Question

S.R. is a 65- year-old woman who presents to the emergency department complaining of shortness of breath, productive cough, and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases. The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered.

What subjective information should the nurse obtain?

The nurse is assessing the patient’s pulses. Which locations should the nurse check?

The nurse needs to evaluate the adequacy of the collateral circulation before obtaining an arterial blood gas (ABG) sample. How should the nurse proceed?

What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs?

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Answer 1

***Nurse should obtain Subjective information from the S.R is ...

• Information regarding life style.
• History of heart failure and predisposing factors about heart failure.
• Dietery modifications .
• Weaknesses and fatigue level.
• Look for the weight increases/or less.
• Ability of exercise.
• About chest pain
• About cough.
• Lack of appetite.
• Problems regarding breathing.
• About swelling in extremities.
• Medications .

***Nurse can check pulse ......

Nurse should obtain pulses in the wrist area below the base of thumb .use index finger and third finger of your hand to find the pulse .Then count pulses for 30seconds, then doubles that number .**his way nurse can use to check pulse.

***ABG

An arterial blood gas is to measures oxygen and carbondioxide levels in the blood.it also measures acid base level, which is usually in balances when you are healthy.

Things needs to do before obtain blood from artery.

• Apply pressure to the arteries in your wrist for severe seconds.
• Check that blood flow to the hand is normal.
• Collect information regarding medication.
• Stop oxygen for 20minutes .if client with oxygen.
• Obtain consent.

Now can obtain arterial blood. Expose the wrist area for the procedure.postion the patient and area of procedure. Collect blood from artery. You may feel dizziness or lightheadedness .sonrest for some time.

***Causes of shortness of breath, swelling in both legs, and productive cough.

In the heart failure the muscle has reduced contractibility. This causes reduction in cardiac output this leads to inadequate to meet peripheral demands of the body. The determinants of left ventricle is altered as

1. Intrinsic decrease in muscle contractibility
2. Left arterial filling pressure is increase ,this leads to pulmonary congestion and dyspnea.
3. Systemic blood pressure is often reduced there is an increase in systemic vascular resistance which can further leads to decrease cardiac output.
4. Increase in heart rate as a part of compensatory mechanisms

These are the reasons for swelling in both legs ,shortness of breath, and productive cough.