This is a terrifying symptom for the patient, and the subjective feeling of shortness of breath is not predictably related to the type or degree of pathology. This, combined with the fact that the cause is often organic, means that a careful and urgent assessment and appropriate referral is mandatory.
Acute chest pain is a regular visitor to general practice: It may generate more adrenaline in the clinician than the patient. In spite of a constellation of causes, a good basic clinical approach within your scope of practice will determine your actions and appropriate referral in nearly all cases, long before any necessary investigations are complete.
Shortness of breath is defined as difficult, laboured breathing. Medical teaching, unlike nursing teaching, tends to focus on individual pathologies. however, in practice there is often some overlap between several contributory causes and sometimes the diagnosis can only be made after ongoing referral to a doctor and the subsequent therapeutic trials of treatment.
This is a symptom that patients seem to fear or value – as a signifier of possible cancer or a justifier of antibiotics – far more than clinicians. Most coughs are simply viral URTIs, but the nurse should be aware of the various other possibilities, especially when the symptom is persistent.
This symptom can appear so trivial. If managing children is within your scope of professional practice, reassurance and explanation are often all that is required, and this can build a bond with parents and children. Take parents seriously and sympathetically: nocturnal cough is a destroyer of sleep and family peace.
Patients invariably view this relatively uncommon symptom as representing something serious – this is rarely the case in primary care. In practice, the origin of the blood may not be immediately obvious: quite often, blood from the nose or throat may be coughed out with saliva (spurious haemoptysis) and described as ‘coughing up blood’.
Palpitations are presented fairly frequently in primary care, sometimes in isolation but more often immersed in other symptoms. Patients use the word ‘palpitations’ to describe a remarkable variety of sensations, and it is important to establish exactly what is meant. Cardiac causes are relatively rare; anxiety about a cardiac problem, and anxiety as a cause of the symptom, are common.