Assessment of a breathless patient in end-stage heart failure in A&E

Nursing case review
First published in this online journal
Declaration of interests: 
Marie Ranson
Author profile (accurate when this article was originally published): 
Marie Ranson, Senior Staff Nurse, Accident and Emergency Department, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London. Email: marie.ranson@imperial.

Breathlessness is a common reason for the hospitalisation of people with chronic heart failure (CHF). It is a distressing symptom for both patients and their informal carers. Breathlessness in CHF derives from physical, psychological, social, spiritual and environmental factors. Optimal management of breathlessness in CHF requires both pharmacological and non-pharmacological interventions. This article examines the assessment and management of a patient who was experiencing acute breathlessness as a result of end-stage CHF within an accident and emergency (A&E) department. The patient had only just been discharged from hospital, where she had been an inpatient for 4 weeks because of her breathlessness. However, on discharge home, she became acutely anxious and breathless and returned to the hospital via the A&E department. The article describes how her condition was evaluated holistically. It demonstrates the end-of-life care implications for nurses managing breathless CHF patients in acute settings. A pseudonym has been used to maintain confidentiality (Nursing and Midwifery Council, 2008).

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