D visited Rachael to discuss with her the breathing difficulties and feelings of anxiety that Rachael has been experiencing recently.
After discussing Rachael's symptoms and anxieties in detail D proposed the following courses of action.
1. A prescription of Oramorph for Rachael to take before she goes to bed. This should relax her and allow her breathing to synchronise better with the NIV. She also recommended using the NIV overnight. She will organise this with Rachael's GP, Dr.G.
2. To make more frequent use of the Lorazepam but to use only half a tablet at a time. 0.5mg. D recommended that Rachael should take a smaller dose of the Lorazepam as required. D hoped that the smaller dose would still help with anxiety but would not knock Rachael out.
3. D will make enquiries about improving Rachael's bed to make her more comfortable and to improve the quality of her sleep.
4. D will return as soon as possible, hopefully next week, to spend a couple of hours with Rachael whilst she is on the NIV, in order to further assess Rachael and to make any adjustments to the machine that may be required.