Your Guide to Understanding Delirium

Providing a range of NHS services inGateshead, South Tyneside and Sunderland.

South Tyneside District Hospital

Providing a range of NHS services in Gateshead, South TYneside and Sunderland

The Breathlessness Management Group

The Aim

To increase your confidence in the management of your

breathlessness.

The Lungs

To make it easier to understand breathlessness, it may help to understand the way lungs work.

We have two lungs – one on each side of the chest. When we breathe in, air passes from our nose or mouth down through a tube called the windpipe (trachea). The windpipe divides into two tubes (airways), one going to each lung. These tubes are known as the right and left bronchus. They divide to form smaller tubes called bronchioles, which carry air through the lungs.

At the end of the bronchioles are millions of tiny air sacs called alveoli. In the alveoli, oxygen is absorbed from the air we breathe in. This oxygen passes into the bloodstream to be circulated around the body.

Carbon dioxide is a waste gas that needs to be removed from the body. It passes from the bloodstream into the alveoli and is then breathed out by the lungs.

Just below our lungs is a sheet of muscle called the diaphragm. The diaphragm and the muscles of the chest contract and relax to suck air in and out of the lungs. They’re the main muscles used for breathing when you’re relaxed.

During heavy exercise, the muscles in your shoulders and upper chest can also help with breathing. These muscles are not designed to work for long periods of time and get tired easily.

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The Diaphragm

What do we do when we become breathless?

Shoulder girdle

We use our shoulder girdle which makes us work harder, use more oxygen, makes breathing less efficient, makes us tired and become tense.

Relax - gentle shoulder rolls and shrugs help.

Breathe faster

Our breathing becomes faster using more effort. Oxygen doesn’t get down to the air sacs making us work harder to take in more oxygen.

Control breathing - breathe in 1, 2, hold, breathe out 1,2,3

Panic and fear

When we cause all of the above problems we have discussed.

Take control

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Chestrelaxes

Distraction Techniques

Distraction is a good tool to manage breathlessness you could try:-

• A hand held fan

• Massaging lung meridian

• Calming hand

• Written plan

• Quiet area/ comfort zone

• Pressure point

• Rectangular breathing

Comfort zone

It is very useful to identify a place within your home where you can keep the basic equipment we will be recommending, and have it readily available.

Breathlessness is often unpredictable but to have a ‘chill out zone’ ready and waiting can be invaluable.

For example:

We would suggest an area of the lounge with a comfortable armchair or riser recliner chair.

You could use your bedroom if you prefer but this may involve climbing the stairs when you are breathless adding to the problem.

Have pillows, fan, nebuliser, oxygen, this booklet and any other tools which may be suggested to you ready for use when you need them.

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The Lung Meridian

Stroke downwards using the back of your hand slowly to achieve a calming effect. You may like to ask somebody else to do this for you.

Sedation of the Lung Meridian

The lung has a pathway from the front of the shoulder to the thumb.

In a period of acute breathlessness this technique can be extremely useful.

Gently stroking from the armpit to the thumb nail will calm the breathing quickly. This is best done by a carer but can be a self-help technique. If the arm is supported on a pillow this will be even more effective.

Just holding the thumb nail will be of benefit as this is where the lung meridian ends.

Acupressure

Can be self/carer administered to certain points. An active acupuncture point will be easy to locate. It will be tender to touch, much like a bruise. Applying steady firm pressure for one minute with the middle finger or thumb and releasing the pressure slowly will stimulate relaxation of the tender area.

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Breathlessness plan

1. Keep calm

2. Deep breaths

3. Think!! Nothing is going to happen - you’re going to be alright

4. Deep breaths

5. Take your time - Don’t rush

6. You’ve done this before, you can do it again

7. Deep breaths

8. Don’t panic

9. Try one of the techniques

10. Deep breaths

Rectangular breathing

Using a door or rectangle shape such as a wall or window can help to focus your breathing and encourage you to make the breath out longer. This will slow your breathing down and encourage relaxed breathing.

breathe in

breathe in

breathe out breathe out

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Using a hand held fan

Will using a fan help my breathlessness?

Research studies have shown that a cool draft of air from a handheld fan can be very helpful in reducing the feeling of breathlessness.

You may also find that the following can also help ease breathlessness:

• Desktop or floor standing fans

• Opening windows, for example in a car,

• Some people like to use a cool flannel on their face.

How should I use the handheld fan?

• Fans with three or more rotating blades seem to be most effective as the airflow is stronger.

• When you feel breathless adopt a comfortable position.

• Hold your fan approximately six inches or 15cms from your face.

Aim the draft of air towards the central part of your face so that you feel the draught around the sides of your nose and above your top lip. You should feel the benefit within a few minutes.

Calming hand

The calming hand is a tool we use for teaching control of panic attacks. It also works well with episodes of breathlessness, whatever the cause. Its simplicity makes it very useful in helping you remember the main points of your coping strategy when you are actually experiencing panic or breathlessness. You should count the steps out on your fingers as an aide memoire.

ACCEPTANCE: recognition of the signs of the panic and that they are not sinister. Recognition of the need to put learned strategies in to practice. You should hold the thumb firmly whilst reminding yourself of what to do next. This will help to calm the breathing.

SIGH OUT: simple instructions lead to complex reactions. A. Shoulder drops, muscles relax B. The association of sighing out with relaxing after effort, or in relief, gives good signals to the brain. C. Breathing out for longer than breathing in causes slowing of the heart rate via the Vagus nerve. This steadies a fast heart rate which can be distressing adding to your anxiety

INHALE/ EXHALE GENTLY: controlled, efficient breathing (as taught in treatment sessions) quickly restores oxygen and carbon dioxide levels to normal, relieving the sensation of breathlessness.

RELAXED HANDS-STRETCH AND STOP: stretching your hand then relax

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2.

3&4.

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Calming hand

Relaxation and fatigue management

We must Plan to relax

Give ourselves Permission to relax

We make a Priority to relax

Relaxation introduces Pacing in to our day

Positioning correctly aids relaxation

Relaxation allows the brain to be distracted from negative thoughts of breathlessness. It uses the brain in a positive way and helps to pace energy and create space in your mind.

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The Circle of Fear

Relaxation

Breathlessness can often cause anxiety and feelings of panic. Anxiety tends to make the feeling of breathlessness stronger, which in turn leads to more anxiety. It is important to remember that breathlessness in itself is not harmful and you will recover your breathing on resting. It is also possible to try to control the level of anxiety you are feeling and relaxation is one way of helping with this.

Relaxation is a useful skill that you can learn.

How can I control my anxiety?Recognise what triggers your anxiety.Are there certain situations that make you feel more anxious?Write down the kinds of things that worry or concern you.Try not to worry about future events, concentrate on the present.Try to identify problems and solve them one at a time.Mention how you are feeling to health professionals.Learn a way of relaxing that works for you.

Preparing for relaxationRelaxation does not come easily to any one of us but the more you practice the easier and more effective you will find it. Try to allow yourself to have some time each day to practice your relaxation exercise.Tell the people with whom you share your home that you will need at least 20 minutes every day to practice relaxation undisturbed. Allow plenty of time for relaxation so that you will finish slowly and gently. Ensure the light and temperature of the room is at a comfortable level.

PositioningCheck your postureEnsure that you neck, shoulders and arms are relaxed. Gentle shoulder rolls or shrugs can help relax tight muscles.Try to have your elbows supported at your side on cushions or on the arm of the chairLet your shoulders and arms sink down into the cushionsTry to close your eyes. If this is too difficult, choose a spot in front of you, on the wall or floor and keep your eyes fixed on this point. When you are relaxed it will be easier to keep your eyes closed

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Relaxation helps us with• Sleep• Lowers heart rate• Lowers breathing rate• Lowers tension in muscles• Lowers pain• Makes us feel happy • Calms the mind• Gives us energy

All of these help with pacing throughout the day

Colour relaxation

To begin, make yourself comfortable. Adjust your clothing as needed and assume a comfortable position.

First, before the calming colour relaxation begins, notice how your body feels in this moment.

Passively pay attention to the state of your body right now. Do not try to change anything, simply notice how your body and mind feel.

Feel your body begin to relax slightly, as your shoulders drop a little lower.... your jaw loosens so your teeth are not touching.... and your eyelids start to feel heavy.

Take a deep breath in.... hold it.... and slowly breathe out....

Now just notice your breathing. Your body knows how much air you need. Notice with interest how your breath goes in and out. Feel the pause after you inhale and before you exhale.... and the pause before drawing another breath.

Allow your body to relax and your mind to focus on the calming colour relaxation.

Allow the relaxation to occur naturally.... allow and observe....

Create a picture in your mind of the colour red.

Imagine red of all shades....

You might picture red objects, a red landscape, or just a solid colour.....

Imagine all of the different tones of red.... roses.... bricks.... apples....sunset....

Enjoy the colour red.

Now allow the colour you are imagining to change to orange. Picture the colour orange.... infinite shades of orange.... flowers.... pumpkins .... carrots....

Fill the entire visual field of your mind’s eye with the colour orange.

Enjoy the colour orange.

Visualize the colour yellow. See in your imagination all the various shades of yellow. Allow yellow to fill your vision.... lemons.... flowers..... autumn leaves...

Imagine the endless tones of the colour yellow. Imagine yourself surrounded with the calming colour yellow..... Immerse yourself....

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Enjoy the colour yellow.

Let the colour you are imagining become green. Fill your imagination with the colour green. Endless shades and tones of green.... plants.... leaves.... grass....

Imagine being surrounded by beautiful green..... all shades from the lightest to the darkest, bright green.... subdued green…

Enjoy the colour green.

Now see in your mind the colour blue. Surround yourself with beautiful blue.... Unending shades of blue..... water....sky....

Imagine blue filling your vision.....

Enjoy the colour blue.

Allow the colour in your imagination to become violet..... Focus on the multitude of purples around you.... flowers.....sunrise....

Immerse yourself in the colour violet....

Enjoy violet.

Now allow your attention to return to your breathing..... notice how calm and regular your breathing is now.....

Meditate on the calming colour relaxation once more....

Imagine the colours again, one at a time.... starting with

Red....

Orange....

Yellow....

Green.....

Blue.....

Violet.....

Now picture whatever calming colour you wish. Do you have a favourite? Or a colour that suits your mood right now? Imagine whatever colours you like.

Allow your mind to be relaxed, focused, and calm.....

Enjoy the feeling of relaxation you are experiencing......

Now it is time to return your attention to your regular activities.....

Become more alert with each breath you take....

More aware of your surroundings....

Stretch your muscles.... and open your eyes. Fully alert and calm.

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This booklet has been put together as a tool to remind you of some of the techniques demonstrated in the Breathlessness group that you could use when feeling symptoms of breathlessness and fatigue.

We have taken information from several sources including:

• Macmillan cancer support (www.macmillan.org.uk)

• Addenbrooke hospice (www.cuh.org.uk/addenbrookes-hospital)

Google images

• http://www.massagehealth.co.uk/spinalreflexology

• http://www.buzzle.com/images/diagrams/human-body/diaphragm-function.jpg

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Production date: Dec 2017 Author: PhysiotherapyCode: 1217/502 Review date: Dec 2020

We are committed to raising the standard of written information for patients, their carers, people who use the NHS and the general public.

This information can be made available in another format or language on request. For further copies of this leaflet please contact on telephone numbers above.

Further information please contact:St Benedict’s Hospice andCentre for Specialist Palliative CareSt Benedict’s Way Sunderland SR2 0NY

Phone number:Main Reception: 0191 5128400Day Services: 0191 5128440Physiotherapy Direct Line: 0191 5128442

Website: www.stbenedicts.co.uk

Supported by St Benedicts Hospice charityRegistered charity number 1019410