From the Guidelines
The PQRSTU assessment for a patient with dyspnea includes six key components: P (Provocative/Palliative factors), Q (Quality), R (Region/Radiation), S (Severity), T (Timing), and U (Understanding), which help healthcare providers systematically evaluate breathing difficulties. P stands for Provocative/Palliative factors, identifying what triggers or relieves the dyspnea, such as position changes, exertion, or medications 1. Q represents Quality, describing the nature of the breathing difficulty (wheezing, tightness, inability to get enough air) 1. R refers to Region/Radiation, determining where the sensation is felt and if it spreads to other areas. S examines Severity, quantifying the intensity of dyspnea on a scale of 1-10 or through functional impact assessment 1. T addresses Timing, including onset, duration, frequency, and whether the dyspnea is constant or intermittent. Finally, U stands for Understanding, exploring the patient's perception of their symptoms and associated concerns, as dyspnea is a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity 1. This comprehensive approach ensures all relevant aspects of the breathing difficulty are captured, facilitating accurate diagnosis and appropriate treatment planning, as recommended by recent guidelines 1. When conducting this assessment, it's essential to allow patients adequate time to respond, as speaking may be difficult during episodes of dyspnea, and to consider the patient's estimated life expectancy and individual needs, as outlined in palliative care guidelines 1.
From the Research
PQRSTU Assessment for Dyspnea
The PQRSTU assessment is a method used to evaluate the characteristics of a patient's symptoms, including dyspnea. The components of the PQRSTU assessment are:
- P: Palliation or precipitating factors - What triggers or relieves the dyspnea? 2, 3
- Q: Quality - What does the dyspnea feel like? Is it a sharp pain, a dull ache, or a feeling of suffocation? 4, 5
- R: Region or radiation - Where is the dyspnea located? Does it radiate to other areas of the body? 4, 5
- S: Severity - How severe is the dyspnea? This can be measured using scales such as the Borg score or the modified Medical Research Council (mMRC) scale 6, 5
- T: Timing - When does the dyspnea occur? Is it constant or intermittent? 2, 3
- U: Understanding or associated symptoms - What other symptoms are associated with the dyspnea? For example, chest pain, anxiety, or depression 2, 3, 5
Key Considerations
When assessing dyspnea using the PQRSTU method, it is essential to consider the underlying causes of the symptom, as well as any associated symptoms or factors that may be contributing to the patient's discomfort. This can include pulmonary or extrapulmonary origins, such as chronic obstructive pulmonary disease (COPD), pulmonary embolism, or other conditions 2, 3, 4, 5. A thorough history and physical examination, as well as diagnostic tests such as chest x-rays and computed tomography scans, may be necessary to determine the underlying cause of the dyspnea 2.