Dyspnea is one of the worst symptoms experienced by patients in the intensive care unit and patients approaching the end of life. The patients in the intensive care unit who are at the highest risk include those with underlying cardiopulmonary conditions and those with respiratory failure. Critical care nurses are integral to assessing and treating dyspnea during the trajectory of critical care illness, especially when a patient is not expected to survive and care goals are shifted to focus on comfort. Paradoxically, cognitive impairment develops along with worsening dyspnea in dying patients, preventing patients from reporting their distress while they may still be able to experience it. Inability to report distressing symptoms can lead to undertreatment or overtreatment. The Respiratory Distress Observation Scale (RDOS), developed by the author, is the only known valid, reliable tool for assessing respiratory distress when the patient...

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