Respiratory disease, or lung disease, is classified into two categories: obstructive and restrictive. Obstructive respiratory disorders are those that prevent a person from fully exhaling all of the air from their lungs. Restrictive respiratory disorders are those that prevent a person from fully expanding their lungs to fill them with air.
There is one symptom that both types share, and that is shortness of breath with activity. Both can also cause chest pain and severe coughing. While respiratory conditions can be grouped into one category or another, many people have a combination of both restrictive and obstructive lung disease.
As a caregiver, you play a crucial role in helping to prevent respiratory infections. You must ensure that you follow all infection control and prevention guidelines. Be sure to perform frequent hand hygiene and use person protective equipment when appropriate.
Encourage individuals with respiratory conditions, as well as their family to get the flu vaccine every year. That means you, too! Remind family members and other visitors to stay away if they are ill. Individuals with respiratory conditions are also recommended to stay up-to-date with their pneumonia vaccine.
Ensure the environment remains clean. Wash bed linens and towels regularly and with hot water. Keep environmental surfaces, especially those that are touched frequently, clean. Prevent exposure to mold, excessive dust, and pet hair and waste. Vacuum carpets, rugs, and curtains with a vacuum that has a HEPA filter.
Keep the air temperature regulated and comfortable. Avoid excessively dry or humid environments.
Be mindful of the air quality in the individual’s immediate environment. Vent smoke from cooking and moisture from bathing to the outdoors when possible. Keep chemicals, such as paint or insecticides, away. Change air filters regularly. Avoid using scented perfumes, sprays, or powders for yourself and for the individual.
The exposure to smoke can exacerbate respiratory conditions. Educate the person about the dangers of smoking and encourage them to speak to their healthcare provider about a smoking cessation program. Ask others not to smoke around the individual.
Fatigue and Shortness of Breath
Fatigue and shortness of breath make it difficult for individuals with respiratory conditions to complete even some of the most basic activities of daily living. While you may need to provide assistance, it is important for you, as the caregiver, to always promote independence to the greatest extent possible. Identify what is the individual can realistically do, given their condition.
Adopt a “work, rest, work” approach to all activity to reduce fatigue and shortness of breath. This means you instruct individuals to insert a period of rest between all physical exertion efforts. Many larger tasks that consume a lot of energy can be broken down into smaller tasks and allow the individual to rest between them. Organize activities in such a way that the individual can be efficient and conserve energy. Place frequently used items within arm’s length of the person’s usual resting spot. For example, arrange tissues, the telephone, a cup of water, and the TV remote control on a table next to their recliner.
Encourage the individual to use pursed lip breathing during times of increased stress. This is a technique used to control breathing. It involves inhaling through the nose with the lips closed, then exhaling through lips that are tightly pressed together in an “o” shape, like blowing out a candle. Also remind the individual to take frequent deep breaths and cough to open airways and clear out mucus.
Teach the individual additional techniques that can reduce shortness of breath. These include:
- Avoiding tight clothing that can constrict their chest and abdomen. This includes belts, bras, pantyhose, and girdles.
- Suggesting light layers during colder seasons that can be removed easily. Avoid heavy, bulky tops.
- Using layers of light sheets on the bed that can be easily pushed away. Avoid heavy blankets.
Ask a social worker to see what resources may be available. For example, securing a handicapped parking sticker for trips outside can reduce walking distance and conserve energy.
Be sure the individual is using oxygen as ordered by their health care provider. Make sure oxygen tubing is long enough that they can move around freely but not so long as to create a fall hazard.
Nutrition and Hydration
Maintaining nutrition and hydration is another important component to the day-to-day care you provide. Some individuals with respiratory disorders have specific dietary restrictions, so be sure to provide food and fluids according to their restrictions.
Recommend several small meals a day instead of a few large meals. This keeps the stomach from pushing excessively on the diaphragm and interfering with breathing. Encourage adequate protein intake to keep respiratory muscles strong. Suggest waiting an hour after a meal before taking on an activity to give the body time and energy for digestion.
Ensure the individual has easy access to water or other fluids. For example, placing a water pitcher next to their recliner can encourage intake as they don’t have to get up to get a drink. Monitor urinary output and report any changes to their healthcare provider.
Getting an adequate amount of sleep each night is important for individuals with respiratory disorders. There are many things you can do to promote sleep. First and foremost, prepare a soothing setting conducive to sleep, free from disturbances such as loud noises, bright lighting, or uncomfortable air temperature. Offer to turn on a fan during sleep for air circulation and to provide background noise, if this will help promote rest. Support the individual’s request for elevation using pillows or a recliner for improved breathing during sleep.
Work with the individual to establish a consistent bedtime routine. Discourage daytime sleeping. Short naps of 15-30 minutes once or twice a day, however, may be beneficial if the individual is unable to sleep at night. Educate the individual to avoid caffeine, nicotine, and alcohol at night. Large meals right before bed can also be disruptive to sleep so they should be avoided.
Addressing the individual’s psychosocial needs is just as important as the physical care that you provide. Take time to listen to the individual’s concerns. Encourage relaxation techniques such as:
- Listening to soft music
- Maintaining calm, soothing surroundings
- Meditating or praying
- Reading a good book or the newspaper
- Watching TV or a movie
- Playing a game
- Working a crossword puzzle
Encourage frequent visits by family and friends to prevent social isolation. Help the individual identify pleasurable activities that they can do given their physical limitations. Recommend local and national support groups, such as the American Lung Association Better Breathers club. If you feel that depression or anxiety is a concern, report this to for further evaluation.
Observation and Reporting
As a caregiver, you likely spend more time with the individual than any other healthcare provider. Therefore, you are in a unique position to recognize when the person’s condition is changing. Being able to recognize symptoms that are worsening can allow for early treatment of the condition, improving outcomes. Observe for:
- An increase in the individual’s shortness of breath or wheezing
- A change in their cough
- Mucus that becomes bloody, green, or yellow or has a bad odor
- Swelling in the hands, feet, or legs
- Unusual sleep interruptions
- Worsening weakness and fatigue
- Any signs of respiratory distress
Be sure to immediately report any changes in the person’s condition, no matter how minor, to a healthcare provider. There are a number of interventions you can incorporate into your care to try to reduce the risk for respiratory complications. You might also be able to relieve some of the burden that activity places on those who are simply struggling to breathe.
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