Dyspnea NGC: 004217
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	In summary the NGC web site is user friendly. The fact that you can easily narrow down your searches will be very helpful in the future. The only thing I regret is that I had not found this web site sooner.
Assessment recommendation 1.0
	One of the most important assessment tools of dyspnea is the patient’s self report. Dyspnea is a condition that can be very subjective. As a nurse we can not evaluate the patient’s distress of dyspnea with out the patients report. Also as nurses we must accept what the patient tells us. Every patient’s threshold is different, that is why as nurses we must treat each patient individually. The level of evidence is IV. This indicates the evidence was obtained from expert committee reports or opinions and or clinical experience of respected authorities. (USDHHS, 2010, Assessment)
Assessment recommendation 1.1
	This part of the assessment can be very objective. The nurse measures the level of dyspnea with the medical research councils’ dyspnea scale. This scale includes the following; vital signs, pulse oximetry, chest auscultation, chest wall movement and shape, presence of peripheral edema, use of accessory muscles, presence of cough and sputum, ability to complete a full sentence and the level of consciousness. These measurable levels are very helpful when combined with the patient’s self report. As nurses we need to treat every patient on an individual basis. The best patient care is when the nurse uses both subjective and objective information to treat the patients dyspnea. The level of evidence is IV. This indicates the evidence was obtained from expert committee reports of opinions and or clinical experience of respected authorities. (USDHHS, 2010, Assessment)
Self management recommendation 5.0
	The patient needs to be aware of what their baseline symptoms and activity levels are. This can be measured by how much activity the patient can do with out experiencing symptoms of dyspnea. The patient also needs to recognize the factors that can worsen their dyspnea. A patient understands baseline activity when they state “I can walk down two flights of stairs without shortness of breath, but I can not walk up two flights of stairs without getting short of breath.”  Management and recognition of acute exacerbation is key in prevention symptoms of dyspnea. The level of evidence is Ib. This indicates that the evidence was obtained from at least one random controlled trial. (USDHHS, 2010, Assessment)
Discharge recommendation 5.2
	Discharge recommendations that the nurse needs to promote is pulmonary rehabilitation. It is important for all patients to get some kind of exercise and rehabilitation. The degree of the patient’s dyspnea will dictate the level of rehab that the patient is able to participate in.  Upon discharge the nurse needs to educate the patient on the importance of pulmonary rehabilitation. The nurse also needs to inform the patient about programs available in their area. It makes it easier for patients to participate in rehab when it’s close to home, work and convenient for them. The level of evidence is Ia. This indicates that the evidence obtained was from meta-analysis or systematic review of randomized controlled trials. (USDHHS, 2010, Assessment)

Education recommendation 6.0
	Nurses play a key role in education their patients about dyspnea. The education should include; smoking cessation strategies, pulmonary rehabilitation, exercise training, secretion clearing strategies, breathing strategies, energy conserving strategies, relaxation strategies, oxygen therapy, medication therapy and inhaler device techniques. The more the patient understands about dyspnea the better they can manage their dyspnea. As nurses we care for the entire patient and want our patients to have the best quality of life they can achieve with dyspnea. The level of evidence is IV. This indicates that the evidence was obtained from expert committee reports or opinions and or clinical experience of respected authorities. (USDHHS, 2010, Assessment)
U.S. Department of Health and Human Services [USDHHS], National Guideline Clearinghouse. (2005). Nursing care of dyspnea: The 6th vital sign in individuals with COPD (NGC publication No. 004217). Retrieved from www.guidelines.gov.
Brenda: You did a very good job! You covered all the required components in a very organized manner. After digesting my comments, let me know if you have any questions.--Cindy