Congestion or shortness of breath may occur.  This may be frightening to the patient and the caregiver. With less activity and longer periods in bed, breathing becomes shallower, and secretions may pool in the lungs and throat.  Uncontrolled pain may also limit lung expansion.


  • Be calm.
  • Raise the head of the bed or position on pillows unless there is excessive swelling of the abdomen.
  • Encourage slow, deep breathing. (Demonstrating the following procedure may help the drowsy or confused patient). Fill the lungs until the abdomen protrudes and exhale with force 4 to 5 times. Follow with 2 to 3 coughs. Repeating several times every 2 hours while awake usually will lead to marked decrease in congestion.
  • Encourage turning every 2 hours (more often if needed) to allow gravity to drain the lungs. (Lower the head of the bed).
  • Increased fluid intake will thin lung secretions.
  • Avoid milk and milk products during periods of congestion as these cause thickening of secretions.

Report to the hospice nurse:

  • Increased congestion or shortness of breath.
  • Changes in skin color.
  • Changes in breathing patterns.

Hospice Care- Oxygen Use

  • Oxygen may be ordered for shortness of breath for some patients. An oxygen concentrator and a back-up tank of oxygen will be delivered by the medical equipment company. They will instruct you in its use.
  • Oxygen may not help certain types of breathing patterns due to the patient’s medical condition or disease process.
  • Mouth breathing does NOT decrease the amount of oxygen received through nasal tubing.
  • Too much oxygen may cause headache, slurred speech and slow breathing.
  • Oxygen does not lessen the need to encourage deep breathing, coughing and turning.


  • Call your power company and tell them oxygen is being used in he home. They will be alerted to the need for priority repairs.
  • Display the Oxygen Alert Notices.
  • Follow the safety instructions supplied by the equipment company.
  • Wash your hands prior to cleaning humidifier or tubing.
  • Know how to connect the oxygen tank in the event of power failure and call the equipment company for additional tanks of oxygen.
  • Call for additional tanks of oxygen before you connect the last tank.

Hospice Care- Breathing Comfort

  • Apply a water-soluble lubricant (not petroleum jelly) for dry or cracked nostrils.
  • Use cotton to ease pressure around ears or face.

Report to the hospice nurse:


  • Increased difficulty breathing.
  • Restlessness, anxiety or irritability.
  • Blueness of lips or nail beds.
  • Confusion or difficulty with concentration.
  • Points to remember:
  • Suctioning may stimulate coughing or gagging.
  • Encourage the patient to deep breathe slowly several times before inserting the tip of the suction wand into the mouth or to the back of the throat.
  • Don’t leave the suction tip in the mouth for more than 8 – 10 seconds.
  • Dip the tip in a glass of water to clear the tubing between suctions.
  • Allow the patient to rest and encourage the patient to take deep, slow breaths between suctions.
  • Report to the hospice nurse if the patient has a large amount of secretions or the secretions are frothy or pink.
  • Wash the collection container after use and keep a glass of fresh water available for the next suctioning.