# data[].attributes.body
Herbert and his wife are self-funded retirees who spend their winter in the north of Australia to escape the cold. On their most recent trip, Herbert noticed he was much more tired than usual. He had trouble catching his breath and needed to sleep on extra pillows in order to breathe when he was lying down.

He was diagnosed with systolic heart failure five years ago. Heart failure is usually classified according to the severity of a person's symptoms using the New York Heart Association (NYHA) classification system. Herbert was initially classified as NYHA Class II heart failure and his symptoms have been well controlled with medication, until now...

Links to PCC4U Core Module 3: Section 1 Palliative Care Symptoms

# data[].attributes.body
It has been six months since Herbert was told that his heart failure had progressed to Class III. His heart failure continues to worsen and he is upset that it is stopping him from spending time with his friends and doing what he enjoys. He is particularly bothered by his fatigue and his breathing difficulties.

Links to PCC4U Core Module 3: Section 2 Principles of Assessment

# data[].attributes.body
Herbert’s heart failure continues to progress. He has been admitted to hospital with pulmonary oedema. While in the hospital, his cardiologist refers him to the local specialist palliative care team.

Herbert discusses some of his main symptoms with the palliative care physician who introduces possible interventions for managing these symptoms.

Links to PCC4U Core Module 3: Evidence-based symptom management

# data[].attributes.attachment_link.title
Herbert's Story - His Illness Progresses

# data[].attributes.headline
Audio: Herbert calls 000 for help with breathing difficulty

# data[].attributes.subject
Audio: Herbert calls 000 for help with breathing difficulty

# data[].attributes.body
Herbert calls 000 as he is struggling to breathe and has just coughed up pink and frothy sputum. He recognises these symptoms as they are the same as what prompted his most recent hospital admission.

On the call, he said that he thinks he might be dying. Listen to the audio of the 000 call to hear the exchange of information between Herbert and the Emergency Medical Dispatcher.

# data[].attributes.attachment_link.title
Herbert's Story: Herbert calls 000 for help with breathing difficulty

# data[].attributes.body
1. What were some of the common symptoms that Herbert reported that led to his diagnosis?

2. Review the current guidelines on heart failure. Outline the symptom characteristics in each of the four classes of heart failure.

3. Describe what is meant by the term “multidimensional”? How are Herbert’s symptoms multidimensional?

4. Describe what is meant by the term “subjective”? In what way are Herbert’s symptoms subjective?

5. How have Herbert’s symptoms affected his quality of life – and his ability to function?

# data[].attributes.body
1. What observations did you make from the video that indicate deterioration in Herbert’s illness?

2. Consider Herbert’s experience with his illness over the past six months:

In what ways is this consistent, or not, with evidence-based literature about heart failure progression

What factors have influenced Herbert’s illness trajectory?

3. What are the common symptoms or clinical concerns that he may now be experiencing with class III heart failure?

4. What are Herbert’s psychosocial needs likely to be now that his illness is deteriorating?

5. Consider Herbert’s illness and review the pathophysiology of two of the following:

Fatigue

Loss of appetite

Breathlessness.

Within your answer outline how these symptoms are impacting on his quality of life.

# data[].attributes.body
1. What symptoms does Herbert describe?

What are some of the causes of these symptoms?

What are his treatment goals?

2. The palliative care physician recommends both pharmacological and non-pharmacological interventions for managing Herbert’s breathlessness. Identify the supporting evidence and the likely mechanism of action for the following interventions:

Opioids

Relaxation

Fans

Activity pacing

Oxygen therapy.

3. Herbert expresses some concern about taking morphine for his breathlessness.

Was the physician’s response adequate? Provide reasons for your answer.

What further suggestions do you have for addressing personal concerns about palliative treatments?

4. What other pharmacological agents should be considered to treat Herbert’s breathlessness? Provide a rationale for your answer.

# data[].attributes.body
1. Describe your first reactions after listening to the audio of the call – what did you notice, how did you feel, what felt right/wrong to you?

2. If you were the paramedics responding to this call, what additional information would you ask for and what would you be thinking about, what are the priorities in this situation?

3. What are the first things that you do when you arrive?

4. In your conversations with Herbert how would you show empathy, (eg, How would you respond to his comment “I think this might be it for me”?)

# data[].attributes.body
Paramedics were able to give Herbert a small dose of Morphine to help relieve his breathlessness. They then transferred him to hospital where he died peacefully two-days later, with his family around him.