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

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).