68-year-old man with a sevenyear history of lung cancer in remission, was admitted to the oncology unit for increasing dyspnea and extent of disease workup. He reported nonspecific symptoms that included shortness of breath on exertion and sometimes without exertion, causing him to stop participating in some of his activities, difficulty sleeping, and a lack of appetite. He also was worried about the cancer coming back. “Waiting and not knowing,” he said, was very stressful. Mr. B’s physician ordered supplemental oxygen at the rate of 5 L by nasal canulla and scheduled diagnostic imaging examinations, laboratory tests, and a possible bronchoscopy. The morning after admission, Mr. B experienced significantly increased dyspnea. Because he was so short of breath he had postponed going to the bathroom as long as he possibly could and called for his nurse as he was leaving the bathroom. He was very apprehensive about his shortness of breath and appeared to be using a great deal of effort to breathe, telling his nurse “I can’t catch my breath.” To help ease Mr. B’s breathing, the nurse had him sit upright in the bedside chair and asked him to relax and breathe normally. However, Mr. B’s high level of anxiety, caused by his difficulty breathing and his fears about a possible lung cancer recurrence, made following instructions challenging. His entire body was tense, and he was expending needed energy by leaning forward, grasping the arms of the chair. Being told by the nurse to relax and breathe deeply had the opposite effect; Mr. B. became even more anxious and dyspneic. One of the resources available to the nursing staff in the hospital was a stressmanagement nurse available to work with patients and families. Noticing that the nurse was on the unit, Mr. B’s oncology nurse described his situation and asked the stress-management nurse to visit Mr. B to see if stress reduction techniques might help improve his breathlessness.