Breathlessness in an Older Woman

      The following case involves a healthy, 75-year-old woman who presented with the symptom of breathlessness. Research has shown that patients’ descriptions of their symptom of breathlessness can provide diagnostic clues.
      • Bull A.
      Primary care of chronic dyspnea in adults.
      The two general categories of dyspnea causation are pulmonary and cardiovascular. Less common pathologies causing the symptom of breathlessness include psychiatric, gastrointestinal, and neuromuscular disorders.
      • Jefferies J.L.
      • Towbin J.A.
      Dilated cardiomyopathy.
      Patients who describe breathlessness as not getting enough air may have heart failure (HF), whereas patients who describe chest tightness may have a pulmonary etiology. The experience of dyspnea derives from interactions among multiple physiologic, psychological, social, and environmental factors and may induce secondary physiologic and behavioral responses. Providers must determine whether the symptom of breathlessness is of pulmonary origin or a symptom secondary to an alteration of another body system. Prioritization of treatment of breathlessness requires astute clinical knowledge of differential etiologies that can cause a sensation of inability to breathe.
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      All authors are affiliated with the Johns Hopkins University School of Nursing in Baltimore, MD. Roseann Velez, DNP, FNP, is an instructor. She can be reached at .


      Mary K. Donnelly, DNP, ANP, is an instructor.


      Krysia Hudson, DNP, RN, is a clinical instructor.


      Elizabeth Sloand, PhD, FAAN, is an associate professor and chair of the Department of Acute and Chronic Care.