What are nursing interventions for paroxysmal nocturnal dyspnea?

Paroxysmal nocturnal dyspnea describes recurring attacks of shortness of breath that wake you up at night, gasping for air, coughing, wheezing and feeling like you're suffocating. This scary crisis passes when you sit up on the side of your bed, or stand up to get some fresh air. Also known as cardiac asthma (though it is a completely different condition than asthma), paroxysmal nocturnal dyspnea is usually a sign of left-sided heart failure or congestive heart failure. It usually happens several hours into sleep, when your weakened heart begins having trouble pumping against the build-up of fluid in your lungs. Paroxysmal nocturnal dyspnea is often considered an extreme form of orthopnea, shortness of breath that happens when you lie down and is relieved by placing several pillows under your head and upper body.

Paroxysmal nocturnal dyspnea is treated by addressing its causes. Most commonly, the cause is left-sided heart failure and so treatment is focused on reducing congestion in the lungs and improving the heart's function, if possible. Medical treatment includes the use of medications known as diuretics, or "water pills," which help reduce the amount of fluid in circulation. Vasodilators and inotropic drugs may be used as well.


Nursing interventions for paroxysmal nocturnal dyspnea might include administering supplemental oxygen to help ease the symptoms of shortness of breath, and dietary recommendations. The most important dietary change that people suffering from congestive heart failure and paroxysmal nocturnal dyspnea need is to reduce their salt intake. Salt causes the body to retain fluid, and so minimizing your salt intake will help reduce the fluid that builds up in your lungs at night. The nurse might suggest that you not add salt to your food, and that you use herbs and spices rather than salt in your cooking. Processed food, canned or frozen food, and fast food, should all be nearly eliminated. Your nurse might also offer suggestions for altering the way you sleep; she might suggest you sleep propped up with several pillows to help alleviate lung congestion at night.