Item 1 of 6
Question 1 of 6
Health History
A 72-year-old client arrives at the emergency department accompanied by his daughter. The client reports a 4-day history of worsening shortness of breath, especially when lying flat, and states he has been "sleeping in the recliner all week." He reports a 6-lb (2.7 kg) weight gain over the past 3 days and swelling in both legs. His daughter states he has been eating canned soup and frozen dinners because he lives alone and "doesn't cook much." The client has a history of heart failure with reduced ejection fraction (HFrEF), hypertension, and type 2 diabetes mellitus. He reports missing his last two doses of furosemide because he "ran out and forgot to refill it."
Assessment — 1000
| System | Findings |
|---|---|
| Neurologic | Alert and oriented x3; slightly anxious, restless |
| HEENT | Jugular venous distension noted at 45-degree angle; no facial edema |
| Respiratory | Bilateral crackles auscultated in lower lung fields; use of accessory muscles; unable to speak in full sentences |
| Cardiovascular | S3 heart sound auscultated; irregular rhythm; 3+ pitting edema bilateral lower extremities to mid-shin |
| Gastrointestinal | Bowel sounds normoactive x4 quadrants; abdomen mildly distended |
| Integumentary | Skin cool and pale; diaphoresis noted; capillary refill 4 seconds |
| Extremities | 2+ pulses in upper extremities; 1+ pulses in lower extremities; bilateral lower extremity edema |
Vital Signs — 1000
| Vital Sign | Value |
|---|---|
| Temperature | 98.4°F (36.9°C) |
| Heart Rate | 118 bpm, irregular |
| Respiratory Rate | 28/min |
| Blood Pressure | 158/96 mmHg |
| Pulse Oximetry | 88% on room air |
| Weight | 214 lb (97.1 kg); baseline dry weight 208 lb (94.3 kg) |
Select the top 4 findings that require immediate follow-up.
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